by Bill Snyder
Genotyping can improve outcomes in patients who require anti-platelet therapy following stent placement to open narrowed or blocked coronary arteries and prevent a heart attack.
So why isn’t genotyping the standard of care?
That’s the question raised by Dan Roden, MD, Senior Vice President for Personalized Medicine at Vanderbilt University Medical Center, in an editorial published Oct. 24 in the New England Journal of Medicine (NEJM).
Roden, holder of the endowed Sam L. Clark, MD, PhD Chair at Vanderbilt University School of Medicine, is an internationally recognized expert on genetic variations in CYP2C19 that limit the effectiveness of the widely prescribed antiplatelet drug Plavix (clopidogrel).
Newer antiplatelet drugs, Effient (prasugrel) and Brilinta (ticagrelor), can prevent clot re-formation in the stented coronary artery even in patients who carry variants that reduce the efficacy of Plavix. But they’re more expensive and have a higher bleeding risk.
Roden reviewed a study published Oct. 24 in NEJM that found a genotype-guided strategy for identifying patients most likely to respond to Plavix was at least as good, if not better than prescribing Effient or Brilinta to every patient.
While the cost of genotyping remains “a moving target,” atherosclerosis has reached epidemic proportions in East Asia, including China and Japan, where 14.5% of people carry a CYP2P19 variant that affects their response to Plavix and where higher-cost alternatives are less affordable, he noted.
The cardiology community has been reluctant to endorse pharmacogenetic testing. Considering the latest research findings and the growing worldwide burden of heart disease, Roden said it’s time to rethink that position.