Heartburn drug may help to slow progression of chronic heart failure

Additional research needed to verify results, including dosage and other safety issues

An over-the-counter medication used to treat heartburn and acid reflux also appears to help decrease the debilitating effects of chronic heart failure, preliminary research shows. But more testing must be done before the drug is recommended for use by heart failure patients, doctors say.

According to the research, the same type of chemical reaction that allows stomach acid to cause heartburn and create ulcers also appears to damage and weaken diseased hearts. Blocking this process with the drug famotidine (Pepcid) may help to slow the progression of chronic heart failure (CHF).

The research, conducted by the National Cardiovascular Center in Suitra, Japan, appears in the Oct. 3, 2006 edition of the Journal of the American College of Cardiology. Lead researcher Masafumi Kitakaze, MD, PhD, said although the initial results look promising, more research is needed.

"We performed the present prospective study with only 50 CHF patients," said Dr. Kitakaze, director of the Cardiovascular Division and vice president of the Research and Clinical Center at the National Cardiovascular Center. "Now we need to conduct a large-scale trial to confirm the present findings. The large-scale trial based on the results our present research may not help current heart failure patients because it takes time, but we hope it helps our children and grandchildren and others in the future."

Gary Francis, MD, did not participate in the research, but is a cardiologist and heart failure expert at Ohio's Cleveland Clinic. He, too, cautions that the benefits of famotidine for CHF patients remain unclear.

"At this point, we don't know whether it would help," said Dr. Francis, head of the Section of Clinical Cardiology at Cleveland Clinic. "In addition, there is an expense involved, and we're not certain what the dose should be or what the safety would be of larger doses if they were necessary.

"I certainly would not recommend that patients go out and start taking Pepcid three times a day or anything like that," he said.

Still, the research is important because it opens a new avenue of study in the ongoing effort to treat chronic heart failure, said Dr. Francis, who co-wrote an editorial that will be published in conjunction with Dr. Kitakaze's research. Heart failure, which affects an estimated 23 million people worldwide, occurs when the heart is unable to pump as effectively as it should, resulting in shortness of breath, swelling in the legs and ankles, and other health issues.

For the current study, Dr. Kitakaze and his colleagues at Japan's National Cardiovascular Center began with a unique hypothesis. Based on previous research, they speculated that blocking the effects of a specific chemical released by damaged heart cells would slow the development of heart failure. This chemical, one of several types of histamines produced by the body, also contributes to chronic heartburn and stomach ulcers. Famotidine is a histamine blocker, which prevents the chemical from binding to its receptor and causing problems.

To prove their theory, the researchers began by searching existing medical data for patients being treated for both chronic heart failure and gastroesophageal reflux disease (GERD). As suspected, the patients taking famotidine for their stomach problems seemed to have less-severe heart failure symptoms than patients using other types of stomach remedies. But could heart health really be linked to a stomach medication?

To find out, the researchers designed a prospective study in which 25 patients with both medical conditions were given famotidine and 25 patients were given an alternate heartburn medication called teprenone. (Instead of blocking histamine, this second medication works by causing the stomach to secret more mucous to coat and protect itself against excess acid.)

After 24 weeks, Dr. Kitakaze and his colleagues discovered that as hypothesized those patients receiving 30 mg doses of famotidine each day were displaying less-severe symptoms of chronic heart failure. All patients were examined by three independent cardiologists who were unaware of the treatment protocols to ensure unbiased results.

Dr. Kitakaze reports no disclosures with this research. Funding comes from the Japan Cardiovascular Research Foundation.

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The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a 34,000-member nonprofit medical society and bestows the credential Fellow of the American College of Cardiology upon physicians who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at www.acc.org.

The American College of Cardiology (ACC) provides these news reports of clinical studies published in the Journal of the American College of Cardiology as a service to physicians, the media, the public and other interested parties. However, statements or opinions expressed in these reports reflect the view of the author(s) and do not represent official policy of the ACC unless stated so.


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