International Circulation: As A-HeFT and other trials have shown, there are different responses to same drugs among different races, or more precisely, genotypes. Could you share with us your insights on this topic? Do you think the genetic differences play a very important role in pharmacotherapy for cardiovascular diseases
Jay Cohn: Genotype is an important contributor, as is environment. Epigenetics tells us that environmental factors can influence genetic factors so that it is a combination of many genes, many proteins, and a combination of environmental factors. The prevalence in one population or another cannot be simply characterized as a genetic determinant. It will be very important to explore the polymorphisms that exist because we know there are polymorphisms different in prevalence among the different racial populations as well. That may be playing an important role but may not be the sole mechanism as to why these differences exist.
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