Reflux and Heart Health: Newest Research on Links Between GERD and Cardiovascular Disease
Now we move beyond overlapping symptoms to explore the systemic connections between chronic acid reflux (GERD) and cardiovascular health.
Reflux and Your Heart: More Than Just Heartburn vs Heart Attack
In parts 1 and 2 of the series on Angina and Reflux, I focused on helping you differentiate between reflux pain and chest/heart pain, decide when to seek help, and summarize what to expect from the diagnosis process for each issue. We now zoom back out to examine the relationship between reflux and cardiovascular disease (CVD) in general.
Understanding the many ways that the gut and the heart are connected means realizing that wondering "is this heartburn or a heart attack?" is really only the first step in detangling the links between the digestive and cardiovascular systems—and how gastroesophageal reflux disease, or GERD, may be a risk factor for heart disease.
Chronic GERD May Influence Cardiac Disease
Although the direct pathways by which GERD may contribute to cardiac risk have yet to be established, several mechanisms have been proposed. These include physiological mechanisms, and through various treatments or therapies. The resulting "hidden" effects on the heart may precipitate, modulate, or mitigate the progression of CVD. For example:
- A significant association may exist between GERD and angina, stroke, and myocardial infarction (heart attack), according to a 2023 report from the American Heart Association. There was a stronger correlation for women, people under age 60, and those with a body mass index (BMI) of 25 or higher.
- GERD is implicated as an independent risk factor for CVD, especially in people who have taken PPI acid-suppressing medication for longer than one year.
The Biological Bridge Between GERD and the Heart
GERD is more than just a digestive-related disease. Chronic acid reflux affects multiple organ systems, promoting a systemic, chronic immune response (systemic inflammation). In fact, GERD is now considered a chronic inflammatory disorder.
Chronic inflammation is a key factor in the development of atherosclerosis and CVD. So if inflammation is the bridge between GERD and heart disease, what exactly built that bridge? Here are a few potential culprits...
The Role of Cytokines in Linking Esophageal Irritation to Atherosclerosis
Our bodies have ways to help control inflammation. Cytokines are a group of proteins that help spread the word through the body that an immune response is needed when "invaders" are attacking the body. In essence, they help signal the body to initiate (or suppress) the inflammatory process to protect against infections and promote healing. Sometimes, excessive pro-inflammatory cytokines (especially certain types) are released, which can lead to chronic inflammation and organ or tissue damage. Research suggests that inflammatory cytokines are commonly elevated in GERD, as are signs of oxidative stress.
Oxidative Stress Drives Both Digestive and Vascular Damage
Studies show that oxidative stress contributes to damage across multiple organs and body systems. Oxidative stress is a condition in which the body is out of balance between the accumulation of reactive oxygen species (sometimes called free radicals) in cells and tissues and the body's ability to counter these damaging agents with antioxidants. The development of GERD, as well as Barrett's esophagus and other esophageal conditions, is known to be promoted by oxidative stress, and the same can be said for vascular problems, including damage to the lining of the blood vessels and even heart failure.
The Vagal Nerve Connection to Irregular Heart Rhythms
Roemheld syndrome, sometimes known as gastrocardiac syndrome, occurs when a collection of gastrointestinal (GI)-related symptoms causes heart problems. These problems could include symptoms ranging from shortness of breath and nausea to irregular heartbeat patterns (palpitations, arrhythmias, and skipped heartbeats). The GI symptoms typically implicated in Roemheld syndrome vary and range from structural defects like hiatal hernia to excess gas and GERD. Diagnosis is complicated, and the syndrome is rare. However, research indicates that the vagus nerve is involved, since it's the main nervous connector between the gastrointestinal system and the heart. Whether caused by a hernia or bloating, gastric distention appears to trigger overstimulation of the vagus nerve, resulting in irregular heart rhythms.
Medication Complications: PPIs and the Heart
The use of reflux medication, such as proton pump inhibitors (PPIs), is associated with increased cardiac and vascular events. And yet they remain a highly effective treatment option for people with GERD. According to a recent review of studies in which different PPI protocols resulted in adverse health events, the medications tend to be associated more with vascular conditions than cardiac ones.
