{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:05:59Z","timestamp":1793833559029,"version":"4.6.1"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,6,18]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Cytochrome P450 2C19 (CYP2C19) intermediate and poor metabolizer patients exhibit diminished clopidogrel clinical effectiveness after percutaneous coronary intervention (PCI). However, outcome studies to date have lacked racial diversity. Thus, the impact of\n                      <jats:italic toggle=\"no\">CYP2C19<\/jats:italic>\n                      genotype on cardiovascular outcomes in patients treated with clopidogrel who identify as Black or African American remains unclear.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Adults among 5 institutions who self\u2010identified as Black or African American, underwent PCI and clinical\n                      <jats:italic toggle=\"no\">CYP2C19<\/jats:italic>\n                      genotyping, and were treated with clopidogrel were included. Data were abstracted from health records. Major atherothrombotic (composite of death, myocardial infarction, ischemic stroke, stent thrombosis, or revascularization for unstable angina) and bleeding event rates within 1 year after PCI were compared across CYP2C19 metabolizer groups using multivariable Cox regression adjusted for potential confounders and baseline variables meeting a threshold of\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.10. The population included 567 Black patients treated with clopidogrel (median age, 62\u2009years; 46% women; 70% with an acute coronary syndrome indication for PCI). Major atherothrombotic events rates were significantly higher among clopidogrel\u2010treated intermediate and poor metabolizers (24 of 125 [19.2%]) versus patients treated with clopidogrel without a no function allele (43 of 442 [9.7%]; 35.1 versus 15.9 events per 100 person\u2010years; adjusted hazard ratio, 2.00 [95% CI, 1.20\u20133.33],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.008). Bleeding event rates were low overall (23 of 567 [4.1%]) and did not differ among the metabolizer groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Black patients with CYP2C19 intermediate and poor metabolizer phenotypes who are treated with clopidogrel exhibit increased risk of adverse cardiovascular outcomes after PCI in a real\u2010world clinical setting. Bleeding outcomes should be interpreted cautiously. Prospective studies are needed to determine whether genotype\u2010guided use of prasugrel or ticagrelor in intermediate and poor metabolizers improves outcomes in Black patients undergoing PCI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.033791","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T07:09:46Z","timestamp":1718348986000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["<i>CYP2C19<\/i>\n                    Genotype Is Associated With Adverse Cardiovascular Outcomes in Black Patients Treated With Clopidogrel Undergoing Percutaneous Coronary Intervention"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3442-7347","authenticated-orcid":false,"given":"Kayla R.","family":"Tunehag","sequence":"first","affiliation":[{"name":"University of North Carolina at Chapel Hill","place":["Chapel Hill, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron D.","family":"Thomas","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Florida","place":["Gainesville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Franchi","sequence":"additional","affiliation":[{"name":"College of Medicine\u2010Jacksonville, University of Florida","place":["Jacksonville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Rossi","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill","place":["Chapel Hill, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2915-4751","authenticated-orcid":false,"given":"Ellen C.","family":"Keeley","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Florida","place":["Gainesville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3490-3286","authenticated-orcid":false,"given":"R. David","family":"Anderson","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Florida","place":["Gainesville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0958-7197","authenticated-orcid":false,"given":"Amber L.","family":"Beitelshees","sequence":"additional","affiliation":[{"name":"Department of Medicine and Program for Personalized and Genomic Medicine","place":["Baltimore, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9766-4038","authenticated-orcid":false,"given":"Julio D.","family":"Duarte","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Florida","place":["Gainesville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8218-1620","authenticated-orcid":false,"given":"Yan","family":"Gong","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Florida","place":["Gainesville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Kerensky","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Florida","place":["Gainesville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6393-7288","authenticated-orcid":false,"given":"Caitrin W.","family":"McDonough","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Florida","place":["Gainesville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anh B.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill","place":["Chapel Hill, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9567-3253","authenticated-orcid":false,"given":"Luis","family":"Ortega\u2010Paz","sequence":"additional","affiliation":[{"name":"College of Medicine\u2010Jacksonville, University of Florida","place":["Jacksonville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine","place":["Durham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7040-1561","authenticated-orcid":false,"given":"Yehua","family":"Wang","sequence":"additional","affiliation":[{"name":"University of Florida","place":["Gainesville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Johnson","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Florida","place":["Gainesville, 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