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It may be time to re-evaluate if it's been a while since you started using proton-pump inhibitors.

Long-term use of some heartburn medications appears to be associated with an increated risk of dementia, heart attack, and chronic kidney disease.聽
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You may think you're reaching for heartburn relief when you take a proton-pump inhibitor (PPI), a type of medication that helps block the production of stomach acid. PPIs are effective, and some鈥攕uch as lansoprazole (Prevacid) and omeprazole (Prilosec)鈥攁re readily available over the counter. Others, such as pantoprazole (Protonix), are frequently prescribed for long-term use. But PPIs may have risks when taken over a long period.

Even the newer, targeted cancer therapies may harm the heart.

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About 14 million people in the United States are living with cancer, a number that reflects the steady rise in cancer survivorship in recent decades. In 1980, only about half of people with cancer lived five years after diagnosis. Today, five-year cancer survival rates are greater than 70%.

Unfortunately, many cancer-suppressing treatments can have undesirable effects on the heart and blood vessels. The increasing awareness of these effects鈥攃oupled with the surge of older people being diagnosed with and surviving cancer鈥攈as spurred a new specialty known as cardio-oncology. Experts in this burgeoning field focus on promoting heart health in people with cancer, both during and after their treatment.

Supplements aren't held to the same standards as FDA-approved drugs. Evidence indicates that few are effective, many are useless, and others may be harmful.

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Dietary supplements鈥攊ncluding herbs, vitamins, minerals, and other products鈥攁re a $37-billion industry in the United States, and 60% of women are taking them regularly. At the same time, mounting research is suggesting that supplements鈥攅ven mainstays like calcium鈥攎ay be harmful at high doses.

The use of supplements and other alternatives to standard treatments is centuries old, but Dr. David Eisenberg, adjunct associate professor at the Harvard T.H. Chan School of Public Health, was the first to document the widespread use of alternative therapies in the United States. In a 1993 article in The New England Journal of Medicine, Dr. Eisenberg and colleagues reported that more than a third of Americans were using unconventional therapies, largely for chronic conditions, and most were doing so without letting their clinicians know. That report covered acupuncture, spinal manipulation, massage, and yoga, but it also focused public attention on all unconventional treatments, including the growing use of herbal remedies and other dietary supplements. In 1998, the Office of Alternative Medicine in the National Institutes of Health (NIH) was revamped as the National Center for Complementary and Alternative Medicine and charged with funding rigorous studies into the safety and effectiveness of alternative physical treatments as well as popular dietary supplements and herbs.

Although risk calculators disagree, at some point age becomes the deciding factor in the decision to take a cholesterol-lowering medication.

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If you've been diligent about monitoring your risk factors for developing heart disease, you may have realized that online calculators can be helpful. If you have the results from your latest cholesterol test, these online calculators can compute your chance of having a heart attack or stroke in the next decade:

• Framingham Risk Calculator

• ACC/AHA Heart Risk Calculator

• Reynolds Risk Score

However, each may give you a slightly different number. And while the Framingham calculator might indicate that your risk is low and therefore you don't need a cholesterol-lowering statin drug, the ACC/AHA calculator could indicate that you should be taking a statin to reduce your聽risk.

Millions of postmenopausal women are taking a bisphosphonate like oral alendronate (Fosamax) or intravenous (IV) zoledronic acid (Reclast) to increase bone density. But because long-term use of these drugs has been associated with an increased risk of bone death in the jaw and unusual thighbone fractures, experts have debated how long women should stay on the drugs to minimize the risk of hip or vertebral fractures without raising their risk for these rare but serious complications.

After considering major randomized controlled clinical trials, a task force of the American Society for Bone and Mineral Research has released guidelines on the optimal duration of bisphosphonate therapy for osteoporosis. The guidelines, published in the January 2016 issue of the Journal of Bone and Mineral Research, recommend reassessing a woman's fracture risk after five years of oral bisphosphonates or three years of IV therapy. They advise that women whose risk is still high should continue to take oral bisphosphonates for up to 10 years or IV therapy for up to six years. However, fracture risk should be reassessed every two to three years during extended therapy.

