Genotype‐guided dual antiplatelet therapy in minor stroke or transient ischemic attack with metabolic syndrome: A post hoc analysis of CHANCE ‐2
Authors' conclusion
Among CYP2C19 LOF carriers with minor stroke or TIA, patients with MetS received more clinical benefit from TIC-ASA versus CLO-ASA compared to those with non-MetS. Registry:
Study context
- Population
- Patients with minor stroke or TIA carrying the CYP2C19 loss-of-function allele, classified as metabolic syndrome (MetS) (2347) or non-MetS (3305)
- Participants
- 5,652 patients
- Comparison
- Ticagrelor-aspirin vs clopidogrel-aspirin, by metabolic syndrome status
- Primary endpoint
- Stroke recurrence
- Follow-up
- 90 days
Methodological detailspost hoc analysis, subgroup analysis by metabolic syndrome
- Post hoc analysis
- Subgroup analysis by metabolic syndrome
Primary result
As reported in the abstract
Stroke recurrence, MetS subgroup
TIC-ASA vs CLO-ASAHazard ratio (95% CI)P value
MetS
0.64(0.48–0.85)
P < 0.01non-MetS: 6.03% vs. 5.96%
1.01(0.77–1.34)
P = 0.93- Interaction MetS vs non-MetS
- P for interaction = 0.03
- Linear trend by metabolic health status
- P for trend = 0.04
Safety
Severe or moderate bleeding by MetS · 90 days
- MetS: TIC-ASA vs CLO-ASA
- 0.42% vs. 0.35%
- non-MetS: TIC-ASA vs CLO-ASA
- 0.25% vs. 0.36%
- No significant difference by metabolic syndrome
- P for interaction = 0.55
Original publication
Genotype‐guided dual antiplatelet therapy in minor stroke or transient ischemic attack with metabolic syndrome: A post hoc analysis of CHANCE ‐2. Diabetes Obes Metab. Published 27 October 2025. doi:10.
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