New study: A Common Class of GI Medications Reduce Protection Against Heart Attack in Patients Taking Widely Prescribed Cardiovas...(study 9862 patients were taking clopidog...),Health

Results of the study were striking: researchers reported that the relative risk of a major adverse cardiovascular event was 50 percent higher, and the relative risk of a heart attack specifically was 74 percent higher, in patients taking both medications together. The incidence of a major cardiovascular event within 12 months of starting clopidogrel was 25 percent for patients taking both medications concurrently. The study was funded solely by Medco.

Genetic variability and clopidogrel:

For clopidogrel to work, it must first be converted to its active form by a liver enzyme called cytochrome P450 2C19. PPIs interfere with this enzyme reducing the amount of clopidogrel that is converted to an active form. The gene that produces this enzyme can vary such that individuals can have more or less enzyme activity, thus affecting its functionality. The way PPIs interfere with the conversion of clopidogrel to an active form may mimic this genetic variation that produces lower amounts of the enzyme, suggesting that genetic testing for this enzyme may be useful. Other studies have shown that as many as 30 percent of people worldwide are born with this particular genetic variation.

Alerting physicians to potential risk for patients

Based upon this and other research on the issue, Medco will begin alerting prescribing physicians through a range of communications via its Medco Therapeutic Resource Centers (R) and other channels so that prescribers can reconsider the risk/benefit of concurrent prescribing of clopidogrel and PPIs based on their patients individual circumstances.

Medco will also communicate its findings to various clinical organizations to encourage continued dialogue around prescribing guidelines for these tw
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