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Not only CYP2C19 loss-of-function but also gain-of-function alleles should be considered to define the pharmacogenetic response to clopidogrel. The results question the relevance of the CYP2C19 loss-of-function alleles in the prediction of major cardiovascular events beyond stent thrombosis in coronary patients treated with clopidogrel. The gain-of-function variant is associated with a lower risk of cardiovascular events but a higher risk of bleeding.

Study objective-To establish the prevalence of main cardiovascular risk factors in the province of Gerona, where the incidence of myocardial infarction is known to be low. Design-This was a cross sectional study of prevalence of cardiovascular risk factors conducted on a large random population sample. Setting-The province of Gerona, Spain. Participants-Two thousand four hundred and four eligible inhabitants of Gerona aged between 25 and 74 years were randomly selected for a multi-stage sample stratified by age and sex. The following were standardly measured: lipids (total cholesterol, high density, low density, lipoprotein (a) and triglycerides), fibrinogen, basal glycaemia, arterial pressure, anthropometric variables, smoking, history of angina (Rose questionnaire), and a medical history questionnaire. Population measurements were standardised for the world population of 24 to 74 years of age. Results-The participation rate was 72.7% (1748). Total mean cholesterol was 5.69 mmol/l in men and 5.61 mmol/l in women and mean high density cholesterol was 1.22 mmol/l and 1.47 mmol/l, respectively. Median lipoprotein (a) was 0.22 g/l. These three lipids increased significantly with age. Mean fibrinogen was 2.92 g/l in men and 3.09 g/l in women, and was higher in smokers. The prevalence of hypertension (systolic arterial tension >140 mm Hg or diastolic >90 mm Hg or drug treatment) was 31.3% in men and 27.7% in women. The proportion of male smokers was 33.8% and female smokers 22.7%. The proportion of female smokers in the 25-34 year age group exceeded that of the remaining age groups for both men and women. Conclusions-The prevalence of cardiovascular risk factors in Gerona is relatively high for the low myocardial infarction incidence typical of the area, although similar to that of other Spanish areas. The factors that confer suYcient protection to compensate for the eVect of the prevalence of these risk factors remain to be elucidated.(J Epidemiol Community Health 1998;52:707-715)To be able to explain the behaviour of the incidence, mortality and morbidity of cardiovascular diseases (CVD), it is necessary to know the distribution and frequency of determining factors.CVD, particularly ischaemic coronary diseases (ICD) continue to be the main cause of death in Spain. In 1993, ICD represented a total of 20 785 deaths in men (11.6% of overall mortality) and 15 280 in women (9.6%). 1 Furthermore, ICD produce high morbidity in Spain: the cumulated incidence rate of acute myocardial infarction (AMI) in 1990-1992 per 100 000 inhabitants and year, standardised for age, in the 25-74 age group was 207.5 in men and 48.5 in women.2 Estimations of the prevalence of classic cardiovascular risk factors (CRF) have been made in Spain in population samples from various communities [3][4][5] and groups of workers.6 These studies, despite being well designed and conducted, diVer in the measurement methods used, which jeopardises their comparability. Moreover, studies in populations whose ICD incidence is known 2 and can be put i...

The cardiovascular risk factor prevalence change in Gerona was marked in this decade by a shift of total cholesterol and low-density lipoprotein cholesterol distributions to the left, independent of the increase in lipid-lowering drug use, and better hypertension control with increased use of antihypertensive drugs.