Coronary Artery Disease Risks You Can Change, and Those You Can't

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What Is Atrial Fibrillation?

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What Is Atrial Fibrillation? - Heart Disease - Health.com S
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How to Quit Smoking

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How to Quit Smoking - Heart Disease - Health.com S
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Best Treatments for a Heart Attack

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What You Must Do if You Think You Are Having a Heart Attack

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Stomach-Acid-Suppressing Drugs May Raise Risk of Death After Angioplasty

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TUESDAY, Nov. 17, 2009 (Health.com) — Heart patients who take certain stomach-acid-suppressing drugs to prevent gastrointestinal bleeding may be at increased risk of dying after a cardiac procedure, according to a study presented at the annual meeting of the American Heart Association (AHA) in Orlando.

Researchers at Mount Sinai Medical Center, in New York City, reported that patients who underwent angioplasty, a procedure to clear blocked blood vessels in the heart, were 30% more likely to die if they were taking proton pump inhibitors (PPIs).

It’s unclear whether the patients in the study who were prescribed these medications were sicker than those who weren’t, and thus more likely to die. The study's lead author, Joseph M. Sweeny, MD, a cardiologist at Mount Sinai, says that he will continue to follow current guidelines on prescribing PPIs, but that he will also be "very careful" in deciding which of his patients need to be on the drugs.

Before undergoing angioplasty, heart patients are typically prescribed blood-thinning drugs such as aspirin and Plavix, which increase the risk of stomach bleeding and ulcers. In a joint statement issued in 2008, the AHA, the American College of Gastroenterology, and the American College of Cardiologists indicated that PPIs could help prevent stomach bleeding in people at high risk.

But some experts have raised concerns that PPIs could make Plavix less effective because they block the action of enzymes that are crucial for metabolizing the blood-thinning drug. A number of studies have suggested that mixing the two drugs could be risky for patients, while others have not.

The study examined some 8,300 angioplasty patients who had had drug-secreting stents placed in their hearts to prop open narrowed blood vessels. In all, 17% of the patients were prescribed PPIs.

During the follow-up period, which lasted an average of two years, 602 patients died. When Dr. Sweeny and his colleagues broke patients into groups according to which PPI they were taking, they found that omeprazole (Prilosec) and pantoprazole (Protonix) were associated with an increased risk of death of 72% and 54%, respectively, in the years following the procedure.

Two other PPIs, esomeprazole (Nexium) and lansoprazole (Prevacid), were not associated with a greater risk of dying after the procedure. It’s not clear whether this means some PPIs were safer than others, says Dr. Sweeny.

“The numbers that I got were very dramatic,” Dr. Sweeny says. “You have to raise questions as to exactly what this is coming from.”

The findings need to be interpreted cautiously, he adds, because the patients who were taking PPIs may have been sicker to begin with. “What the clinical implications of this are right now I don’t know,” he says. However, the risk of death and complications after angioplasty is relatively low overall.

“The jury is still out regarding acid-suppressing medications and Plavix,” says Shoshana J. Herzig, MD, a researcher at Beth Israel Deaconess Medical Center and Harvard Medical School, in Boston, who didn’t participate in Dr. Sweeny’s study.

Because overall mortality in the current study was greater among the patients on PPIs, says Dr. Herzig, it’s definitely possible they may have been sicker in the first place.

Even so, she says, “I think that it’s fairly clear that in patients who are on Plavix and an acid-suppressing medication, we should evaluate whether they actually need that acid-suppressing medication.” Although PPIs usually aren’t intended to be taken indefinitely, patients often wind up staying on the drugs anyhow, she says.

At least in ICU patients, Dr. Herzig says, PPIs are prescribed too often, in large part because the ulcer drugs are viewed as very safe. However, she adds, rarer side effects do come to light when a drug is prescribed to millions of people.

Any patient who is prescribed a PPI, Dr. Herzig and Dr. Sweeny agree, should ask their physician why, and find out how long they need to take the medication.

At the American Heart Association's annual Scientific Sessions meeting, more than 20,000 cardiologists and other physicians from around the country give presentations on new research and on advances in the diagnosis and treatment of heart disease and stroke.

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The Slim Way to Organize Your Kitchen

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The first place to start? The refrigerator
First, ditch the soda—regular and diet (carbonation plus artificial sweetners equals bloat), and replace it with water and iced green tea. Better yet, try the CarbLovers Fat-Flushing Cocktail: Take 2 quarts brewed green tea and add the juice of 1 lemon, 1 lime, and 1 orange. Mix all ingredients together in a large pitcher. Store in the fridge for up to 3 days. If you must keep soda and fruit juice around for your family, do yourself a favor and store them out of sight. That way, you'll be more likely to grab something diet-friendly.

Invest in fridge- and freezer-friendly stackable containers so the healthy stuff—chopped veggies, herbs, sliced fruit, and all your make-ahead beans, barley, and brown rice—is easier to grab than fattening fare. These will keep your fridge clutter-free, and encourage you to cook CarbLovers meals in large batches that you can use for the whole week. Look for the "make-ahead" icon on some of the recipes. These meals can be made in advance of serving, and many are appropriate for freezing.

Your next stop is the countertop
This is a space that can make or break your diet. Keep your blender close to where you chop fruits or veggies so it's always supereasy to prepare a healthy smoothie or soup. Set out a wooden block or hang a magnetic strip for chopping knives to make it easy to trim excess fat from meat and slice fiber-filled veggies and fruit.

Next to those slicers, use decorative hooks to dangle tools like an apple corer, a citrus zester, and a handheld squeezer (to add no-fat flavor to fish, pastas, marinades, and salad dressings).

Top your countertop with a big, beautiful basket, and use it to contain kitchen-table clutter, so you won't be tempted to multitask during meals. (Also recommended: a bouquet of fresh flowers, just because you deserve it.) Cooking and eating without distractions will help you focus! Speaking of focus, plug in your iPod and listen to music that de-stresses you. Research suggests that ab fat cells expand in response to the stress hormone cortisol, but cortisol levels decrease faster in people who listen to relaxing music than in those who don't.

De-clutter the pantry
Don't keep unhealthy snacks around to tempt you into mindless munching while you're cooking meals. Instead, keep airtight containers of dry ingredients like pasta and beans on the lowest shelves, so they're convenient for everyday use (check them periodically for freshness).

An extra tip: grow your own oregano, thyme, and rosemary along your windowsill, and you'll have an easy, no-cal way to jazz up healthy foods like grilled chicken and veggies.

Cooking tips, nutrition news, and incredible, healthy recipes anyone can make.

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