Cardiovascular Pharmacogenomics--Implications for Patients With CKD

Larisa H Cavallari; Darius L Mason

doi:10.1053/j.ackd.2015.12.001

Cardiovascular Pharmacogenomics--Implications for Patients With CKD

Adv Chronic Kidney Dis. 2016 Mar;23(2):82-90. doi: 10.1053/j.ackd.2015.12.001.

Authors

Larisa H Cavallari¹, Darius L Mason²

Affiliations

¹ Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL; Division of Nephrology and Hypertension, Albany Medical College, Albany, NY; and Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY. Electronic address: lcavallari@cop.ufl.edu.
² Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL; Division of Nephrology and Hypertension, Albany Medical College, Albany, NY; and Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY.

Abstract

CKD is an independent risk factor for cardiovascular disease (CVD). Thus, patients with CKD often require treatment with cardiovascular drugs, such as antiplatelet, antihypertensive, anticoagulant, and lipid-lowering agents. There is significant interpatient variability in response to cardiovascular therapies, which contributes to risk for treatment failure or adverse drug effects. Pharmacogenomics offers the potential to optimize cardiovascular pharmacotherapy and improve outcomes in patients with CVD, although data in patients with concomitant CKD are limited. The drugs with the most pharmacogenomic evidence are warfarin, clopidogrel, and statins. There are also accumulating data for genetic contributions to β-blocker response. Guidelines are now available to assist with applying pharmacogenetic test results to optimize warfarin dosing, selection of antiplatelet therapy after percutaneous coronary intervention, and prediction of risk for statin-induced myopathy. Clinical data, such as age, body size, and kidney function have long been used to optimize drug prescribing. An increasing number of institutions are also implementing genetic testing to be considered in the context of important clinical factors to further personalize drug therapy for patients with CVD.

Keywords: Clopidogrel; Genotype; Pharmacogenomics; Simvastatin; Warfarin.

Publication types

Research Support, N.I.H., Extramural
Review

MeSH terms

Adrenergic beta-Antagonists / metabolism
Adrenergic beta-Antagonists / therapeutic use
Anticoagulants / metabolism
Anticoagulants / therapeutic use
Cardiovascular Diseases / drug therapy*
Cardiovascular Diseases / etiology
Clopidogrel
Cytochrome P-450 Enzyme System / genetics*
Genotype
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
Hydroxymethylglutaryl-CoA Reductase Inhibitors / metabolism*
Immunosuppressive Agents / metabolism
Pharmacogenetics
Phenotype
Platelet Aggregation Inhibitors / metabolism*
Platelet Aggregation Inhibitors / therapeutic use
Precision Medicine
Purinergic P2Y Receptor Antagonists / metabolism
Purinergic P2Y Receptor Antagonists / therapeutic use
Renal Insufficiency, Chronic / complications
Renal Insufficiency, Chronic / metabolism*
Renal Insufficiency, Chronic / physiopathology
Solute Carrier Proteins / genetics*
Ticlopidine / analogs & derivatives
Ticlopidine / metabolism
Ticlopidine / therapeutic use
Vitamin K Epoxide Reductases / genetics
Warfarin / administration & dosage
Warfarin / metabolism*

Substances

Adrenergic beta-Antagonists
Anticoagulants
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Immunosuppressive Agents
Platelet Aggregation Inhibitors
Purinergic P2Y Receptor Antagonists
Solute Carrier Proteins
Warfarin
Cytochrome P-450 Enzyme System
Clopidogrel
VKORC1 protein, human
Vitamin K Epoxide Reductases
Ticlopidine

Abstract

Publication types

MeSH terms

Substances

Grants and funding