Evaluation of race and ethnicity disparities in outcome studies of CYP2C19 genotype-guided antiplatelet therapy.
Evaluation of race and ethnicity disparities in outcome studies of CYP2C19 genotype-guided antiplatelet therapy.
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DOI：
10.3389/fcvm.2022.991646
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发表时间：
2022
影响因子：
3.6
通讯作者：
Lee, Craig R.
中科院分区：
文献类型：
--
作者：
Nguyen, Anh B.;Cavallari, Larisa H.;Rossi, Joseph S.;Stouffer, George A.;Lee, Craig R.
P2Y12 抑制剂（氯吡格雷、普拉格雷或替格瑞洛）和阿司匹林双重抗血小板治疗仍然是所有接受经皮冠状动脉介入治疗 (PCI) 患者的标准治疗。众所周知，携带 CYP2C19 无功能等位基因的患者将氯吡格雷转化为其活性代谢物的能力受损，因此发生主要不良心血管事件 (MACE) 的风险较高。普拉格雷和替格瑞洛的代谢和临床疗效不受 CYP2C19 基因型的影响，并且来自多项随机和观察性研究的积累证据表明，PCI 后 CYP2C19 基因型引导的抗血小板治疗可改善临床结果。然而，迄今为止，大多数抗血小板药物基因组结果研究缺乏种族和民族多样性。在这篇综述中，我们将（1）总结与 CYP2C19 基因型引导的抗血小板治疗相关的当前指南建议和临床结果证据，（2）评估支持当前基因型引导抗血小板治疗建议的主要结果研究中是否存在潜在的种族和民族差异，以及（3）确定剩余的知识差距和未来研究方向，以推进在不同的现实世界临床环境中推进双重抗血小板治疗的精准医学策略的实施。
Dual antiplatelet therapy with a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) and aspirin remains the standard of care for all patients undergoing percutaneous coronary intervention (PCI). It is well-established that patients carrying CYP2C19 no function alleles have impaired capacity to convert clopidogrel into its active metabolite and thus, are at higher risk of major adverse cardiovascular events (MACE). The metabolism and clinical effectiveness of prasugrel and ticagrelor are not affected by CYP2C19 genotype, and accumulating evidence from multiple randomized and observational studies demonstrates that CYP2C19 genotype-guided antiplatelet therapy following PCI improves clinical outcomes. However, most antiplatelet pharmacogenomic outcome studies to date have lacked racial and ethnic diversity. In this review, we will (1) summarize current guideline recommendations and clinical outcome evidence related to CYP2C19 genotype-guided antiplatelet therapy, (2) evaluate the presence of potential racial and ethnic disparities in the major outcome studies supporting current genotype-guided antiplatelet therapy recommendations, and (3) identify remaining knowledge gaps and future research directions necessary to advance implementation of this precision medicine strategy for dual antiplatelet therapy in diverse, real-world clinical settings.
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影响因子：
24
作者：
通讯作者：
--
影响因子：
5.4
作者：
Basra SS;Wang TY;Simon DN;Chiswell K;Virani SS;Alam M;Nambi V;Denktas AE;Deswal A;Bozkurt B;Ballantyne CM;Peterson ED;Jneid H
通讯作者：
Jneid H
影响因子：
14.9
作者：
Buniello, Annalisa;MacArthur, Jacqueline A. L.;Parkinson, Helen
通讯作者：
Parkinson, Helen
DOI：
10.1161/circinterventions.120.009434
发表时间：
2021-04-01
影响因子：
5.6
作者：
Claassens, Daniel M. F.;Bergmeijer, Thomas O.;ten Berg, Jurrien M.
通讯作者：
ten Berg, Jurrien M.
影响因子：
11.3
作者：
Angiolillo, Dominick J.;Capodanno, Davide;Price, Matthew J.
通讯作者：
Price, Matthew J.