Jennifer Tovar, PharmD – Niharika Koppulu
Have YOU EVER WONDERED…how genetics influences heart treatment outcomes in women?
- Biological sex influences cardiovascular disease risk and treatment response, with women facing greater comorbidities and adverse outcomes
- Women with genetic variants that impair clopidogrel activation are at increased risk cardiovascular events.
- Pharmacogenomic testing enables personalized antiplatelet strategies to minimize risks
The Challenge.
Sex-based biological differences predispose women to greater comorbidity after cardiovascular events, increasing the risk of complications and treatment challenges.
- As highlighted in the landmark 2001 Institute of Medicine report, Does Sex Matter?, biological sex plays a critical role in cardiovascular disease development, clinical presentation, and therapeutic response (Wizemann, et al. 2001).
- Women undergoing percutaneous coronary intervention (PCI) often present with more comorbidities, such as diabetes and hypertension. Women are at greater risk for adverse cardiovascular outcomes compared to men.
- Studies such as ADAPT-DES have shown that women exhibit higher platelet reactivity, increasing the risk of blood clot, while also facing a greater likelihood of bleeding complications Kim, et al. 2016).
Benefits & Real-World Applications of PGx.
Pharmacogenomics (PGx) offers a valuable approach by identifying genetic variants that affect clopidogrel metabolism, helping tailor treatment to improve safety and effectiveness in women.
- Clopidogrel relies on CYP2C19 for activation, reduced-function variants can limit its effectiveness and increase the risk of cardiovascular events.
- Clopidogrel, a standard treatment following PCI, shows different effects in women compared to men, while both may see reduced ischemic events, women experience less benefit and greater risk (Berger, et al. 2009).
- The HOST-EXAM trial indicated reduced clopidogrel effectiveness in women., who had higher overall death rates compared to men. PGx testing for CYP2C19 variants can help personalize antiplatelet therapy, as supported by ADAPT-DES findings on platelet reactivity (Kim, et al. 2016).
Conclusion.
PGx helps bridge this gap by guiding treatment selection based on an individual’s genetic makeup.
- As precision medicine advances, pharmacogenomics (PGx) will play a vital role in optimizing cardiovascular care. Genetic testing can guide safer, more effective use of therapies like clopidogrel—particularly for women at higher risk.
Learn more about UGenome.
Personalized Medication Service, ProPEx, or contact UGenome. You can also find case studies for UGenome’s bioinformatics services Metabolite Identification, Bone Metastasis Risk Analysis in Breast Cancer, Survival Analysis with gene signatures in cancer
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