Key result
CYP2C19 loss-of-function phenotypes peak in Asian populations at up to ~77% prevalence.
Why the study?
Although global CYP2C19 variant prevalence is well described, CYP2C19 diplotype and metaboliser phenotype frequencies specifically in clopidogrel-indicated populations needed characterisation.
The high global prevalence of CYP2C19 intermediate and poor metabolisers in clopidogrel-indicated patients highlights a major opportunity for implementing pharmacogenomic-guided antiplatelet therapy, particularly in Asian populations.
Answers are grounded in this paper and cite their sources.
Supports CYP2C19 testing consideration in East/South Asian clopidogrel patients; leaves open prospective outcome trials before routine adoption.
Clopidogrel is a widely prescribed antiplatelet prodrug, with activation affected by CYP2C19 loss- and gain-of-function variants. Whilst global CYP2C19 variant prevalence is well described, this scoping review characterises CYP2C19 diplotype and metaboliser phenotype frequencies in clopidogrel-indicated populations. A literature search of Scopus, PubMed, Ovid MEDLINE, and Ovid Embase was conducted from inception to 6 July 2026. Forty-one studies (n = 18958) reporting CYP2C19 diplotypes were synthesised across Asia, the Middle East and North Africa (MENA), Europe and the Americas and converted to phenotypes. Intermediate and poor metabolisers were most prevalent in East Asia (54.0–77.2%) and South Asia (47.3–71.1%). Rapid and ultrarapid metabolisers were most prevalent in MENA (27.3–44.3%) and Europe (27.3–36.2%). Frequent diplotypes were *1/*2 in intermediate and *2/*2 in poor metabolisers. Overall, phenotype distribution reflects global population trends. High global prevalence of CYP2C19 intermediate and poor metabolisers amongst clopidogrel-indicated populations presents an opportunity to implement pharmacogenomic-guided prescribing.
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Antonopoulos et al. (2026) conducted a review in Clopidogrel-indicated cardiovascular conditions (n=18,958). CYP2C19 variant diplotypes and metaboliser phenotypes was evaluated on Prevalence of CYP2C19 diplotype and metaboliser phenotype frequencies. CYP2C19 intermediate/poor metabolisers were most prevalent in East (54.0-77.2%) and South Asia (47.3-71.1%), while rapid/ultrarapid metabolisers peaked in MENA (27.3-44.3%) and Europe (27.3-36.2%).
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