Pharmacogenetics in Practice Pharmacogenetics in Cardiology: Forays into Modern Practice

When one discusses pharmacogenetics in cardiology practice, it is almost obligatory to discuss clopidogrel. Clopidogrel is an antiplatelet used for acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) with stenting, and as secondary stroke prevention in patients with aspirin allergy, among other indications. Clopidogrel is a prodrug that must be metabolized through the cytochrome P450 system to form the active molecule. Consequently, differences in hepatic metabolism are responsible for considerable variability in clopidogrel response across patients. Indeed, my colleagues and I now have managed dozens of cases where pharmacogenetics has played a central role in the efficacy of clopidogrel.