Long Term PPI Use Increases Your Risk of a Heart Attack

I wrote an article awhile back on how long-term PPI use can harm your health.

In the article, I mentioned that PPI’s are known to cause heart arrhythmia. A new study has been released from the Stanford University of Medicine that PPI use is linked to heart attacks. ¹

The lead author, Nigam Shah, does admit that since this is a data-mining study:

“The association we found with PPI use and increased chances of a subsequent heart attack doesn’t in and of itself prove causation,”

However, the data does show:

“roughly 20 percent increase in the rate of subsequent heart-attack risk among all adult PPI users.”

Even in those who were not taking Plavix. The increased risk of heart issues when taking Plavix with PPI’s have been known for years. ²

So why the elevated risk of heart disease in people taking PPI’s?

I believe it might have to do with the fact that PPI’s deplete magnesium and B12. ^{3 4 5 6 7} The increased risk may have to do with PPI’s interrupting nitric oxide production in the body.

I have written extensively on the importance of the supplementation of magnesium and how it applies to your overall health. Magnesium depletion can lead to increased blood pressure, stiffening arteries from calcification, and heart disease. ^{8 9}

B12 deficiency may lead to increased homocysteine levels. Without being too technical, the body produces homocysteine from the amino acid methionine during numerous necessary metabolic processes. The body uses folate and B12 to turn homocysteine back into methionine. ¹⁰ There is a big debate going on currently if elevated homocysteine levels are a true marker of atherosclerosis and development of heart disease. ¹¹ High levels of homocysteine in the blood seem to be a marker of cardiovascular disease. ¹² Studies have been mixed in the supplementing of folate, B6, and B12 to reduce homocysteine levels and risk of cardiovascular disease. ^{13 14 15 16} Elevated homocysteine levels are not the only marker / cause of heart disease. Therefore I can understand why the studies were mixed. I believe that it is important to keep your homocysteine levels as close to normal as possible, and supplementation of those B vitamins in their correct forms can help depending on your methylation pathways.

H2 antagonists have a lower risk of intrinsic factor loss and B12 deficiency, but the risk has still been noted in studies. ¹⁷ The authors of the Stanford PPI study have concluded from the same data that H2 antagonists, however, have no elevated risk of heart attacks from their use. It appears that B12 deficiency from PPI use may not be a direct cause of the increased heart attack risk, but is worth noting due to the link between B12 deficiency and high amounts of homocysteine in the blood. ¹⁸

PPI’s also increase asymmetrical dimethylarginine that is an endogenous inhibitor of nitric oxide. ¹⁹ One of the primary uses of nitric oxide by the body is to relax endothelium like that found in blood vessels. Lack of nitric oxide can cause the stiffening of blood vessels that lead to increased blood pressure and atherosclerosis. ²⁰

PPI’s should not be used long-term unless medically necessary (Zollinger-Ellison Syndrome for example.) ²¹ If you are using PPI’s supplementation with magnesium glycinate, sublingual B12 (hydroxy, adeno, methyl,) and possible nitric oxide stimulators (ingestion of beets,) ²² might help combat the damage PPI’s do to your cardiovascular system. If you are taking PPI’s long-term I would get regular blood tests including: RBC Magnesium, CRP, B12, serum nitric oxide, and homocysteine to help measure the state of your health while on the medication. ^{23 24}