JAHA: Tell us about the key findings from your recent article in JAHA.
Dr. Dunn: Our major findings are twofold: One, that the analysis of proton pump inhibitor (PPI) use in the CREDO population whereby the antiplatelet efficacy of clopidogrel may be interfered with, is by and large consistent with previously published randomized, controlled trials such as TRITON and PLATO. Second, that in a randomized, controlled trial of single antiplatelet therapy with aspirin-only versus clopidogrel-only (CAPRIE), PPI use significantly impacted the efficacy of clopidogrel, but not aspirin (p-value for interaction 0.047).
JAHA: What are the major implications of this work?
Dr. Dunn: The CREDO data is largely reassuring in the interventional cardiology arena in combination with previously published data. In fact, I think this data set nicely illustrates what we’ve largely seen as concerning signals in observational studies may just reflect confounded data as PPI use “worsened” adverse cardiovascular event rates in both the clopidogrel and placebo 1-year primary endpoint. The CAPRIE data suggests that the PPI drug interaction may be more significant in patients receiving single antiplatelet therapy with clopidogrel.
JAHA: How did you get the idea to do this study?
Dr. Dunn: I was fortunate to have access to some of the individuals who had worked on the CREDO and CAPRIE clinical trial programs and spoke early-on to people within Sanofi and BMS. When the mechanistic potential for this interaction was first described, it seemed logical to me that the randomized data sets would be valuable information to examine, especially when the observational and registry data begin to emerge that this was potentially a serious issue. Fortunately, these two trials had the foresight to capture all concomitant medication use.
JAHA: What was your biggest obstacle in completing this study?
Dr. Dunn: It was very difficult to merge and combine the findings from two disparate clinical trials which essentially concluded opposite findings. While this makes for good contrast, it was difficult to rationalize how this could be possible and make a cohesive manuscript.
JAHA: What was your most unexpected finding?
Dr. Dunn: The data from CAPRIE were very unexpected to us. To our knowledge, this is the only data from a randomized, controlled trial which demonstrates harm in patients receiving both PPI therapy and clopidogrel versus a comparator.
JAHA: What do you plan to do next, based on these current findings?
Dr. Dunn: I think it would be very valuable to obtain more information about patients taking single antiplatelet therapy with clopidogrel only and whether the interaction is more significant in this particular population of patients. This occurs often, for example, in ischemic stroke prevention.
JAHA: What do you like to do in your free time?
Dr. Dunn: I enjoy spending time with my family and am very busy keeping up with my two-and-a-half year old daughter. Outside of that, I “dabble” in technology and more outdoorsy stuff like hiking, mountain biking, golfing, and “technical” outdoors activities like photography.
JAHA: What is your favorite sports team or musical group?
Dr. Dunn: I am a
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