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Inicio Medicina Clínica (English Edition) CYP2C19 activity and cardiovascular risk factors in patients with an acute coron...
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Vol. 149. Issue 6.
Pages 235-239 (September 2017)
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Vol. 149. Issue 6.
Pages 235-239 (September 2017)
Original article
DOI: 10.1016/j.medcle.2017.02.030
CYP2C19 activity and cardiovascular risk factors in patients with an acute coronary syndrome
Actividad de CYP2C19 y factores de riesgo cardiovascular en pacientes con síndrome coronario agudo
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Efrén Martínez-Quintanaa,
Corresponding author
efrencardio@gmail.com

Corresponding author.
, Fayna Rodríguez-Gonzálezb, José María Medina-Gila, Paloma Garay-Sánchezc, Antonio Tugoresc
a Servicio de Cardiología, Hospital Universitario Insular-Materno Infantil, Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
b Servicio de Oftalmología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
c Unidad de Investigación, Hospital Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
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Tables (2)
Table 1. Polymorphic variants, tests performed, protein effect and enzyme activity.
Table 2. Demographic, analytical and coronary angiographic data related to CYP2C19 activity.
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Abstract
Introduction

CYP2C19 is a major isoform of cytochrome P450 that metabolizes a number of drugs and is involved in the glucocorticoids synthesis. CYP2C19 polymorphisms have been associated with the genetic risk for type 2 diabetes.

Methods

Five hundred and three patients with an acute coronary event were studied to assess the association between the CYP2C19 activity (CYP2C19*2, CYP2C19*3 and CYP2C19*17 variants) and the type of acute coronary syndrome, cardiovascular risk factors (arterial systemic hypertension, diabetes mellitus, dyslipidemia and smoking), analytical parameters and the extent and severity of coronary atherosclerosis.

Results

Genotype distribution in our series was similar to that expected in the Caucasian population. Among the traditional cardiovascular risk factors, very poor metabolizer patients (*2/*2, *3/*3 or *2/*3) had a greater tendency to present diabetes mellitus needing insulin (p=0.067). Conversely, when we compared very poor, poor and normal metabolizers vs. rapid and ultrarapid metabolizers we found significant differences in those diabetic patients under insulin treatment (64 patients [18%] vs. 17 patients [11%]; p=0.032). On the contrary, analytical parameters, systemic arterial hypertension, dyslipidemia, smoking or the personal/family history of coronary artery disease did not reach statistical significance regardless of CYP2C19 activity. Similarly, the number and the type of coronary disease (thrombotic, fibrotic or both) did not differ between patients with different CYP2C19 enzyme activity.

Conclusion

Patients with an acute coronary event and a very poor, poor and normal CYP2C19 metabolizer genotype have a higher prevalence of diabetes mellitus needing insulin than patients with the rapid and ultrarapid metabolizers CPY2C19 genotype.

Keywords:
CYP2C19
Acute coronary syndrome
Diabetes mellitus
Insulin
Arterial hypertension
Resumen
Introducción

El CYP2C19 es una isoforma del citocromo P450 que metaboliza una serie de fármacos y participa en la síntesis de glucocorticoides. Los polimorfismos del CYP2C19 se han asociado al riesgo genético de padecer diabetes tipo 2.

Métodos

Se estudiaron 503 pacientes con síndrome coronario agudo para determinar la asociación entre la actividad de CYP2C19 (variantes CYP2C19*2, CYP2C19*3 y CYP2C19*17) y el tipo de síndrome coronario agudo, los factores de riesgo cardiovascular (hipertensión arterial sistémica, diabetes mellitus, dislipidemia y tabaquismo), los parámetros analíticos y la extensión y gravedad de la aterosclerosis coronaria.

Resultados

La distribución de genotipos fue similar a la esperada en caucásicos. Los metabolizadores muy pobres del CYP2C19 (*2/*2, *3/* 3 o *2/*3) tuvieron una mayor tendencia a presentar diabetes mellitus con necesidad de insulina (p=0,067). Sin embargo, cuando comparamos los metabolizadores muy pobres, pobres y normales frente a los metabolizadores rápidos y ultrarrápidos encontramos diferencias significativas en los pacientes diabéticos en tratamiento con insulina (64 pacientes [18%] frente a 17 pacientes [11%], p=0,032). Por el contrario, los parámetros analíticos y el resto de los factores de riesgo cardiovascular no alcanzaron significación estadística independientemente de la actividad de CYP2C19. De forma similar, el número y el tipo de enfermedad coronaria (trombótica, fibrótica o ambas) no difirieron según la actividad enzimática del CYP2C19.

Conclusión

Los pacientes con un episodio coronario agudo y con genotipo metabolizador CYP2C19 muy pobre, pobre y normal presentan una mayor prevalencia de diabetes mellitus en tratamiento insulínico que los pacientes con un genotipo CPY2C19 con una mayor actividad enzimática (metabolizadores rápidos y ultrarrápidos).

Palabras clave:
CYP2C19
Síndrome coronario agudo
Diabetes mellitus
Insulina
Hipertensión arterial

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