RESUMEN
Clopidogrel and aspirin are the most commonly used medications worldwide for dual antiplatelet therapy after percutaneous coronary intervention. However, clopidogrel hyporesponsiveness related to gene polymorphisms is a concern. Populations with higher degrees of genetic admixture may have increased prevalence of clopidogrel hyporesponsiveness. To assess this, we genotyped CYP2C19, ABCB1, and PON1 in 187 patients who underwent percutaneous coronary intervention. Race was self-defined by patients. We also performed light transmission aggregometry with adenosine diphosphate (ADP) and arachidonic acid during dual antiplatelet therapy. We found a significant difference for presence of the CYP2C19*2 polymorphism between white and non-white patients. Although 7% of patients had platelet resistance to clopidogrel, this did not correlate with any of the tested genetic polymorphisms. We did not find platelet resistance to aspirin in this cohort. Multivariate analysis showed that patients with PON1 and CYP2C19 polymorphisms had higher light transmission after ADP aggregometry than patients with native alleles. There was no preponderance of any race in patients with higher light transmission aggregometry. In brief, PON1 and CYP2C19 polymorphisms were associated with lower clopidogrel responsiveness in this sample. Despite differences in CYP2C19 polymorphisms across white and non-white patients, genetic admixture by itself was not able to identify clopidogrel hyporesponsiveness.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Aspirina/farmacología , Plaquetas/efectos de los fármacos , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/farmacología , Ticlopidina/análogos & derivados , Alelos , Arildialquilfosfatasa/genética , Subfamilia B de Transportador de Casetes de Unión a ATP/genética , Enfermedad de la Arteria Coronaria/genética , Citocromo P-450 CYP2C19/genética , Quimioterapia Combinada , Genotipo , Intervención Coronaria Percutánea , Polimorfismo Genético , Estudios Prospectivos , Ticlopidina/farmacologíaRESUMEN
BACKGROUND:The role of trypanocidal therapy in patients with established Chagas' cardiomyopathy is unproven.METHODS:We conducted a prospective, multicenter, randomized study involving 2854 patients with Chagas' cardiomyopathy who received benznidazole or placebo for up to 80 days and were followed for a mean of 5.4 years. The primary outcome in the time-to-event analysis was the first event of any of the components of the composite outcome of death, resuscitated cardiac arrest, sustained ventricular tachycardia, insertion of a pacemaker or implantable cardioverter-defibrillator, cardiac transplantation, new heart failure, stroke, or other thromboembolic event.RESULTS:The primary outcome occurred in 394 patients (27.5%) in the benznidazole group and in 414 (29.1%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.81 to 1.07; P=0.31). At baseline, a polymerase-chain-reaction (PCR) assay was performed on blood samples obtained from 1896 patients; 60.5% had positive results for Trypanosoma cruzi on PCR. The rates of conversion to negative PCR results (PCR conversion) were 66.2% in the benznidazole group and 33.5% in the placebo group at the end of treatment, 55.4% and 35.3%, respectively, at 2 years, and 46.7% and 33.1%, respectively, at 5 years or more (P<0.001 for all comparisons)...
Asunto(s)
Cardiomiopatía Chagásica , Enfermedad de ChagasAsunto(s)
Humanos , Angina Inestable/prevención & control , Angina Inestable/rehabilitación , Infarto del Miocardio/prevención & control , Infarto del Miocardio/rehabilitación , Enfermedades Cardiovasculares/prevención & control , Depresión/prevención & control , Hiperlipidemias/prevención & control , Obesidad/prevención & control , Medición de Riesgo , Fumar/prevención & control , Estrés Psicológico/prevención & controlRESUMEN
Congenital heart diseases are one of the most common structural defects present at birth, with an approximate
significant public health concern. This paper provides a brief overview of the burden of congenital heart disease in
South America, focusing on its local prevalence, facilities for treatment and outcomes after medical, surgical or
catheter intervention for the most common diseases.
incidence of 8 per 1000 live births. As most countries in South America have a high birth rate, they are a