Dr. Iftikhar Kullo discusses a number of projects underway at Mayo Clinic, which are aimed at improving healthcare. One project aims to use information about a person's genetics to tailor medications to them. Three medications form the core of this project - clopidogrel, statins, and warfarin. These are used to inhibit blood clots and to lower cholesterol. A second project is looking at the genetics of coronary heart disease (CHD). Genetic information about a patient's risk of CHD and recommendations about the three drugs listed above will be integrated within their electronic health record.
Dr. Iftikhar Kullo explains that pharmacogenomics is the science of using genetic information to determine medications an individual should receive. It can help tailor the right drug or the right dose an individual should receive. It can also help prevent adverse side effects an individual may experience as a consequence of taking a drug. It is a step towards individualized medicine.
Dr. Iftikhar Kullo discusses coronary heart disease (CHD). CHD is the leading cause of death in the United States, causing either sudden death or heart attach. CHD does have a strong genetic component, and the main "genetic test" is family history. Individuals with a family history of CHD should discuss with their doctor. Dr. Kullo and other researchers in the eMERGE consortium are also looking at whether variations in a person's DNA can help predict their risk of CHD, with the ultimate goal of improving healthcare through knowledge of genetic risk factors.
Dr. Iftikhar Kullo explains that everyone does not respond in the same way to clopidogrel, and responses may be related to your genetic make-up. Genetic testing may be used to determine appropriate doses or alternative medications.
Dr. Iftikhar Kullo explains that people do not all respond in the same way to statin medications. Some individuals experience muscle aches, while a small minority of individuals (1 in 10,000) experience muscle damage that can severely affect kidney function. There is a genetic predisposition to muscle-related damage. Researchers in the eMERGE consortium are also investigating whether we can predict muscle aches following statin treatment.
Dr. Iftikhar Kullo explains that not everyone responds in the same way to warfarin. The dose that patients receive depends on their age, gender, race, and weight. In addition, genetic factors dictate an individual's response to the drug. Calculators are available to doctors to help determine the correct dose for each patient.
Dr. Iftikhar Kullo explains that genetic test results are visible to your healthcare provider. Patients can also access their own results if an electronic portal is available. However, health insurance companies cannot access a patient's genetic test results.