Correspondence Response to Letter Regarding Article, “Association of Proton Pump Inhibitor Use on Cardiovascular Outcomes With Clopidogrel and Ticagrelor: Insights From PLATO”

We thank Drs Ford and Plachetka for their interest in our article.1 We agree that other unmeasured factors could be associated with our findings that the use of a proton pump inhibitor (PPI) was indepen-dently associated with a higher rate of cardiovascular events in patients with an acute coronary syndrome receiving clopidogrel. However, there was a similar association between cardiovascular events and PPI use during treatment with ticagrelor, a directly acting adenosine diphosphate (P2Y12) inhibitor that does not require biotransformation and without known interaction with PPIs. There was also a similar association between cardiovascular events and other non-PPI gastrointestinal (GI) treatment. We therefore con-cluded that the association between PPI use and adverse events may be attributable to confounding, suggesting that PPI use may be more a marker for, rather than a cause of, higher rates of cardiovascular events