Exploring the Ticagrelor-Statin Interplay in the PLATO Trial

<b><i>Context:</i></b> Much emphasis has been placed on a ticagrelor-aspirin (ASA) interaction in the Platelet Inhibition and Patient Outcomes (PLATO) trial, despite this particular interaction being inconclusive. However, a potential ticagrelor-statin interplay occurred and may be important in PLATO, especially considering the remarkable and yet unexplained mortality advantage. <b><i>Objective:</i></b> To explore the ticagrelor-statin interaction in the PLATO trial. <b><i>Results:</i></b> The background statin use in hospital or at discharge was similar between ticagrelor (89.7%) and clopidogrel (89.2%) PLATO arms, respectively. In patients on statins, ticagrelor significantly decreased all-cause mortality (30 day and through study end), vascular mortality (30 day and through study end) and exhibited a trend in benefit for 30-day major adverse cardiovascular events (MACE) compared to clopidogrel: hazard ratio, HR = 0.55, 95% confidence interval, CI = 0.36–0.84 (p = 0.005), and HR = 0.69, 95% CI = 0.52–0.92 (p = 0.012); HR = 0.70, 95% CI = 0.51–0.96 (p = 0.030), and HR = 0.68, 95% CI = 0.49–0.94 (p = 0.020), an