Evaluation of race and ethnicity disparities in outcome studies of CYP2C19 genotype-guided antiplatelet therapy

Figures

• 

  FIGURE 1. CYP2C19 metabolizer phenotype frequency estimates across diverse biogeographical groups. This figure summarizes the relative frequency estimates (in percentages) of CYP2C19 metabolizer phenotypes in the 9 distinct biogeographical groups defined by PharmGKB to annotate racial and ethnicity information about participants in pharmacogenomic studies (21). The CYP2C19 metabolizer phenotype and respective CYP2C19 genotypes are as categorized: ultrarapid metabolizers (*17/*17), rapid metabolizers (*1/*17), normal metabolizers (*1/*1), intermediate metabolizers (e.g., *1/*2 or *2/*17), and poor metabolizers (e.g., *2/*2). Frequency data was obtained from CPIC (12).

• 

  FIGURE 2. Reported race and ethnicity data from selected major clinical outcome trials utilizing clopidogrel and in which CYP2C19 status was reported. This figure compares the relative percent distribution of reported race and ethnicity from study participants included major retrospective and prospective clinical outcome studies of CYP2C19 genotype-guided antiplatelet therapy. *Studies with the gray hatched bars did not report race and ethnicity data, and an assumption about the population demographics was made based on the study site locations described in Table 1 (Europe or China). For reference, the demographic characteristics of each study were compared to data obtained from the National Cardiovascular Data Registry (NCDR): the race and ethnicity distribution of patients who underwent PCI in the U.S. was 86.5% White or European, 8.8% Black or African American, 2.8% Asian, 0.7% Native American, 0.3% Pacific Islander, and 5.8% Hispanic or Latino ethnicity (55).

• 

  FIGURE 3. Representation of race and ethnicity data from selected CYP2C19 outcome studies. This figure summarizes race and ethnicity distribution of individuals included in major prospective clinical outcome studies of CYP2C19 genotype guided antiplatelet therapy (as summarized in Supplementary Table 1). Pie graph displays aggregated percent race and ethnicity composition from the N = 12,467 patients enrolled in the 4 studies with reported race and ethnicity data (TAILOR PCI, POPular Genetics, IGNITE, PHARM-ACS).