Individualized approach to the management of coronary heart disease: identifying the nonresponders before it is too late.

everal therapies have proven effective in the treatment of oronary heart disease (CHD), primarily, 3-hydroxy-3ethylglutaryl-coenzyme A reductase inhibitors (statins), ngiotensin-converting enzyme inhibitors, and antiplatelet gents (aspirin, clopidogrel). The 20% to 40% reduction in ardiovascular events achieved by each of these agents in lacebo-controlled, randomized trials has been duly celerated yet it leaves many patients unprotected. Among the ighest risk CHD patients, namely, those presenting with cute coronary syndromes, 7% will suffer a myocardial nfarction (MI) or CHD death within 24 months of the nitial presentation despite intensive treatment to recomended guidelines (1). Thus, it is of utmost importance to dentify individual patients who do not respond to therapy efore adverse outcomes intervene. Several approaches to his individualized medicine are in development, including harmacogenetic testing, measurement of inflammatory iomarkers, and assessment of endothelial function.