People taking the acid reflux drugs Omeprazole or pantoprazole in combination with blood thinners such as clopidogrel have a higher risk for death after angioplasty than people who don't take the two popular antacids, a new study has found. The people in the study were undergoing "percutaneous coronary intervention," or PCI, a common procedure used to widen a narrowed artery. PCI typically involves balloon angioplasty followed by the insertion of a drug-emitting stent, a tiny mesh tube, to keep the vessel open. "It's a moving target," the scientist said, adding that, "although certain confounders are going to be at play that do cause limitations of the study, but the data speaks for itself. The researchers found an overall increased mortality in this patient population that takes a PPI with clopidogrel. One expert agreed that the study, while interesting, does not prove cause-and-effect. "All this shows is that people taking PPIs have a worse outcome than those not taking PPIs," said the scientist of the Mayo Clinic's catheterization lab in Rochester, Minn. "This does not prove there's causation. That would be like saying that carrying matches is associated with lung cancer. It is associated, but it doesn't mean it causes lung cancer." "These data do not show that patients should stop taking PPIS, and, in fact, it would be dangerous for patients to stop PPIs or other medication without a physician's advice," the researcher added. PPIs are frequently given with aspirin and clopidogrel after an angioplasty procedure to reduce the chances of gastrointestinal bleeding. Many people also take PPIs for various gastrointestinal conditions, including acid reflux, gastric ulcers and stomach bleeding. For the study, The researchers looked back at records of more than 8,300 people who underwent the procedure between April 2003 and June 2007. They were followed for an average of two years. During the study period, 17 percent of them took a PPI. All of the patients also took both aspirin and clopidogrel, the researchers said. Overall, people taking a PPI had a 30 percent higher risk for dying after their PCI procedure than did people who were not taking a PPI. Two drugs in the class appeared to contribute most of the added risk: Omeprazole  was associated with 72 percent higher risk for death after PCI, and pantoprazole was linked to a 54 percent increased risk, the study found. Two other common PPIs – esomeprazole and lansoprazole -- did not show a heightened risk. There wasn't enough data to rank a fifth drug, raberprazole, according to the study. The researcher could not say why esomeprazole and lansoprazole were exempt from the effect. "It's a very heterogenous interaction and depends on how a specific population metabolizes that drug," he said. People taking PPIs along with a blood thinner also had a small risk for developing blood clots after insertion of a stent, the team found. The findings add to a lively back-and-forth about the dangers -- or lack thereof -- of combining antacids with blood thinners, with studies over the past few years coming down on both sides of the debate. PPIs, used by millions of Americans, have also been linked to a number of other health risks, including an increase in hip fractures, diarrhea and community-acquired pneumonia.

People with bipolar disorder who smoke appear to have a heightened risk of suicidal behavior -- possibly because they are generally prone to impulsive acts, a new study suggests. Bipolar disorder, also known as manic depression, is marked by dramatic swings in mood -- ranging from episodes of debilitating depression to periods of euphoric recklessness. Previous studies have found that bipolar patients who smoke have a higher suicide risk than their non-smoking counterparts, but the reasons have not been clear. The new findings suggest that high levels of impulsivity -- one of the symptoms of bipolar disorder -- may draw some patients to both smoking and suicidal behavior. The researchers at Massachusetts General Hospital in Boston found that among 116 bipolar patients they followed, current smokers generally scored higher on a standard measure of suicidal thoughts and behaviors. Moreover, smokers were more likely to make a suicide attempt over the next nine months, the researchers report. Five of the 31 smokers in the study (16 percent) attempted suicide during the study period. By comparison, only 3 of 85 non-smokers (3.5 percent) attempted suicide during the study. The researchers also used a standard questionnaire to gauge patients' impulsiveness -- such as how often they speak or act without thinking and how well they plan for the future. When those scores were factored in, the link between smoking and suicidal behavior diminished. The implication, according to Ostacher's team, is that high levels of impulsivity partly explain why smokers were at greater risk. From a practical standpoint, the researchers write, the findings add more evidence that smoking can be considered a "clinical marker" of higher suicide risk in bipolar patients. Smoking, in and of itself, may not be a strong  predictor of patients' suicide odds, but doctors can still consider it as part of a comprehensive patient assessment, the researchers suggest. It is unknown, they note, whether helping bipolar patients quit smoking would have any effect on their risk of suicidal behavior.