Thursday, April 19, 2007

Hormone Replacement and Your Heart

This past month in the journal Blood an article caught my eye. Primarily because I had just finished speaking with my mother in law about hormone replacement therapy (HRT). She asked me why estrogen causes heart disease. She had been told by her PMD years ago that it would protect her from a heart attack. The advice was prior to the WHI study. Confusing I agree but if you read my blog posted earlier about giving some risk stratification for HRT and heart disease, then you would know what I am going to tell you now......

Platelets (the bricks of a clot) have proteins which sit on their outside layer. The proteins allow platelets to become sticky(like mortar). Well, It turns out that certain genetic polymorphisms of these proteins can actually increase risk for heart disease when in the presence of hormone replacement therapy(estrogen/progestin)! I knew it was about to be published, I just couldn't spill the beans....Until now! The proteins called glycoprotein 1B alpha, and VI are involved in clot formation, and these polymorphisms actually increase the risk of heart disease either alone or together. More importantly the women who had "normal" genes when placed on HRT actually had a reduction in chest pain, heart attack, or angina! This is a tremendous example of the power of pharmacogenomics and personalized medicine! Imagine being able to give the right drug to the right woman at the right time! This is what I mean by clinical utility. There is no reason to do a genetic test unless you have some utility. Whether that utility is prevention, diagnosis, or guidance you must be able to act on the results of a genetic test. This is why everyone should have a Gene Sherpa!

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