Drug To Prevent Heart Attacks Is Not ‘better Than Aspirin’ For Everyone | Letters

Your article (Doctors find supplier that is amended than aspirin astatine preventing bosom attacks, 31 August) is of awesome interest. It cites a study that proposes replacing aspirin, nan cornerstone of antiplatelet therapy for individuals astatine precocious consequence of bosom attacks and strokes, pinch clopidogrel. We must constituent out, however, that clopidogrel does not activity uniformly crossed individuals. Although mentioned successful nan Lancet publication, it was only lightly considered successful nan Guardian article.

Clopidogrel is simply a prodrug. To work, it needs to beryllium metabolised by a liver enzyme that varies successful nan organization because of variations successful nan CYP2C19 gene. Most individuals person “normal” aliases “supra-normal” levels of nan enzyme and clopidogrel useful arsenic expected. However, “intermediate metabolisers” activate clopidogrel little efficiently and “poor metabolisers” struggle to activate clopidogrel astatine all. For these people, clopidogrel whitethorn not supply capable protection against bosom attacks aliases strokes.

This rumor is not academic: 20%-30% of achromatic individuals successful nan UK are intermediate aliases mediocre metabolisers and successful Asian populations this tin beryllium arsenic precocious arsenic 50%-60%. Ignoring individual familial differences whitethorn besides person ineligible implications. In 2024, Hawaii won a landmark suit against clopidogrel manufacturers for failing to disclose nan efficacy and information floor plan of nan supplier considering that a ample percent of nan Hawaiian organization are intermediate aliases mediocre metabolisers.

In summary, clopidogrel’s effectiveness is not cosmopolitan and a “one-drug-fits-all” attack whitethorn expose patients to preventable harm. Individuals tin beryllium tested for familial variety successful nan CYP2C19 gene, enabling a personalised approach. Patients pinch normal aliases supra-normal levels of nan enzyme tin beryllium treated pinch clopidogrel arsenic modular for nan agelong term, while those pinch little enzyme levels tin proceed pinch aspirin, nan existent standard. Such a personalised attack whitethorn moreover supply amended outcomes than those reported successful nan Lancet paper.

Dr Ronnie Ramlogan, Dr Dimitri Gagliardi, Dr Luigi Venetucci, Dr Abisope Akintola University of Manchester, Dr Cinzia Dello Russo, Prof Sir Munir Pirmohamed University of Liverpool