GERD Linked to 27% Higher Risk of Heart Attack, Global Meta-Analysis Finds
Key Clinical Summary
- Study scope: Meta-analysis of 6 cohort studies (n = 1.32 million) examining gastroesophageal reflux disease (GERD) and acute myocardial infarction (AMI).
- Key finding: Patients with GERD had a 27% higher risk of incident AMI (RR 1.27; 95% CI, 1.13–1.47; P = 0.0001).
- Implication: GERD may contribute to cardiovascular risk through inflammation, oxidative stress, and autonomic dysfunction.
A new systematic review and meta-analysis published in 2025 found that gastroesophageal reflux disease (GERD) is significantly associated with an increased risk of acute myocardial infarction (AMI). Researchers analyzed data from more than 1.3 million participants across multiple global cohort studies and observed a 27% higher incidence of heart attacks in individuals with GERD compared to those without.
Study Findings
The meta-analysis, which searched MEDLINE and EMBASE databases through January 2025, pooled results from 6 large cohort studies involving 1 324 362 participants. Using a random-effects model, investigators calculated a pooled relative risk of 1.27 (95% CI, 1.13–1.47) for incident AMI among patients with GERD, with high heterogeneity (I² = 88%) but no evidence of publication bias.
Potential mechanisms linking GERD and AMI include chronic systemic inflammation, oxidative stress, and autonomic imbalance. GERD may exacerbate coronary risk by promoting cytokine release—such as IL-6, TNF-α, and MMP-9—that contribute to endothelial dysfunction and plaque instability. The authors also cited possible diagnostic overlap, as esophageal acid exposure can mimic or trigger ischemic pain and coronary vasospasm.
Additionally, some studies noted a possible effect of proton pump inhibitors (PPIs)—widely prescribed for GERD—on cardiovascular outcomes, with data suggesting that PPI use may impair endothelial nitric oxide production through increased asymmetric dimethylarginine levels, potentially worsening vascular health.
Clinical Implications
The findings underscore the need for heightened cardiovascular vigilance in patients with GERD, particularly those with coexisting risk factors such as smoking, obesity, and metabolic syndrome. Physicians should be alert to the potential for diagnostic anchoring bias, where GERD-related chest pain may delay recognition of underlying ischemic heart disease.
Preventive strategies—such as optimizing acid suppression therapy, promoting lifestyle modification, and evaluating for concurrent coronary disease—may help mitigate risk. The study also highlights the importance of multidisciplinary collaboration between gastroenterologists and cardiologists to improve patient outcomes.
Future research should investigate whether treating GERD reduces AMI risk and explore mechanistic pathways linking esophageal inflammation and coronary atherosclerosis.
Conclusion
This global meta-analysis suggests that gastroesophageal reflux disease is independently associated with a significant increase in heart attack risk. Clinicians should consider cardiovascular evaluation in GERD patients and pursue strategies that address both reflux symptoms and long-term cardiac protection.
Reference
Anebo T, Srikulmontri T, Byfield K, et al. Gastroesophageal reflux disease (GERD) and risk of incident acute myocardial infarction: a systematic review and meta-analysis of cohort studies. JGH Open. 2025;9(10): e70295. doi:10.1002/jgh3.70295
