Cardiovascular PGx Test Panel

Cardiovascular PGx Test Panel


Many of cardiovascular medications are metabolized by certain cytochromes in liver. The exact same dose of a medication can produce different results in different individuals. This inter-individual variability can be due to genetic of such cytochromes or other genetic pathways. If someone has increased activity of these cytochromes, the drugs may be eliminated from body more quickly resulting in decreased efficacy. If someone has decreased activity of these cytochromes, the drugs may be built up in body resulting in toxicity. Therefore, determining the genetic make-up of an individual can help with precision prescribing of the medications.

Clopidogrel is a prodrug which needs to be activated by a cytochrome called CYP2C19. According to American College of Cardiology Foundation/American Heart Association Acute Coronary Syndrome (ACS) guidelines, genetic testing for CYP2C19 loss-of-function alleles should be considered on a case-by-case basis, especially in individuals with recurrent ACS while receiving treatment with clopidogrel.
“Error and trial approach” in case of a life-threatening condition such as acute coronary event especially may not be advisable.

The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline recommends using an alternative agent in patients with at least one decreased function allele due to risk for decreased response. Patients with genotype of increased metabolism should be monitored for increased bleeding risk.

Warfarin, a vitamin K antagonist is a commonly used anticoagulation medication with significant inter-individual variability and narrow therapeutic index leading to frequent complications due to over and under dosing. Genetic variants in CYP2C9, CYP4F2 and vitamin K epoxide reductase complex subunit 1 (VKORC1) can predict the dose needed to meet the therapeutic level.

Concomitant use of statins such as simvastatin with certain drugs may lead to increased blood concentration of simvastatin resulting in myotoxicity. An alternative agent or a reduced dose of simvastatin should be prescribed to patients with at least one reduced function allele in SLCO1B1.


Frequency of Cytochrome P450 (CYP2D6, CYP2C9, CYP2C19) Metabolizer Types in the population

Cytochrome Poor metabolizer Intermediate metabolizer Normal metabolizer Rapid or ultra-rapid metabolizer
CYP2D6 4-7% 9-35% 50-90% 2-3%
CYP2C9 3% 30% 68% N/A
CYP2C19 2-20% 24-36% 14-44% 30%


Anticoagulants and Antiplatelet agents (Blood thinners)

Medication Gene
Warfarin* VKORC1, CYP2C9, CYP4F2
Clopidogrel CYP2C19
Ticagrelor CYP3A4, CYP3A5
Prasugrel CYP2C19
Acenocoumarol CYP2C9

*CPIC guideline pharmacogenetic algorithm https://cpicpgx.org/content/guideline/publication/warfarin/2017/28198005.pdf

Hyperlipidemia (High blood cholesterol)

Medication Gene
Simvastatin, Atorvastatin, Fluvastatin, Lovastatin, Pitavastatin, Pravastatin, Rosuvastatin SLCO1B1, CYP2C9, ABCG2
Atorvastatin CYP3A4


Hypertension (High blood pressure)

Medication Gene
Beta Blockers (Carvedilol, Timolol, Metoprolol, Propranolol, Nebivolol) CYP2D6
Clonidine ADRA2A


Antiarrhythmics (Irregular Heart Rhythm)

Medication Gene
Flecainide, Propafenone, Ranolazine CYP2D6

General Cardiac

Condition Gene
Thrombosis FII, FV, MTHFR

Drug To Drug Interaction

For drug-drug interactions, please go to Flockhart Table ™


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  • https://cpicpgx.org/genes-drugs
  • https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling