Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan-Feb;66(1):16-24.
doi: 10.1016/j.ihj.2013.10.001. Epub 2013 Nov 6.

CYP 450 2C19 polymorphisms in Indian patients with coronary artery disease

Sudhir S Shetkar  1 , Sivasubramanian Ramakrishnan  2 , Sandeep Seth  3 , Puneet Chandna  4 , Sunil K Verma  5 , Balram Bhargava  6 , Vinay K Bahl  7
Affiliations

CYP 450 2C19 polymorphisms in Indian patients with coronary artery disease

Sudhir S Shetkar et al. Indian Heart J. 2014 Jan-Feb.

Abstract

Background: Dual antiplatelet therapy is the cornerstone in the management of acute coronary syndromes (ACS) and prevention of stent thrombosis (ST). Genetic polymorphisms in CYP2C19 gene involved in hepatic activation of clopidogrel leads to clopidogrel non-responsiveness and may influence clinical outcomes. These polymorphisms in CYP2C19 gene and their impact on clinical outcome in coronary artery disease (CAD) have not been studied in Indian population.

Methods: We studied 110 consecutive patients (mean age 55.7 ± 10.7 years; 90% male) taking clopidogrel with angiographically proven CAD for various genetic polymorphisms in CYP2C19 gene. Relationship between loss of function mutation and clinical presentation with recurrent ACS including ST was analyzed.

Results: Out of 110 patients, 26 (23.64%) had normal genotype, 52 (47.23%) had loss of function mutation *2 and 39 (35.45%) had a gain of function mutation *17, 7 (6.36%) patients were undefined metabolizers (*2/*17) which were excluded from analyses. Final analyses included 103 patients, with 45 (40.90%) having loss of function. Overall 51 patients had ACS, with 27 developing recurrence while on clopidogrel. The prevalence of loss of function mutation was no different between the group with recurrences and those without recurrences (55.6% vs. 50%, p = 0.7). Two patients developed ST while on clopidogrel; both had loss of function mutation.

Conclusion: CYP2C19 gene polymorphisms are common in Indian population. Loss of function mutation status did not affect the clinical outcomes. A larger study also considering P2Y12 receptor polymorphisms together with platelet activity testing, may be required to establish the role of CYP2C19 gene polymorphisms in clinical practice.

Keywords: CYP2C19 polymorphism; Clopidogrel; Coronary artery disease.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
a – Frequency of CYP2C19 mutant alleles in study population. b – Frequency of clopidogrel genotypes in study population. c – Frequency of CYP2C19 alleles, according to metabolizer status in the study population. d – Patient groups according to loss of function versus no loss of function genotype in the study population.
Fig. 1
Fig. 1
a – Frequency of CYP2C19 mutant alleles in study population. b – Frequency of clopidogrel genotypes in study population. c – Frequency of CYP2C19 alleles, according to metabolizer status in the study population. d – Patient groups according to loss of function versus no loss of function genotype in the study population.
Fig. 2
Fig. 2
Relationship of loss of function mutation with recurrence of acute coronary events.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kushner F.G., Hand M., Smith S.C. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines of percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;120:2271–2306. - PubMed
    1. Jneid H., Anderson J.L., Wright R.S. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2012;126:875–910. - PubMed
    1. Levine G.N., Bates E.R., Blankenship J.C. 2011 ACCF/AHA/SCAI guideline for PCI: executive summary: a report of the ACCF/AHA Task Force on Practice Guidelines and the SCAI. Circulation. 2011;124:2574–2609. - PubMed
    1. Bhatt D.L., Fox K.A., Hacke W. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354:1706. - PubMed
    1. Dupont A.G., Gabriel D.A., Cohen M.G. Antiplatelet therapies and the role of antiplatelet resistance in acute coronary syndrome. Thromb Res. 2009;124:6–13. - PubMed

MeSH terms