Current role of pharmacogenomics in cardiovascular medicine.

OPINION STATEMENT: Pharmacogenomics holds the promise of transforming patient care by allowing providers to tailor therapy to each individual patient based on his or her genetic information. Although no established pharmacogenomic applications in cardiovascular medicine yet exist, there are at least three emerging applications that may ultimately become routine clinical practice; these are related to warfarin, clopidogrel, and statins. Of the three, warfarin pharmacogenomics has been the most rigorously evaluated to date, with several clinical trials either completed or underway. Clopidogrel pharmacogenomics has a growing body of supporting scientific evidence and warrants evaluation in prospective clinical trials. Statin pharmacogenomics remains the least developed application, with controversy surrounding a widely marketed genetic test whose validity has been questioned by recent evidence. Providers are advised to take a "wait and see" approach to pharmacogenomics at the present time, with the expectation that it will be a few years before any cardiovascular pharmacogenomic application is unequivocally proven to be both cost-effective as well as of clinical benefit.