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April 11, 2012

CYP2C19 Genotype and Cardiovascular Events

Author Affiliations

Author Affiliations: School of Medicine, University of Maryland, Baltimore (ashuldin@medicine.umaryland.edu).

JAMA. 2012;307(14):1482-1485. doi:10.1001/jama.2012.443

To the Editor: The recent meta-analysis by Dr Holmes and colleagues1 concluding that CYP2C19 genotype is not a significant predictor of clinical outcomes in patients treated with clopidogrel contrasts with a previous meta-analysis2 and a large body of pharmacokinetic and pharmacodynamic evidence,3 including a genome-wide association study.4 The authors cite small-study bias and inability to evaluate effect modification in treatment-only studies as reasons underlying the discrepant findings.