Current Pharmacogenomics and Personalized Medicine (Formerly Current Pharmacogenomics) - Volume 15, Issue 1, 2017

Background: Cardiovascular diseases are the leading causes of mortality and hospitalizations especially in elderly patients, whose therapeutic management is particularly challenging due to the lack of specific recommendations, particularly in old patients with multiple comorbidities and disability. The ageing process is highly heterogeneous with several possible phenotypes ranging from healthy ageing to frailty. While in healthy old individuals, cardiovascular diseases can be treated following suggestions derived from international guidelines, treatment of pre-frail and frail elderly patients is extremely complicated and very frequently recommended standard treatments in these patients cannot be applied. Objective: In the present review, we will discuss the management and treatment of cardiovascular diseases in the elderly. Methods: This review was based on searches of the PubMed database using the following terms: “elderly”, “aging”, “frailty”, “heart failure”, “hypertension”, “atrial fibrillation”, “stroke prevention”, “guidelines”, “therapy”, “management”. Results: we have summarized the current therapies for elderly patients with cardiovascular disease, focusing our attention on heart failure, hypertension and atrial fibrillation that are very common and often coexisting diseases in the elderly. Conclusion: new studies involving frail elderly patients are needed in order to provide evidence-based treatment strategies and to allow more personalized medical approaches.

Background: In the last decades aging of population is becoming even more prevalent, with consequent increasing requirement in health assistance and services. Physical and social environments can affect health directly, or through barriers or incentives conditioning opportunities, decisions and behavior. Moreover, the relationship with environment varies according to several personal characteristics including family background, sex and ethnicity. The impact of these factors is often skewed by these characteristics, leading to inequalities in health. In virtually all countries, the older population is predominantly female. The prevalence and incidence of Cardiovascular Diseases (CVD) are reported to be lower in women than in men, increasing with age in both genders, but at advanced ages women outnumber men. Gender-differences in the contribution of various pathophysiological processes, combined with suboptimal recognition of female specificities, may explain sex-differences in presentation and outcomes of CVD and also partially explain the differences in cardiovascular drug therapy related to gender, where other behavioral and cultural factors can be involved. Purpose: Starting by the conflicting data in literature, the aim of this article is to summarize the gender differences available on the use of the main cardiovascular drugs, and the possible explanation for these disparities. Conclusion: Up to date, data on gender differences in cardiovascular therapy are still controversial, and overall no established factors have been identified to discriminate the different approach in the choice of cardiovascular drugs by gender. Then further more structured and bigger trials should be performed to target these issues, and to better clarify the underlining involved mechanisms.

Background: Cardiovascular side effects occur rarely after iodinated contrast media administration and no real data can be found in literature. The presence of cardiovascular risk factors increases the incidence of these adverse reactions. Objective: Aim of the study was the analysis of the cardiovascular side effects due to use of intra-venous iodinated contrast media in diagnostic imaging. Methods: A MEDLINE and Pubmed research was performed for journals with MeSH major terms “iodinated contrast media” and “cardiovascular side effects”. Non-English speaking literature was excluded. Results: Intravenous iodine contrast agents could be determined with low frequency cardiovascular side effects, such as arrhythmias, related to increased levels of thyroid hormones. Indeed after the contrast media administration, in euthyroid patients the iodine stores remain elevated up to two months. Instead the vasomotor reactions (orthostatic hypotension and reflex tachycardia) and /or vasovagal response (syncope and bradycardia) are the most frequent. Conclusion: The rarity and the mild-moderate type of the cardiovascular side effects do not justify the electrocardiogram test as a preliminary exam for iodine contrast media usage. Emergency medical team should be alert in case of need. Atropine is the first choice in the hypotensive crisis due to contrast agents.

Background: Cardiovascular disease is the leading cause of morbidity and mortality worldwide in developed countries, and its social and economic burden is expected to increase dramatically over the next decades. Despite significative improvement in the pharmacological treatment, and the huge advances in prevention, the quest for new molecular targets and for novel, more efficient and personalized therapies is still a priority for this group of pathologies. Objective: The paramount complexity of the metabolic networks responsible for the onset and progression of cardiovascular disease is highlighted by the wide and diverse array of new molecular targets recently described in literature. In this brief review, we focused our interest on a subset of promising molecular targets for the development of new pharmacological treatments specific for cardiac diseases such as coronary artery disease, heart failure and myocardial infarction. Conclusion: The global quest for new molecular targets for the treatment of cardiac diseases is leading to an impressive amount of records in the more recent literature. Although several promising molecular pathways have been identified so far, great caution should be used in considering all these targets effective in promoting the production of new drugs. The identification of suitable therapeutic targets is in fact an ongoing challenge that often lacks enough pre-clinical and clinical studies, which hinders the effective utilization of several new drugs due to a lack of efficacy or induction of safety liabilities.

Background: Cardiovascular diseases (CVD) are the leading causes of death worldwide. Objective: The aim of this review is to evaluate several non-pharmacological approaches to fight the development of CVD. Results: Various strategies have been used to induce lifestyle changes in order to reduce CVD development. In recent years, accumulating evidence has suggested that plant-foods polyphenols, due to their biological properties, may be useful as supplement food for treatments of the various aspects of CVD. Moreover, in addition to nutraceuticals supplementation, several rehabilitation programs have been standardized to improve physical function and reduce overall CVD risks. The scientific literature recommends the type of exercise useful in patients with CVD. However, very little or nothing is known about the individualized therapeutic dose for each risk profile. Conclusion: To date, the efficacy of non-pharmacological strategies, as well as the optimal rehabilitation program remains unclear. The present review highlights the effects of personalizing the non-pharmacological intervention to contrast development and progression of CVD.

Background: The definition of the individual's molecular profile will promote a specific and tailored therapeutic approach for each patient. This method has found application in specific drug decision-making in the oncology field, but not for cardiovascular pathologies. Objective: In this review, we describe some relevant molecular features of the cardiovascular disease in the context of personalized medicine, discussing how a multidisciplinary approach can favor its translation into daily patient management as a component of integrated care. Conclusion: Prevention of the Cardiovascular disease still lacks efficient models for personalized medicine, but the definition of the individual Metabolomics may represent a promising approach for filling this gap.

Background: Variability in response to pharmacological treatment is one of the most important issues in the clinical practice at first exclusively attributed to clinical and demographic factors such as age, sex, nutritional status, alcohol abuse, smoking, presence of comorbidities and polypharmacy. Nowadays, it is well known that also genetic factors can modify the outcomes of pharmacological treatments. Polymorphisms in genes encoding molecules involved in both pharmacodynamics and pharmacokinetics may influence efficacy, tolerability, and safety of medications; thus, the knowledge of these genetic variants may help physicians to individualize and optimize the therapies. Objective: The main aim of this review is to summarize the current scientific evidence about cardiovascular pharmacogenomics. Conclusion: Cardiovascular pharmacogenomics is recommended only for some antiplatelet, anticoagulant and antihypercholesterolemic drugs thanks to standardized pharmacogenetic tests that are helpful in preventing thromboembolic and hemorrhagic events. Despite many studies have demonstrated that the application of pharmacogenetics may be useful also to individualize the therapy with other cardiovascular drugs, the paucity of large clinical trials and of cost-effectiveness studies limits the translation of such knowledge into clinical practice.