Pharmacogenomics in Stroke and Cardiovascular Disease: State of the Art

Author:

Ross Stephanie1,Krebs Kristi2ORCID,Paré Guillaume1345ORCID,Milani Lili2ORCID

Affiliation:

1. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.R., G.P.).

2. Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia (K.K., L.M.).

3. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (G.P.).

4. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (G.P.).

5. Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada (G.P.).

Abstract

There is considerable interindividual variability in the response to antiplatelet and anticoagulant therapies, and this variation may be attributable to genetic variants. There has been an increased understanding of the genetic architecture of stroke and cardiovascular disease, which has been driven by advancements in genomic technologies and this has raised the possibility of more targeted pharmaceutical treatments. Pharmacogenetics promises to use a patient’s genetic profile to treat those who are more likely to benefit from a particular intervention by selecting the best possible therapy. Although there are numerous studies indicating strong evidence for the effect of specific genotypes on the outcomes of vascular drugs, the adoption of pharmacogenetic testing in clinical practice has been slow. This resistance may stem from sometimes conflicting findings among pharmacogenetic studies, a lack of stroke-specific randomized controlled trials to test the effectiveness of genetically-guided therapies, and the practical and cost-effective implementation of genetic testing within the clinic. Thus, this review provides an overview of the genetic variants that influence the individual responses to aspirin, clopidogrel, warfarin and statins and the different methods for pharmacogenetic testing and guidelines for clinical implementation for stroke patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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