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Comparison of Cardiovascular Events in Patients Receiving Concomitant Clopidogrel and Proton Pump Inhibitors
Seonji Kim1,2, Jimyung Park3, Hsin Yi Chen4
1Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea (Seonji Kim, Subin Kim, S.C.Y.).
Arteriosclerosis, Thrombosis, and Vascular Biology
|March 5, 2026
Summary
Proton pump inhibitors (PPIs) do not increase cardiovascular risk when used with clopidogrel, regardless of PPI strength. This study found no significant difference in major adverse cardiovascular events between strong and weak CYP2C19-inhibiting PPIs.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Drug Interactions
Background:
- Proton pump inhibitors (PPIs) may potentially reduce clopidogrel's antiplatelet effect, increasing cardiovascular risk.
- CYP2C19 inhibition varies among PPIs, necessitating studies on individual PPIs by inhibition strength.
- Few international studies have evaluated PPIs by CYP2C19 inhibition strength in clopidogrel users.
Purpose of the Study:
- To compare cardiovascular event incidence between strong CYP2C19-inhibiting PPIs and weak or non-CYP2C19-inhibiting PPIs in clopidogrel patients.
- To assess the association between PPIs and cardiovascular risk in patients receiving clopidogrel.
- To evaluate the clinical significance of potential drug interactions between PPIs and clopidogrel.
Main Methods:
- International observational cohort study using 14 databases (US, South Korea, Taiwan) from 1985-2023.
- Patients (≥18 years) receiving clopidogrel with PPIs were classified based on CYP2C19 inhibition strength.
- 1:1 propensity score matching and Cox proportional hazards models were used to compare major adverse cardiovascular events (MACE).
Main Results:
- Large-scale propensity score matching identified 166,005 patient pairs.
- No significant difference in MACE risk between strong and weak/non-CYP2C19-inhibiting PPI groups (17.63 vs. 16.82 per 1000 person-years; calibrated HR, 1.00 [95% CI, 0.79-1.26]).
- No significant differences observed for secondary outcomes including cardiovascular mortality, myocardial infarction, stroke, and all-cause mortality.
Conclusions:
- Concomitant use of clopidogrel and strong CYP2C19-inhibiting PPIs was not associated with higher cardiovascular risk.
- This study does not support the clinical significance of potential interactions between PPIs and clopidogrel.
- The choice of PPI strength does not appear to impact cardiovascular outcomes in patients taking clopidogrel.
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