And people with severe reflux may be at higher risk of MI independent of PPI use, for many reasons. First, people with severe acid reflux who use PPIs are more likely to smoke, drink alcohol in excess, eat poorly, be overweight and use NSAIDS like Motrin, all of which increase MI risk. Second, people with coronary artery disease (the condition that leads to heart attacks) are more likely to take aspirin, which can cause reflux, which can cause such people to use PPIs; thus people with heart disease may be using PPIs more than people without heart disease. Third, some people having heart pain may think it is acid reflux and start taking PPIs. These people are at risk for having a heart attack, and they may be using PPIs more than people at less risk, but the drug is not what puts them at higher risk of MI. In other words, in all these instances, the conditions and risks that prompt certain people to use PPIs put them at risk for heart attacks, not the PPIs themselves.