Research on drug interactions and efficacy optimization of combined medication for elderly patients with ischemic cerebrovascular disease in Guangxi Zhuang Autonomous Region

Background: The incidence of ischemic cerebrovascular disease (ICVD) among the elderly in Guangxi is higher than the national average. The Zhuang ethnic group, the dominant ethnic group in the region, has unique genetic backgrounds and medication habits, often taking antiplatelet drugs and digestive system medications simultaneously, increasing the risk of drug interactions. Objectives: To explore combined medication characteristics and optimize regimens for elderly ICVD patients in Guangxi, focusing on ethnic genetic differences and drug interactions. Methods: A retrospective analysis included 2135 elderly ICVD patients (873 Zhuang, 1262 Han) from 2019–2022; 807 patients received a prospective stratified regimen (2023). CYP2C19 genotypes, platelet function, and clinical outcomes were analyzed. Results: Zhuang patients had a higher CYP2C19*3 allele frequency (28.7% vs 19.2%, P=0.004) and clopidogrel resistance rate (34.1% vs 14.7%, P<0.001). The aspirin +clopidogrel +omeprazole regimen (51.3% usage) increased stroke recurrence risk (HR=2.81). The stratified regimen boosted efficacy to 89.2%, reduced severe bleeding by 57.3%, and lowered 6-month recurrence rate from 15.7% to 8.3% (all P<0.01). Conclusion: Elderly Zhuang ICVD patients show distinct CYP2C19 genotypes associated with clopidogrel resistance. A genotype-liver/kidney function stratified regimen improves efficacy and safety, supporting precision medication in ethnic minority areas.