Atherosclerosis of Arteries of the Extremities, Unspecified, Atherosclerosis of Coronary Artery, Atherosclerotic Vascular Disease, Coronary Arterial Disease (CAD), Heart Diseases, Stroke, Venous Thromboembolic Disease
Conditions
Keywords
Cardiovascular disease, Atherosclerotic vascular disease, Coronary artery disease, Stroke
Brief summary
Several studies have shown that the efficacy of clopidogrel for secondary prevention of major adverse cardiovascular events (MACE), including acute coronary syndrome, depends on the polymorphism of the CYP2C19 gene. However, studies with large sample sizes and long-term follow-up are missing. Moreover, the impact of this polymorphism on the risk of major adverse limb events (MALE), particularly in patients with peripheral artery disease of the lower limb, is unexplored. Additionally, the impact of CYP2C19 gene polymorphism on clopidogrel effectiveness in preventing recurrent stroke in diverse populations is unknown since most of the data are from Asian ancestry populations. We hypothesize that patients with CYP2C19 gene loss of function alleles are at high risk of MACE and MALE compared to those without loss of function alleles at long-term follow-up. We propose to assess MACE and MALE in a large cohort of patients with available CYP2C19 genotypes treated at the University of Florida Health to evaluate the impact of CYP2C19 gene polymorphisms on the risk of new or recurrent events at long-term follow-up. Our specific aims are Aim 1) to determine the impact of CYP2C19 gene polymorphisms (loss of function alleles vs. non-loss of function alleles) on the risk of MACE (a composite of all-cause death, non-fatal MI, and non-fatal stroke) at long-term follow-up; Aim 2) to evaluate the impact of CYP2C19 gene polymorphisms (loss of function alleles vs. non-loss of function alleles) on the risk of MALE (a composite of limb amputations, chronic threatening limb ischemia, acute limb ischemia, and limb revascularization) at long-term follow-up; and Aim 3) to evaluate the impact of CYP2C19 gene polymorphisms (loss of function alleles vs. non-loss of function alleles) on the risk of cerebrovascular events (CVE, a composite of any stroke and transient ischemic attack) at long-term follow-up.
Interventions
None listed
Sponsors
University of Florida
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients aged ≥18 years with available CYP2C19 genotyping results obtained within the predefined period.
Exclusion criteria
* Absence of CYP2C19 genotyping results obtained within the predefined period.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Major adverse cardiovascular events | 5 years | Defined as the composite of all-cause death, non-fatal MI, ornon-fatal stroke |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Major adverse limb events | 5 years | A composite of limb amputations, chronic threatening limb ischemia, acute limb ischemia, or limb revascularization. |
| Net adverse clinical events | 5 years | a composite of all-cause death, myocardial infarction, stroke, and major bleeding. |
| Cerebrovascular event | 5 years | A composite of any stroke or transient ischemic attack. |
| Major bleeding | 5 years | Defined in accordance with the Bleeding Academic research consortium as BARC type 3 to 5 bleeding. |
| Minor bleeding | 5 years | Defined in accordance with the Bleeding Academic research consortium as BARC type 1 to 2 bleeding. |
| Clinically relevant bleeding | 5 years | Defined in accordance with the Bleeding Academic research consortium as BARC type 2 to 5 bleeding. |
| Venous thromboembolic disease | 5 years | Defined as the composite of deep vein thrombosis or pulmonary embolism. |
Countries
United States
Outcome results
None listed