Current findings on the relationship between PPIs and vascular health suggest mechanisms, including increased vascular inflammation and a tendency to promote endothelial aging. More research is needed on the impact of PPIs on heart health, especially related to the length of use and their use in people who have concurrent heart problems.
Acid Reflux and Increased C-Reactive Protein (CRP)
C-reactive protein (CRP) is made in the liver in response to inflammation in the body. There are multiple reasons why CRP might be elevated, including a recent surgery, a heart attack, repeated injury to the body, an infection, autoimmune conditions, and some digestive disorders.
Chronic reflux isn't known to directly increase C-reactive protein levels; GERD is characterized by esophageal damage from repeated exposure to acidic fluid. Therefore, it's biologically plausible that GERD may contribute to increased bodily inflammation and, consequently, to increased CRP production. More research on this topic is needed.
Anti-Inflammatory Diet: A Dual Solution for Reflux and Heart Disease
GERD and coronary artery disease share multiple common risk factors, including male gender, alcohol use, smoking, elevated body mass index, and metabolic syndrome. These conditions increase the risk of both conditions. Given this, it is reasonable to expect that lifestyle-related management strategies may improve outcomes for both reflux and heart disease. One potential dietary approach that addresses both issues is to follow an anti-inflammatory diet. It emphasizes consuming more foods considered less inflammatory and fewer pro-inflammatory foods.
In general, on an anti-inflammatory diet, you'd eat fewer refined carbohydrates, saturated fats, and red or processed meat products, and more fruits, vegetables, whole grains, nuts and seeds, seafood, unsaturated fats, and plant-based proteins. Examples of anti-inflammatory dietary approaches include the Mediterranean Diet and the MIND Diet. Research indicates that these eating styles are associated with improved cardiovascular and gut health, better blood sugar control, improved weight management, improved mood, mental health, and cognition, and a reduced risk of certain cancers, among other benefits. Eating an anti-inflammatory diet is a widely recommended approach that is flexible and customizable to individual needs and food preferences, and may be a primary lifestyle modification for overall health.
FAQs
Does having GERD mean I will develop heart disease?
No. Having GERD does not mean you will automatically develop cardiovascular disease. However, emerging research suggests there may be associations between chronic GERD and certain cardiovascular conditions. Researchers believe shared risk factors—such as obesity, smoking, inflammation, and metabolic syndrome—may contribute to both conditions. More research is needed to fully understand the relationship.
How are GERD and heart disease connected?
One possible link is chronic inflammation. GERD is increasingly recognized as an inflammatory condition, and long-term inflammation has been associated with the development of atherosclerosis and cardiovascular disease. Researchers are also exploring the roles of oxidative stress, inflammatory cytokines, and the gut-heart connection in influencing cardiovascular health.
Can acid reflux medications affect heart health?
Proton pump inhibitors (PPIs) remain one of the most effective treatments for GERD and are considered safe and appropriate for many individuals when used as directed. However, some studies have suggested possible associations between long-term PPI use and certain cardiovascular or vascular conditions. These findings do not prove that PPIs cause heart disease, and individuals should never stop prescribed medications without discussing concerns with their healthcare provider.
What lifestyle changes may benefit both GERD and heart health?
Many of the same habits that support heart health may also help manage reflux symptoms. These include maintaining a healthy weight, avoiding smoking, limiting alcohol intake, eating an anti-inflammatory diet rich in fruits, vegetables, whole grains, and healthy fats, and engaging in regular physical activity. Dietary patterns such as the Mediterranean Diet may support both digestive and cardiovascular health.
Can GERD symptoms ever feel like a heart problem?
Yes. GERD can cause chest discomfort, pressure, or burning sensations that may feel similar to heart-related symptoms. Because heart attacks and other cardiac conditions can sometimes present similarly, new, severe, unexplained, or persistent chest pain should always be evaluated by a healthcare professional immediately.
References
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