Genomewide Association Study of Platelet Reactivity and Cardiovascular Response in Patients Treated With Clopidogrel: A Study by the International Clopidogrel Pharmacogenomics Consortium

Research output: Contribution to journalJournal articleResearchpeer-review

  • Shefali Setia Verma
  • Thomas O. Bergmeijer
  • Li Gong
  • Jean Luc Reny
  • Joshua P. Lewis
  • Braxton D. Mitchell
  • Dimitrios Alexopoulos
  • Daniel Aradi
  • Russ B. Altman
  • Kevin Bliden
  • Yuki Bradford
  • Gianluca Campo
  • Kiyuk Chang
  • John H. Cleator
  • Jean Pierre Déry
  • Nadia P. Dridi
  • Israel Fernandez-Cadenas
  • Pierre Fontana
  • Meinrad Gawaz
  • Tobias Geisler
  • Gian Franco Gensini
  • Betti Giusti
  • Paul A. Gurbel
  • Willibald Hochholzer
  • Holmvang, Lene
  • Eun Young Kim
  • Ho Sook Kim
  • Rossella Marcucci
  • Joan Montaner
  • Joshua D. Backman
  • Ruth E. Pakyz
  • Dan M. Roden
  • Elke Schaeffeler
  • Matthias Schwab
  • Jae Gook Shin
  • Jolanta M. Siller-Matula
  • Jurriën M. ten Berg
  • Dietmar Trenk
  • Marco Valgimigli
  • John Wallace
  • Ming Shien Wen
  • Michiaki Kubo
  • Ming Ta Michael Lee
  • Ryan Whaley
  • Stefan Winter
  • Teri E. Klein
  • Alan R. Shuldiner
  • Marylyn D. Ritchie
  • for the ICPC Investigators

Antiplatelet response to clopidogrel shows wide variation, and poor response is correlated with adverse clinical outcomes. CYP2C19 loss-of-function alleles play an important role in this response, but account for only a small proportion of variability in response to clopidogrel. An aim of the International Clopidogrel Pharmacogenomics Consortium (ICPC) is to identify other genetic determinants of clopidogrel pharmacodynamics and clinical response. A genomewide association study (GWAS) was performed using DNA from 2,750 European ancestry individuals, using adenosine diphosphate-induced platelet reactivity and major cardiovascular and cerebrovascular events as outcome parameters. GWAS for platelet reactivity revealed a strong signal for CYP2C19*2 (P value = 1.67e−33). After correction for CYP2C19*2 no other single-nucleotide polymorphism reached genomewide significance. GWAS for a combined clinical end point of cardiovascular death, myocardial infarction, or stroke (5.0% event rate), or a combined end point of cardiovascular death or myocardial infarction (4.7% event rate) showed no significant results, although in coronary artery disease, percutaneous coronary intervention, and acute coronary syndrome subgroups, mutations in SCOS5P1, CDC42BPA, and CTRAC1 showed genomewide significance (lowest P values: 1.07e−09, 4.53e−08, and 2.60e−10, respectively). CYP2C19*2 is the strongest genetic determinant of on-clopidogrel platelet reactivity. We identified three novel associations in clinical outcome subgroups, suggestive for each of these outcomes.

Original languageEnglish
JournalClinical Pharmacology and Therapeutics
Volume108
Issue number5
Pages (from-to)1067-1077
Number of pages11
ISSN0009-9236
DOIs
Publication statusPublished - 2020

ID: 260190714