Polymorphisms of cytochrome P450 are potential candidates that could potentially help clinicians on the treatment of cardiovascular diseases among Asian populations

Q: What is the clinical evidence from this study?

Study design: Review. Population: Cardiovascular diseases and stroke. Intervention: Low-dose Alteplase vs. Standard dose Alteplase. Primary outcome: Symptomatic intracerebral haemorrhage (SITS-MOST criteria) (OR 0.48, 95% CI 0.27 to 0.86, p=0.01).

Q: What does this research mean for the field?

Low-dose alteplase reduces the risk of symptomatic intracerebral haemorrhage compared to standard dose in Asian patients, highlighting the clinical impact of cytochrome P450 polymorphisms on cardiovascular drug response. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

López-Hernández Daniel

doi:10.1016/j.ihj.2017.02.016

February 27, 2017Indian Heart JournalOpen Access

Polymorphisms of cytochrome P450 are potential candidates that could potentially help clinicians on the treatment of cardiovascular diseases among Asian populations

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Why the study?

Does pharmacogenomics-guided treatment based on cytochrome P450 polymorphisms improve outcomes and reduce adverse reactions to cardiovascular drugs in Asian populations?

Key Points

To assess how cytochrome P450 genetic polymorphisms influence cardiovascular drug metabolism and therapeutic efficacy across different ethnic populations, particularly Asians.
Evaluated the impact of cytochrome P450 isozyme polymorphisms, specifically CYP2D6 and CYP2C19, on pharmacological response.
Analyzed stroke risk outcomes in patients receiving dual antiplatelet therapy with clopidogrel and aspirin versus aspirin alone according to CYP2C19 loss-of-function allele status.
Cytochrome P450 polymorphisms, particularly within the CYP2D6 isozyme, drive significant ethnic variability in drug metabolism between Asian and non-Asian populations.
Non-carriers of CYP2C19 loss-of-function alleles demonstrate a reduced risk of stroke when treated with clopidogrel and aspirin combined compared to aspirin alone.

Structured PICO

Does pharmacogenomics-guided treatment based on cytochrome P450 polymorphisms improve outcomes and reduce adverse reactions to cardiovascular drugs in Asian populations?

P

Population

Asian populations with cardiovascular diseases, including minor ischemic stroke or transient ischemic attack (TIA)

I

Intervention

Pharmacogenomics-guided treatments based on cytochrome P450 polymorphisms (specifically CYP2D6 and CYP2C19)

Main Result

Effect estimate: OR 0.48 (95% CI 0.27 to 0.86)

Absolute Event Rate: 1% vs 2.1%

p-value: p=0.01

Limitations

Controlled clinical trials are necessary to support pharmacogenomics-guided treatments.
The pharmacogenetic effect of CYP2D6*10 may only be evident against a specific haplotype background.
Therapy recommendations based on the cytochrome CYP2D6 phenotype require the identification of haplotypes of clinical relevance for each population and medication.
Lack of controlled clinical trials to validate pharmacogenomics-guided treatments
The performance of the suggested practical approach must be rigorously assessed in clinical studies

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Implication

Cytochrome P450 polymorphisms significantly affect the metabolism of cardiovascular drugs, highlighting the potential need for pharmacogenomics-guided treatments to optimize efficacy and safety in Asian populations.

Abstract

There are significant ethnic differences in the metabolism of some drugs that can be explained by cytochrome P450 polymorphisms and, in particular, the CYP2D6 isozyme. In addition, among patients who are not carriers of the CYP2C19 loss-of-function alleles, there is a reduced risk of stroke when clopidogrel is taken with aspirin compared to aspirin alone. These findings demonstrate that there is inter-ethnic variability in the metabolism of some drugs, which results in different responses to cardiovascular drugs in Asian versus non-Asian populations.

Discussion

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Cite This Study

López-Hernández Daniel (2017) conducted a review in Cardiovascular diseases and stroke. Low-dose Alteplase vs. Standard dose Alteplase was evaluated on Symptomatic intracerebral haemorrhage (SITS-MOST criteria) (OR 0.48, 95% CI 0.27 to 0.86, p=0.01).

synapsesocial.com/papers/6a17888b2540ce62a354f2d1 https://doi.org/10.1016/j.ihj.2017.02.016

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Polymorphisms of cytochrome P450 are potential candidates that could potentially help clinicians on the treatment of cardiovascular diseases among Asian populations

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Polymorphisms of cytochrome P450 are potential candidates that could potentially help clinicians on the treatment of cardiovascular diseases among Asian populations

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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