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Volume 18, Issue 2 (2026)
Iran J War Public Health 2026, 18(2): 149-155 |
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Received: 2026/02/11 | Accepted: 2026/04/1 | Published: 2026/04/20
Received: 2026/02/11 | Accepted: 2026/04/1 | Published: 2026/04/20
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Jasim A, Hamadi H. Cytochrome P450 2C19 Deficiency as the Sole Predictor of Major Adverse Cardiovascular Events in Post-COVID-19 Patients. Iran J War Public Health 2026; 18 (2) :149-155
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A.K. Jasim *1, H.S. Hamadi1
1- Al-Manara College for Medical Sciences, University of Manara, Maysan, Iraq
Abstract (77 Views)
Aims: Post-COVID-19 syndrome increases the risk of major adverse cardiovascular events (acute myocardial infarction, deep vein thrombosis, ischemic stroke, and pulmonary embolism). We examined whether the cytokine-driven inflammatory milieu after COVID-19 continuously decreases circulating cytochrome P450 2C19 activity and whether this reduction independently predicts MACE risk in these patients.
Materials & Methods: This prospective, single-center, case-control study was conducted at the Maysan Center for Heart Diseases and Surgery, Maysan Health Directorate, Amarah, Maysan Province, Iraq, from October 2022 to November 2024. A total of 210 adult participants were recruited from the outpatient cardiology and post-COVID-19 follow-up clinics of the Maysan Center for Heart Diseases and Surgery and divided into two groups (n=105 per group). Statistical analyses were conducted using SPSS 26 and GraphPad Prism 10.
Findings: Case patients had significantly lower plasma cytochrome P450 2C19 activity than post-COVID-19 controls (0.531±0.114 vs. 0.812±0.071U/L; p<0.001; Cohen’s d=2.98). Cytochrome P450 2C19 activity was negatively correlated with hsCRP (r=0.481; p<0.001), IL-6 (r=0.512; p<0.001), and D-dimer (r=0.443; p<0.001). In ROC analysis, CYP2C19 activity showed excellent discrimination for major adverse cardiovascular events after COVID-19 (area under the curve=0.924; 95% CI: 0.889–0.959; p<0.001). Using an optimal cut-off of 0.6480U/L yielded sensitivity of 86.7% and specificity of 90.5%.
Conclusion: Markedly reduced post–COVID-19 cytochrome P450 2C19 enzymatic activity is a standalone, highly reliable independent biomarker for predicting major adverse cardiac events.
Materials & Methods: This prospective, single-center, case-control study was conducted at the Maysan Center for Heart Diseases and Surgery, Maysan Health Directorate, Amarah, Maysan Province, Iraq, from October 2022 to November 2024. A total of 210 adult participants were recruited from the outpatient cardiology and post-COVID-19 follow-up clinics of the Maysan Center for Heart Diseases and Surgery and divided into two groups (n=105 per group). Statistical analyses were conducted using SPSS 26 and GraphPad Prism 10.
Findings: Case patients had significantly lower plasma cytochrome P450 2C19 activity than post-COVID-19 controls (0.531±0.114 vs. 0.812±0.071U/L; p<0.001; Cohen’s d=2.98). Cytochrome P450 2C19 activity was negatively correlated with hsCRP (r=0.481; p<0.001), IL-6 (r=0.512; p<0.001), and D-dimer (r=0.443; p<0.001). In ROC analysis, CYP2C19 activity showed excellent discrimination for major adverse cardiovascular events after COVID-19 (area under the curve=0.924; 95% CI: 0.889–0.959; p<0.001). Using an optimal cut-off of 0.6480U/L yielded sensitivity of 86.7% and specificity of 90.5%.
Conclusion: Markedly reduced post–COVID-19 cytochrome P450 2C19 enzymatic activity is a standalone, highly reliable independent biomarker for predicting major adverse cardiac events.