Chen Jianqiao, Zheng Jin, Zhu Zifan, Hao Benchuan, Wang Miao, Li Huiying, Cai Yulun, Wang Shiqi, Li Jun, Liu Hongbin
Department of Cardiology, the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Medical School of Chinese PLA, Beijing, China.
Front Pharmacol. 2022 Apr 6;13:876392. doi: 10.3389/fphar.2022.876392. eCollection 2022.
The latest consensus has changed genotyping among Chinese population, while its impact on metoprolol tolerance and adverse events in elderly Chinese patients with cardiovascular diseases remains unclear. In this study, we prospectively included elderly patients who started metoprolol treatment for cardiovascular indications. According to the latest consensus on genotype-to-phenotype translation, the patients were categorized as normal, intermediate, or poor metabolizers (NMs, IMs, or PMs, respectively) by detecting the presence of the , , , , and . Logistic regression model was used to analyze the correlation between the phenotype and incidence of adverse events, which were assessed over a 12-week period. In this study, there were 651 (62.7%) NMs, 385 (37.1%) IMs, and 3 (0.3%) PMs. After 12 weeks of follow-up, compared with NMs, IMs had the lower maintenance dose [50.0 (25.0-50.0) mg/day vs. 25.0 (25.0-50.0) mg/day, < 0.001] and lower weight-adjusted maintenance doses (0.52 ± 0.25 mg/day/kg vs. 0.42 ± 0.22 mg/day/kg, < 0.001), and had higher incidence of postural hypotension (6.0% vs. 10.9%, = 0.006), bradycardia (21.5% vs. 28.6%, = 0.011), asystole (0.8% vs. 3.1%, = 0.009) and syncope (2.0% vs. 6.2%, = 0.001). In logistic regression model, the overall incidence of adverse events was 1.37-fold larger in IMs than in NMs (odds ratio = 1.37, 95% confidence interval = 1.05-1.79, = 0.021). We conclude that IMs have lower tolerance and higher incidence of metoprolol-related adverse events than NMs in elderly Chinese patients with cardiovascular diseases. genotyping is justifiable in elderly patients to minimize the risk of adverse events and ensure the benefits of metoprolol.
最新共识改变了中国人群的基因分型，但其对中国老年心血管疾病患者美托洛尔耐受性及不良事件的影响尚不清楚。在本研究中，我们前瞻性纳入了开始接受美托洛尔治疗心血管适应证的老年患者。根据最新的基因型-表型转化共识，通过检测 、 、 、 及 的存在情况，将患者分为正常代谢者、中间代谢者或慢代谢者（分别为NMs、IMs或PMs）。采用逻辑回归模型分析表型与不良事件发生率之间的相关性，不良事件在12周期间进行评估。本研究中，有651例（62.7%）NMs、385例（37.1%）IMs和3例（0.3%）PMs。随访12周后，与NMs相比，IMs的维持剂量较低[50.0（25.0 - 50.0）mg/天 vs. 25.0（25.0 - 50.0）mg/天， < 0.001]且体重调整后的维持剂量较低（0.52±0.25 mg/天/千克 vs. 0.42±0.