Thorough risk assessment and family assistance may help you take them more safely.

Prescription pain pills such as oxycodone (Oxycontin) and hydrocodone (Vicodin) are in a class of drugs known as opioids. They're typically used to treat severe pain after surgery, and sometimes to treat chronic pain. But these drugs come with many risks, including addiction. Does that put you at risk if you take opioids? "You have to look at it on a case-by-case basis," says Dr. Hilary Connery, an addiction psychiatrist at Harvard-affiliated McLean Hospital.

Risks and benefits

Opioids are powerful painkillers that block messages of pain to the brain and decrease the body's perception of discomfort. They may also create a feeling of euphoria. Opioids are especially useful in the short term, such as the initial weeks following joint replacement. Common side effects include nausea, itching, drowsiness, or constipation.

There's encouraging news for people who take dabigatran (Pradaxa), a newer type of blood thinner that's had a rare side effect of uncontrolled bleeding during surgery or accidents. In October 2015, the FDA approved an antidote called idarucizumab (Praxbind), which may be able to reverse dabigatran's blood-thinning effects.

Dabigatran was approved by the FDA in 2010 and welcomed as a convenient alternative to warfarin (Coumadin) for people with certain types of atrial fibrillation, deep-vein thrombosis, or pulmonary embolism. While warfarin is generally safe and inexpensive, it takes about a week for it to become effective, and dosing is so complicated that people taking warfarin need frequent blood tests to see if the dose needs to be adjusted. Dabigatran is effective within two hours and doesn't require dose adjustment or lab monitoring. But dabigatran has caused more episodes of major bleeding than had been expected, without a way to reverse the problem.

There is no evidence that so-called "bioidentical" alternatives to prescription hormones are either safe or effective.

Over the past couple of years, science has validated what many women already know: hot flashes and other symptoms of menopause can persist long after menstrual periods stop. It's also well established that estrogen鈥攁lone or combined with a progestin鈥攊s the most reliable treatment for menopausal symptoms and that, for most postmenopausal women, it is safe to take these hormones for up to five years at doses that relieve hot flashes.

But in 2002 the Women's Health Initiative reported that Prempro鈥攁n FDA-approved preparation combining synthetic estrogens with a progestin鈥攊ncreased the risk of cardiovascular disease and breast cancer. Since then, women have shied away from pharmaceutical companies' hormones. A third of women who use hormones for relief of menopausal symptoms are now choosing custom-mixed preparations from compounding pharmacies, according to research sponsored by the North American Menopause Society (NAMS). Women surveyed by NAMS commonly said they believed "natural" or "bioidentical" hormones from compounding pharmacies to be safer than the available FDA-approved hormones.

A Spanish clinical trial of 400 people鈥攖wo-thirds of whom were women鈥攈as indicated that waiting to fill an antibiotic prescription may be a good idea for people with sniffles, coughs, sore throats, and other respiratory symptoms.

Researchers recruited volunteers who sought care for respiratory symptoms in primary care clinics throughout Spain. The volunteers were randomly assigned to four equal groups. One was given antibiotics and told to take them immediately. Another was sent home without antibiotics but told to return to the clinic if they hadn't improved after several days. The two remaining groups were told to wait to take antibiotics鈥攐ne was asked to return to the clinic to get their mediation after three days; the other group was given an antibiotic, but told to take the medication only if their symptoms hadn't improved after five to 10 days.

Research we're watching

A nationwide survey conducted by researchers at Harvard T.H. Chan School of Public Health indicates that prescription drug use rose from 51% of U.S. adults in the 1999鈥�2000 calendar year to 59% in 2011鈥�2012. In 2012, women were taking more prescription medications than men, with 65% taking at least one drug and 16% taking more than five.

Although the use of postmenopausal hormones declined, women's prescriptions for blood pressure medication, cholesterol-lowering drugs, antidepressants, and diabetes medications rose significantly. The study was published in the Nov. 3, 2015, issue of The Journal of the American Medical Association.