Positive clinical response to clopidogrel is independent of paraoxonase 1 Q192R and CYP2C19 genetic variants

Authors

  • Efrén Martínez-Quintana MD PhD,

    Corresponding author
    1. Cardiology Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
    • Corresponding Author:

      Antonio Tugores, PhD, Unidad de Investigación, Complejo Hospitalario Universitario Insular Materno-Infantil; Avda Maritima del Sur, s/n. 35016 Las Palmas de GC, Spain

      Email: atugores@yahoo.com

    Search for more papers by this author
  • José M Medina-Gil MD,

    Corresponding author
    1. Cardiology Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
    • Corresponding Author:

      Antonio Tugores, PhD, Unidad de Investigación, Complejo Hospitalario Universitario Insular Materno-Infantil; Avda Maritima del Sur, s/n. 35016 Las Palmas de GC, Spain

      Email: atugores@yahoo.com

    Search for more papers by this author
  • Fayna Rodríguez-González MD,

    1. Intensive Care Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
    Search for more papers by this author
  • Paloma Garay-Sánchez,

    1. Research Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
    Search for more papers by this author
  • José M Limiñana PhD,

    1. Research Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
    Search for more papers by this author
  • Pedro Saavedra PhD,

    1. Department of Mathematics, Universidad de Las Palmas de Gran, Canaria
    Search for more papers by this author
  • Antonio Tugores PhD

    1. Research Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
    Search for more papers by this author

  • Both Martínez-Quintana and Medina-Gil contributed equally to this work.

Abstract

There is increasing controversy about the influence of serum paraoxonase type 1 and cytochrome CYP2C19 in the conversion of clopidogrel to its pharmaceutically active metabolite. The effect of concomitant medication with the proton pump inhibitor omeprazole has been also subject of intense scrutiny.

We present a cohort of 263 patients receiving anti-platelet aggregation treatment with clopidogrel and aspirin for 1 year. The paraoxonase 1 gene Q192R variant along with the presence of CYP2C19*2 and *3 loss of function alleles, concomitant medication with proton pump inhibitors and known cardiovascular risk factors were examined to determine their influence in disease relapse due to an ischaemic event during the 12 month treatment period.

The low number of patients suffering a relapse (20 out of 263), indicates that double anti-aggregation therapy with aspirin and clopidogrel was very effective in our patients. Among the relapsers, evidence of coronary heart disease was the most influencial factor affecting response to therapy, while the presence of the paraoxonase 1 Q192R variant, loss of function of CYP2C19, and concomitant medication with omeprazole were non-significant.

Ancillary