MPO/PON1 ratio could be a useful marker for secondary prevention of coronary artery disease through modulation of HDL function.

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ual antiplatelet therapy with aspirin plus a thienopyridine derivative is recommended for the prevention of thrombotic events in patients with coronary artery disease who have undergone drug-eluting stent (DES) implantation. 1 Clopidogrel, a thienopyridine derivative, is a prodrug that is converted into an active metabolite in the liver and the metabolite irreversibly inhibits the adenosine diphosphate P2Y12 receptor. 2 Because the conversion is achieved by the hepatic cytochrome P450 (CYP) system in a 2-step oxidative process and CYP2C19 is involved in both of these steps, polymorphisms of the genes encoding CYP2C19 are considered to influence clopidogrel's efficacy by affecting the activity of its metabolite. 3-5 Among the single nucleotide polymorphisms of CYP2C19, the CYP2C19*2 polymorphism (mutation of guanine to adenine at position 681 in exon 5) and the CYP2C19*3 polymorphism (mutation of guanine to adenosine at position 636 in exon 5) are considered to be important loss-of-function polymorphisms. Previous studies demonstrated that the CYP2C19*2 and CYP2C19*3 polymorphisms increase the risk of stent thrombosis, 6-8 but only limited data are available regarding the association between the presence of CYP2C19 polymorphisms and future lesion outcomes after DES therapy. Background: Cytochrome P450 (CYP) 2C19 polymorphism is associated with reduced responsiveness to clopidogrel and poor clinical outcome after drug-eluting stent (DES) implantation, but its contribution to lesion outcome after DES implantation is unclear.

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