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Letters |

CYP2C19 Genotype and Cardiovascular Events—Reply

Michael V. Holmes, MBBS, MSc; Aroon D. Hingorani, FRCP, PhD; Juan P. Casas, MD, PhD
JAMA. 2012;307(14):1482-1485. doi:10.1001/jama.2012.446.
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In Reply: We considered all included trials to be within the remit of our systematic review, including those involving patients receiving clopidogrel for indications other than PCI.13 However, based on the letters from Dr Shuldiner and Dr Mega and their colleagues, we excluded these studies, which yielded a summary relative risk (RR) of 1.22 (95% CI, 1.11-1.33) for the association of CYP2C19 genotype with cardiovascular disease (CVD) events. The addition of the 3 studies alluded to by Mega et al, excluded by us because they focused solely on stent thrombosis, yielded a summary RR of 1.21 (95% CI, 1.12-1.30) for CVD events. These modest effect estimates also remain affected by small-study bias.

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Figure. Meta-analysis of Studies Evaluating the Effect of CYP2C19 *2 to *8 vs *1 or *17 on Cardiovascular Disease (CVD) Events
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Data are stratified by the proportion of participants receiving percutaneous coronary intervention (PCI) or stent insertion (fixed effects modeling). The meta-regression was adjusted for study design and sample size. Error bars indicate 95% confidence intervals.aUnable to estimate the 95% confidence interval because only 2 studies contributed to the overall estimate.

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April 11, 2012
Alan R. Shuldiner, MD; Mark R. Vesely, MD; Adam Fisch, BS
JAMA. 2012;307(14):1482-1485. doi:10.1001/jama.2012.443.
April 11, 2012
Jessica L. Mega, MD, MPH; Eric J. Topol, MD; Marc S. Sabatine, MD, MPH
JAMA. 2012;307(14):1482-1485. doi:10.1001/jama.2012.444.
April 11, 2012
Gerasimos Siasos, MD, MSc, PhD; Dimitris Tousoulis, MD, PhD; Christodoulos Stefanadis, MD, PhD
JAMA. 2012;307(14):1482-1485. doi:10.1001/jama.2012.445.
April 11, 2012
Steven E. Nissen, MD
JAMA. 2012;307(14):1482-1485. doi:10.1001/jama.2012.447.
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