Download We spend more on antacids than politics

Title: “We spend more on antacids than politics”
Study: Shah, N.H., et al., Proton Pump Inhibitor Usage and the Risk of Myocardial
Infarction in the General Population. PLoS One, 2015. 10(6): p. e0124653.
John Boehner, the Speaker of the House was recently defending the amount of
money invested in supporting political agendas by saying, “We spend more on antacids than politics.” He may be right. It is estimated that $13 billion is spent annually
on these drugs, in part for treating the heartburn we get from politicians.
Big Data
Electronic medical records are allowing us to mine large datasets which can be quite
helpful, particularly when we need at least 4000 subjects to predict the number
needed to harm from proton pump inhibitors (PPI). This computer mining strategy
evaluated over a trillion pieces of data in 1.8 million patients to come up with the
conclusion that PPIs are associated with a 1.16 elevated risk of MI and a 2-fold risk
(2.0) increase association with CV mortality.
What is the mechanism?
Past research would suggest that this is the result of nutrient malabsorption as acid
suppression has been found to elevate the risk of cardiac arrhythmia due to
magnesium deficiency.1, 2 But if this was the case, H2-blockers would have been
associated with similar risk, which they were not. The authors postulate that PPIs
have a novel effect on enzymes (DDAH and ADMA) that reduce nitric oxide (NO), the
beneficial free radical that dilates blood vessels and lowers blood pressure. If PPIs
reduce NO, this could lead to more heart badness.
We reviewed another paper showing how beets (and other root vegetables)
lowered blood pressure due to their ability to promote nitric oxide. Drinking 250 ml
of beet-root juice lowered blood pressure an amount equivalent to starting one antihypertensive drug. Could PPI’s negate this effect? If a patient were on a PPI, does
this reduce the positive effect of the Mediterranean diet? Would we need two antihypertensive meds instead of just one to keep blood pressure under control when
someone is on a PPI? More research questions to ponder.
Challenges of Data Mining
Even when computers analyze a trillion bits of information, there are still
limitations. Mining data cannot judge causality, only associations. And the method
used did not allow for controlling confounding variables. It is also possible that PPI
use was a marker of a sicker population.
Despite these limitations, this data is compelling us to use these drugs cautiously,
particularly long-term.
So the next time you feel heartburn while watching politicians bicker across the isle,
try some slow deep breathing before popping a PPI. And if you need something
more, use an H2-blocker.
1.
Gau JT, Yang YX, Chen R and Kao TC. Uses of proton pump inhibitors and
hypomagnesemia. Pharmacoepidemiology and drug safety. 2012;21:553-9.
2.
Wilhelm SM, Rjater RG and Kale-Pradhan PB. Perils and pitfalls of long-term
effects of proton pump inhibitors. Expert review of clinical pharmacology.
2013;6:443-51.