The clinical significance of CYP2C19 genotype detection for antiplatelet therapy of cardiovascular and cerebrovascular diseases in the elderly

Objectives To investigate the clinical significance of CYP2C19 genotype detection for antiplatelet therapy of elder cardiovascular and cerebrovascular diseases(CCVD). Methods We enrolled all elderly patients with either cardiovascular or cerebrovascular disorders who received clopidogrel as mono drug or in combination with another antiplatelet drug aspirin as secondary prevention for more than 12 months in our hospital from January to August 2015.Somatotypes of CYP2C19 genotypes of all participants were assessed to analyze the relapse of cardiac-cerebral vascular diseases in these patients. Results A total of 250 patients were enrolled, including 179 male and 71 female, with average age of (85.2±7.9)years.Among these patients, there were 97(38.8%)cases with EM CYP2C19 genotypes, 110 cases(44.0%)with IM CYP2C19 genotypes, 43 cases(17.2%)with PM CYP2C19 genotypes.When treated with clopidogrel for antiplatelet in secondary prevention process, the rate of the relapse in cardiovascular event was 34.9% and higher in PM CYP2C19 genotype than in EM and IM CYP2C19 genotype(19.6% and 15.5%, respectively)(χ2=7.251, P=0.027). This phenomenon was similar to patients who received stent implantation(χ2=6.393, P=0.041). However, no statistically significant difference was observed in the recurrence rate of cerebral vascular disease between three different genotypes(EM 29.9%, IM 20.0%, PM 27.9%, χ2=2.880, P=0.237). Conclusions Our results highlight that CYP2C19 genotype might be a potential guidance for secondary prevention of cardiovascular and cerebrovascular disorders among elderly patients.Clopidogrel may be less effective in patients with SM CYP2C19 genotype than those with EM or PM CYP2C19 genotype for secondary prevention of cardiovascular disease. Key words: Cardiovascular diseases; Blood platelets; Polymorphism, single nucleotide