The future of pharmacogenomics in cardiovascular medicine

Pharmacogenomics (PGX) offers a key route to individualizing cardiovascular therapy, with robust evidence now supporting genotype-guided prescribing for commonly prescribed cardiovascular drugs, such as antiplatelets, -beta-blockers, statins and anticoagulants, yet clinical implementation remains inconsistent. This review summarizes the current state of cardiovascular PGX within clinical practice across major drug classes, highlighting some more recent implementation settings, and considers from the progression toward multigene panels. This review reflects upon the current progress of PGX genome-wide association studies for discovering novel genes influencing drug response, considering the ongoing study design challenges and use of different datasets: from clinical trials to consortium-based meta-analysis and now large biobanks using electronic health record data. This review evaluates the clinical implementation status of PGX, outlining the challenges still remaining, and suggesting possible future directions. The issue of cost effectiveness for PGX is critically assessed as one likely barrier, with unresolved questions around economic sustainability and equitable access. By reviewing some of the new PGX initiatives, in the UK and internationally, we discuss where the greatest promise may lie, for PGX to be able to realize its potential in future real-world cardiovascular care and become embedded as a routine, preemptive component of cardiovascular precision prescribing.