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The prognostic difference study on the individualized clopidogrel administration in Hmong and Dong patients based on

Xiangyi Yuan1, Yang Liu2, Teng Zhang3

  • 1School of Pharmacy, Guizhou Medical University, Guiyang 550025, China. hyun20210929@163.com.

Cellular and Molecular Biology (Noisy-Le-Grand, France)
|September 12, 2024
PubMed

Insights

CYP2C19 gene variations impact clopidogrel effectiveness after percutaneous coronary intervention (PCI). Individualized clopidogrel dosing based on CYP2C19 genotype reduced major adverse cardiovascular events (MACE) in Hmong and Dong patients.

Area of Science:

  • Pharmacogenomics
  • Cardiovascular Medicine
  • Clinical Pharmacy

Background:

  • CYP2C19 gene polymorphism influences clopidogrel metabolism and efficacy.
  • Percutaneous coronary intervention (PCI) patients require antiplatelet therapy, often clopidogrel.
  • Understanding ethnic-specific CYP2C19 distribution is crucial for personalized medicine.

Purpose of the Study:

  • To investigate CYP2C19 genotype and allele distribution in Hmong and Dong populations post-PCI.
  • To evaluate the clinical impact of individualized clopidogrel administration versus conventional therapy.
  • To assess the incidence of major adverse cardiovascular events (MACE) and adverse drug reactions (ADR).

Main Methods:

  • Genotyping for CYP2C19 polymorphism in 208 post-PCI patients (Hmong and Dong).
  • Randomized controlled trial comparing individualized administration (IA) with conventional administration (CA) of clopidogrel.
  • 6-month follow-up for MACE (including myocardial infarction, revascularization) and ADRs.

Main Results:

  • CYP2C19 allele distribution differed between Hmong and Dong patients.
  • Individualized clopidogrel administration (IA) group showed lower rates of non-fatal myocardial infarction and emergency revascularization.
  • While bleeding events were higher in the IA group, overall MACE incidence was lower; slow metabolizers had higher MACE with conventional therapy.
  • ADR incidence varied in the IA group, notably dyspnea.

Conclusions:

  • Significant ethnic differences in CYP2C19 allele distribution exist between Hmong and Dong patients in the Qiandongnan region.
  • CYP2C19-guided clopidogrel therapy is effective in reducing MACE in post-PCI patients, particularly slow metabolizers, without increasing bleeding risk.
  • Individualized clopidogrel administration is supported for rational use in this population.

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