Genetic Variants Spike Cardio Risk for Patients on Clopidogrel

Reduced-function CYP2C19 alleles linked to cardiovascular death, myocardial infarction, stroke

TUESDAY, Oct. 26 (HealthDay News) -- Individuals treated with clopidogrel for percutaneous coronary intervention who are carriers of reduced-function CYP2C19 alleles are more likely to suffer major cardiovascular events than patients without the genetic variants, according to research published in the Oct. 27 issue of the Journal of the American Medical Association.

Jessica L. Mega, M.D., of Brigham and Women's Hospital in Boston, and colleagues searched the medical literature (2000 to 2010) and identified genetic studies in which clopidogrel was used in mainly invasively managed coronary patients, and clinical outcomes were ascertained. The researchers analyzed an aggregate of 9,685 patients for correlations between the composite end point (cardiovascular death, myocardial infarction, or stroke) and CYP2C19 genotype, including one or two reduced-function CYP2C19 genetic variants.

Among the 9,685 patients, 863 experienced the composite end point. In a subgroup of 5,894 patients also analyzed for stent thrombosis, 84 suffered that complication. The researchers found a significantly increased risk for the composite end point in carriers of both one reduced-function allele (hazard ratio [HR], 1.55) and two reduced-function alleles (HR, 1.76), compared with non-carriers. The risk of stent thrombosis was also increased for the carrier groups (HRs, 2.67 and 3.97, respectively).

"Among patients treated with clopidogrel for percutaneous coronary intervention, carriage of even one reduced-function CYP2C19 allele appears to be associated with a significantly increased risk of major adverse cardiovascular events, particularly stent thrombosis," the authors write.

Several study authors reported financial ties to pharmaceutical and/or medical device companies.

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Jeff Muise

Jeff Muise

Updated on October 26, 2010

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