冠状动脉疾病的老年患者中药物基因相互作用
Shizhao Zhang1,2, Chao Lv1,2, Lisha Dong1,2
1Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, No.28 Fu Xing Road, Beijing, 100853, China.
冠状动脉疾病 (CAD) 的老年患者从个性化医疗中受益. 这些患者的药物基因相互作用 (DGI) 与较低的死亡率和主要心血管事件 (MACE) 有关,这突显了综合遗传和临床数据的需要.
科学领域:
- 药物基因组学 药物基因组学
- 心血管医学 心血管医学
- 老年病的医生 老年病的医生
背景情况:
- 患有冠状动脉疾病 (CAD) 的老年人容易受到药物不良反应和不同的药物疗效的影响.
- 通过药物基因相互作用 (DGI) 获得信息的个性化药物治疗策略可以减轻这些风险.
- 当遗传变异影响药物的药理动力学或药理动力学时,DGI会发生.
研究的目的:
- 研究心血管相关的DGI对患有CAD的老年患者临床结果的影响.
- 评估DGI与疗效 (死亡率,MACE) 和安全 (药物反应表型) 结果之间的关联.
主要方法:
- 招募了1,017名住院的老年患者 (≥65岁) 患有CAD.
- 针对与心血管药物相关的可操作的药物遗传变异 (CYP2C9,CYP2C19,CYP2D6,CYP3A5,SLCO1B1) 进行基因定型.
- 随访患者至少1年,以评估疗效和安全结果,包括死亡率,MACE,药物停止和剂量降低事件.
主要成果:
- 96.0%的患者至少有一种可操作的药物遗传变异需要治疗变化.
- 79.5%的患者经历了至少一个DGI.
- 增加的DGI数量与全因死亡率 (aHR:0.84) 和MACEs (aHR:0.84) 的降低以及药物反应表型的增加 (aOR:1.24) 相关.
结论:
- 心血管DGI与老年CAD患者的临床结果有显著的关联.
- 整合遗传和临床数据对于优化心血管多药在这个人群中至关重要.
- 需要进一步的前性研究来确定DGI和临床结果之间的因果关系.
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