A new review of six long-term studies (over 1.3 million people) reports that people with diagnosed gastro-oesophageal reflux disease (GERD) went on to have more heart attacks than people without GERD.
Reflux chest pain can feel very similar to cardiac pain, which is why the two are often confused. There’s also growing interest in how reflux-related inflammation might interact with blood vessels over time.
Researchers, in a new review published in JGH Open, reports that people with diagnosed gastro-oesophageal reflux disease (GERD) went on to have more cases of acute myocardial infarction (AMI) – heart attack – than people without GERD.
The work was led by clinicians at Jefferson Einstein Hospital in Philadelphia, USA, who analysed data from six long-term studies involving more than 1.3 million people.
Reflux chest pain can feel very similar to cardiac pain, which is why the two are often confused. There’s also growing interest in how reflux-related inflammation might interact with blood vessels over time.
The big question the researchers asked was whether people with GERD have higher rates of AMI later on.
How did the study work?
The team systematically searched the medical literature (MEDLINE and EMBASE) up to January 2025 and included cohort studies that followed people with and without GERD to see who later had a heart attack.
Six cohorts from the UK, US, Taiwan and Norway made the cut, totalling 1,324,362 participants. Results were combined in a meta-analysis using a method that allows for differences between studies.
Where possible, they used adjusted risk estimates, so they were comparing people with and without GERD after taking things like age, weight, smoking and existing health conditions into account.
What did they find?
Across the six cohorts, people with GERD had a higher rate of heart attack on follow-up. On average, the increase was about 27% (pooled relative risk 1.27; 95% CI 1.13–1.43).
The size of the link differed between studies – they didn’t all show the same number – which likely reflects differences in how GERD and heart attacks were defined, who was included, and which other risk factors were adjusted for.
How could GERD and heart attacks be connected?
Several ideas are on the table. GERD and heart disease share risk factors such as smoking, higher BMI and diabetes. Reflux has been linked with inflammatory and oxidative stress markers that also matter for artery health.
There’s also a possible nerve reflex: acid in the oesophagus may influence coronary blood flow in susceptible people. And sometimes chest pain is mislabelled – what looks like reflux can turn out to be cardiac.
The authors also note debate about whether long-term reflux medicines could influence cardiovascular risk, but say the evidence there is still mixed.
At a glance findings
- Scope: 6 cohort studies; 1,324,362 participants
- Overall link: GERD associated with a 27% higher rate of heart attack on follow-up
- Variation: the reported size of the link differed across studies
- Bias check: the authors did not see signs of publication bias
What should we keep in mind?
This is observational evidence showing an association rather than cause and effect. Not every study adjusted for the same confounders, and definitions of GERD and heart attack weren’t identical. That helps explain why the results vary and why we can’t say that treating reflux will prevent acute myocardial infarctions without further trials.
What does this mean if you live with reflux?
The authors say that people with ongoing reflux shouldn’t ignore possible heart symptoms. Because reflux pain in the chest and AMI can feel similar, new, severe or unusual chest pain should be assessed urgently rather than assumed to be ‘just indigestion’.
They also argue that looking after general heart health – blood pressure, cholesterol, blood sugar, stopping smoking, weight and activity – matters alongside managing reflux.
If reflux symptoms persist, getting a clear diagnosis helps you and your clinician choose the right care.
Getting reflux confirmed
It also underlines the value of confirming reflux early so symptoms can be managed appropriately. An objective test that shows whether reflux is actually happening can help you and your clinician decide on next steps.
Order Peptest, a home reflux testing kit online.
Peptest detects pepsin — the stomach enzyme that marks reflux — in a saliva sample. Collected at home, analysed in our UK laboratory, results back within 48 hours.
- Results in 48 hours
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