Prescribing clopidogrel based on pharmaco-genetics could “impact significantly” on the management of patients of Bangladeshi and Pakistani ancestry (BPA), according to an analysis of 44,396 people in the UK Genes & Health study. 

Cytochrome p450 2C19 (CYP2C19) converts clopidogrel, a prodrug, to its active metabolite. Despite only 25 per cent of BPA patients being ‘normal’ metabolisers, 69.3 per cent of those who experienced an acute myocardial infarction (MI) and 44.2 per cent of those who received a stent were prescribed clopidogrel. Allowing for confounders, poor metabolisers were 3.1 times more likely to have a recurrent MI. 

“This study highlights the importance of using genetics to determine who can benefit from clopidogrel after a heart attack, and how not doing so is likely to disproportionately disadvantage specific groups, such as South Asians,” says lead author Dr Emma Magavern from Queen Mary University of London.

“This study also illustrates how systemic under-representation [of] South Asians in therapeutics trials has obscured the inter-section of risks impacting this community.” (JACC Adv DOI: 10.1016/j. jacadv.2023.100573)