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Br J Clin Pharmacol. 2015 Oct;80(4):662-9. doi: 10.1111/bcp.12682. Epub 2015 Jul 2.

A population-based study of the drug interaction between clopidogrel and angiotensin converting enzyme inhibitors.

Author information

1
The Institute for Clinical Evaluative Sciences, Toronto, Ontario.
2
Department of Medicine, Faculty of Medicine, University of Toronto, Ontario.
3
Institute of Health Policy, Management and Evaluation, Toronto, Ontario.
4
The Leslie Dan Faculty of Pharmacy, Toronto, Ontario.
5
Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's, Toronto, Ontario.
6
Dalla Lana School of Public Health, University of Toronto, Ontario.
7
Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
8
Sunnybrook Research Institute, Toronto, Ontario.
9
Department of Pediatrics, University of Toronto, Ontario, Canada.

Abstract

AIMS:

Clopidogrel and angiotensin converting enzyme (ACE) inhibitors are commonly co-prescribed drugs. Clopidogrel inhibits carboxylesterase 1 (CES1), the enzyme responsible for converting prodrug ACE inhibitors (such as ramipril and perindopril) to their active metabolites. The clinical implications of this potential drug interaction are unknown. The clinical consequences of the potential drug interaction between clopidogrel and prodrug ACE inhibitors were examined.

METHODS:

We conducted a nested case-control study of Ontarians aged 66 years and older treated with clopidogrel between September 1 2003 and March 31 2013 following acute myocardial infarction. Cases were subjects who died or were hospitalized for reinfarction or heart failure in the subsequent year, and each was matched with up to four controls. The primary outcome was a composite of reinfarction, heart failure or death. The primary analysis examined whether use of the prodrug ACE inhibitors ramipril or perindopril was more common among cases than use of lisinopril, an active ACE inhibitor.

RESULTS:

Among 45 918 patients treated with clopidogrel following myocardial infarction, we identified 4203 cases and 14 964 controls. After adjustment, we found no association between the composite outcome and use of perindopril (adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI) 0.76, 1.16) or ramipril (aOR 0.97, 95% CI 0.80, 1.18), relative to lisinopril. Secondary analyses of each element of the composite outcome yielded similar findings.

CONCLUSIONS:

Following myocardial infarction, use of clopidogrel with ACE inhibitors activated by CES1 is not associated with an increased risk of adverse cardiovascular outcomes relative to lisinopril. These findings suggest that the recently described drug interaction between clopidogrel and prodrug ACE inhibitors is of little clinical relevance.

KEYWORDS:

angiotensin converting enzyme inhibitors; clopidogrel; congestive heart failure; mortality; myocardial infarction

PMID:
25980448
PMCID:
PMC4594702
DOI:
10.1111/bcp.12682
[Indexed for MEDLINE]
Free PMC Article

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