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Abstract

We appreciate the comments of Alegre et al regarding our recent study. They rightly point to the fact that patients taking proton pump inhibitors (PPIs) are often sicker and have more co-morbidities than patients who are not, although in our study, traditional cardiovascular risk factors (e.g., hypertension, diabetes mellitus) were generally similar. An important exception was baseline hematocrit, which was significantly lower in the PPI group and may be a surrogate for patients with histories of peptic ulcer disease (PUD). Although we included this factor in our multivariate Cox regression for major adverse cardiac events, we did not have information regarding history of PUD, gastrointestinal bleeding, or gastroesophageal reflux disease (GERD). Peptic Disease: A Confounding Factor for Proton Pump Inhibitor-Clopidogrel Interaction?American Journal of CardiologyVol. 106Issue 2PreviewThe study by Gaglia et al1 shows an association between proton pump inhibitors (PPIs) and cardiovascular morbidity and mortality in patients with drug-eluting stents who are taking clopidogrel. However, the prescription of PPIs could be related to certain factors, such as a history of peptic ulcer or reflux disease. Peptic and cardiovascular disease have common risk factors, such as low socioeconomic status and unhealthy habits.2,3 Thus, patients with peptic disease could also be at greater risk for cardiovascular disease. Full-Text PDF