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In cardiovascular disease, patient\u2010specific diplotypes determine phenotypes, thereby influencing the efficacy and safety of drug treatments, including statins, antiarrhythmics, anticoagulants and antiplatelets. Notably, polymorphisms in key genes, such as <jats:italic>CYP2C9, CYP2C19, VKORC1<\/jats:italic> and <jats:italic>SLCO1B1<\/jats:italic>, significantly impact the outcomes of treatment with clopidogrel, warfarin and simvastatin. Furthermore, the <jats:italic>CYP2C19<\/jats:italic> polymorphism influences the pharmacokinetics and safety of the novel hypertrophic cardiomyopathy inhibitor, mavacamten. In this review, we critically assess the clinical application of pharmacogenomics in cardiovascular disease and delineate present and future utilization of pharmacogenomics. This includes insights into identifying missing heritability, the integration of whole genome sequencing and the application of polygenic risk scores to enhance the precision of personalized drug therapy. Our discussion encompasses health economic analyses that underscore the cost benefits associated with pre\u2010emptive genotyping for warfarin and clopidogrel treatments, albeit acknowledging the need for further research in this area. 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