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CYP2C19 Polymorphisms and Smoking Status Affects Responsiveness to the Platelet P2Y12 Receptor Antagonist Clopidogrel

 Sang Won Han  ;  Yong-Jae Kim  ;  Woo-Keun Seo  ;  Sungwook Yu  ;  Hyo Suk Nam  ;  Sung Sang Yoon  ;  Seo Hyun Kim  ;  Jong Yun Lee  ;  Jun Hong Lee  ;  Yang-Ha Hwang  ;  Jun Lee  ;  Kyung-A Lee  ;  Kyung-Yul Lee 
 Cardiovascular Prevention and Pharmacotherapy, Vol.1(2) : 63-70, 2019 
Journal Title
 Cardiovascular Prevention and Pharmacotherapy 
Issue Date
Clopidogrel ; Polymorphism, genetic ; Polymorphism, Single nucleotide ; Smoking ; Stroke
Background: The “comparison of triflusal and clopidogrel effects in secondary prevention of stroke based on cytochrome P450 2C19 (CYP2C19) genotyping (MAESTRO)” study was a prospective, multicenter, randomized, open-label, and blind genotype trial. We performed a subgroup analysis of the MAESTRO study to explore the relationship between VerifyNow P2Y12 assay with regard to CYP2C19 polymorphisms and smoking status in patients with non-cardiogenic ischemic stroke who underwent clopidogrel treatment. Methods: For the study, patients treated with clopidogrel and who underwent VerifyNow P2Y12 assay was selected from the MAESTRO study. Results: Of the 393 patients in 18 hospitals, 256 (65%) patients in 12 hospitals were entered for this subgroup analysis. P2Y12 reaction unit (PRU) was significantly lower and percent inhibition (% INH) was higher in the current smoking group than in the nonsmoking group (p<0.001). The same results were also observed in the good genotype group when compared with the poor genotype group (p<0.001). Among the groups, significant lower PRU and higher % INH was demonstrated in current smoking with good genotype group. However, there was no difference in PRU and % INH between current smoking with poor genotype group and nonsmoking with good genotype group, suggesting that clopidogrel activity was concurrently related to CYP2C19 polymorphisms and smoking status. Conclusions: Regarding secondary stroke prevention, patients who were current smokers and had a poor genotype for clopidogrel metabolism may benefit from clopidogrel treatment similar to that in patients who were nonsmokers and had a good genotype.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
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