If your doctor has prescribed multiple drugs for your heart condition — maybe you recently suffered a heart attack or deal with angina — it’s likely that your prescription regimen is entirely different from that of your neighbor. That’s because you are you, thanks to your genes, and you might reap different rewards from certain drugs than other people will.1
When your clinician prescribes specific heart medications, they’re trying to keep you healthy because the risk is all too real: More than 650,000 people die of heart disease in the United States each year, according to the Centers for Disease Control and Prevention.2
You may be familiar with the “big 6” of heart medications: statins (like simvastatin), to lower LDL cholesterol; beta-blockers, to treat heart attack and failure; ACE inhibitors, to treat heart failure and lower blood pressure; and aspirin, clopidogrel, and warfarin, to prevent blood clots.
But as anyone who’s ever taken medication knows, getting better and feeling better are not necessarily the same thing. For instance, it’s possible that the medications you’ve been prescribed are doing their job — while also weighing you down with unpleasant side effects or reactions. Those new side effects may be so severe that you skip doses or stop taking the medications altogether, even if you know that puts you at greater risk of worsening heart health.3
You wouldn’t be alone. According to the American Heart Association (AHA), as many as half of 187 million patients in the United States don’t take their medications as prescribed for various reasons, including fear of side effects and interactions with other drugs they might be taking.3
However, not taking your heart medication as prescribed can be fatal. Studies show that those at risk of heart disease are more likely to die of a stroke if they don’t take their cholesterol or blood pressure medications as prescribed.4
How Your Genes Can Affect Your Body’s Response to Certain Heart Medications
While your doctor can’t be expected to be in your kitchen every morning to check whether you are (or aren’t) taking your medications, they do have ways of figuring out if one drug might be better (or safer) for you than another.1
For example, through precision medicine techniques, conducted by companies like Genomind, clinicians can predict whether you might have an adverse reaction to certain drugs based on your genetic information.1 You will see this type of testing referred to as pharmacogenomic, pharmacogenetic, or PGx testing. Clinicians can then use information from pharmacogenetic testing to identify drugs and dosages that may be more likely to be effective and less likely to result in side effects for you.1 This approach can and has been associated with improved adherence.5 (Medication adherence refers to the practice of consistently taking your medications as prescribed).
Furthermore, a 2020 study published in the Journal of the American Medical Association found that genetic testing and precision medicine could prove to be important when identifying the use of blood thinners in patients, potentially lowering their risk of heart attack and stroke by 34%.6,7 In the study, patients received blood thinners such as clopidogrel to prevent their blood from clotting. This was before they underwent a nonsurgical procedure in which a balloon and metal stent are placed in an artery. Although clopidogrel is intended to stop clotting, about a third of patients have a genetic variant associated with reduced activity of the enzyme required to activate the medication.
While genetic testing isn’t typically conducted prior to the procedure, researchers tested half of the study group for the gene variant(s) that are associated with reduced activity. They treated carriers of those genetic variant(s) with a different medication and reduced complications by a third.6,7 CPIC guidelines support these findings, recommending alternative medications to individuals with reduced activity on certain genes (poor metabolizers).8
Furthermore, the U.S. Food and Drug Administration has added pharmacogenetic information to the drug label for more than 300 medications. This includes a number of heart medications, with warnings about drug-gene interactions that can increase the potential for adverse reactions.9 For example, for the drug Celebrex , the FDA label recommends starting at half of the normal dose in people with the “poor metabolizer” CYP2C9 gene.9
Clinicians who use pharmacogenetics in clinical practice often use these FDA labels and other guidelines from international organizations to influence treatment decisions.
Want your clinician to leverage these insights to make more informed decisions for your care? Talk to them about Genomind’s pharmacogenetic testing services.
Treatment Safety: Why it’s Important to Identify Underlying Conditions
Another type of genetic testing, genetic risk assessments (not to be confused with PGx testing), has already proven to be useful in the clinical management of certain inherited cardiovascular diseases, such as cardiomyopathies, which affect how blood is pumped throughout the body, notes Charles Schulman, M.D., a cardiologist with Beth Israel Deaconess Medical Center in Boston and a member of the faculty at Harvard Medical School.
Genetic testing for the risk of heart conditions can also be helpful in treating arrhythmia problems (irregular heartbeats), as well as certain types of lipid disorders, which can lead to abnormal amounts of fat, such as bad cholesterol and triglycerides, in the blood.10
“One example is homozygous familial hypercholesterolemia, where extremely high cholesterol levels early in life leads to bad outcomes,” Dr. Schulman explains. “Another is arrhythmogenic right ventricular cardiomyopathy, a condition that may lead to sudden death.”
In other words, knowing your underlying genetic condition can help steer your doctor’s decision-making to effective medications to treat you.
How Your Genes Could Spell a Bright Future
Whether you’re learning if you’re at risk of a potential gene-drug interaction from your heart medication through PGx testing, or figuring out if you’re at risk of developing heart disease in the first place through genetic risk assessment, your genes can unlock a much healthier future for you.
Looking ahead, Dr. Schulman believes genetic risk assessment will play an important part in not only treatment but also the prevention of heart disease.
“I think more research needs to be conducted, but the potential exists for genetic testing to assist cardiologists in identifying and treating heart disease in patients before they even display symptoms,” he says.
But let’s not get too far ahead of ourselves. Heart disease is still a reality, and for those of you who currently suffer from it and take medications to treat it, frustrating and potentially harmful side effects can be a bitter pill to swallow. But there could be relief for you in PGx testing. It certainly isn’t a cure for heart disease, but it may help your provider create an individualized treatment for you. Find out more by clicking here.
- Heart disease treatment tailored to you: Pharmacogenetics to guide cardiovascular drug therapy (2021)
- 659,000 die from heart disease annually: Heart Disease Facts (2021)
- 187 million patients don’t use drugs correctly: A Tough Pill to Swallow: Medication Adherence and Cardiovascular Disease (2016)
- Medication non-adherence can be fatal: Poor Adherence to Statin and Antihypertensive Therapies as Risk Factors for Fatal Stroke (2016)
- PGx increases adherence: Pharmacogenetic-guided psychiatric intervention associated with increased adherence and cost savings (2014)
- Study on genetic testing cutting heart attack and stroke risk: Effect of Genotype-Guided Oral P2Y12 Inhibitor Selection vs Conventional Clopidogrel Therapy on Ischemic Outcomes After Percutaneous Coronary Intervention (2020)
- Info explaining genetic testing and heart attack and stroke risk: Using Genetic Testing to Guide Antiplatelet Therapy Post-PCI Misses Goal to Cut Rate of Cardiovascular Events in Half (2020)
- CPIC® Guideline for Clopidogrel and CYP2C19: Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2C19 Genotype and Clopidogrel Therapy: 2022 update (2022)
- Info on the FDA’s pharmacogenomic labeling: Table of Pharmacogenomic Biomarkers in Drug Labeling (2021)
- Info on AHA’s guidelines for genetic testing: Genetic testing for heart diseases may help patients and families identify risks (2020)