CardioExchange Archive

New Study Raises Fresh Concerns About Clopidogrel and PPIs: In a retrospective analysis of a large insurance plan appearing in Archives of Internal Medicine, patients taking a PPI and clopidogrel had a 93% higher risk of rehospitalization for MI than patients taking clopidogrel alone. To better account for underlying differences associated with PPI use, the investigators matched patients by their baseline risk using propensity scoring. The study also included more women and elderly patients than previous studies, write Karen Stockl and colleagues in their article. Previous studies have centered on the PPI omeprazole; in this study, pantoprazole accounted for nearly two-thirds of PPI usage, suggesting “that the potential interaction between PPIs and clopidogrel is not specific to omeprazole.”

Universal Versus Targeted Screening: The United Kingdom plans to screen for cardiovascular risk all adults between the ages of 40 and 74 who have not already been diagnosed with diabetes or cardiovascular disease. However, a new study in BMJ from the MRC Epidemiology Unit finds that this may not be the most cost effective method to reduce the burden of CVD. Simon Griffin and colleagues analyzed data from a prospective cohort of 17,000 patients and found that by using routine data from electronic patient records to identify high-risk individuals, they could prevent an equal number of events and would only need to screen 60% of the population. In an accompanying editorial, Tom Marshall writes that “universal screening is cost effective compared with no screening but not compared with targeted screening” and recommends that “before we investigate the complicated ideas we should implement the simple ones. There are untreated patients at high risk of cardiovascular disease, most of whom can be identified from their electronic primary care records. We should act on this information.”