Rational medical therapy is the key to effective cardiovascular disease prevention

Publication date: Available online 19 January 2017 Source:Canadian Journal of Cardiology Author(s): J. David Spence In an era in which personalized medicine based on genotyping is being proposed, it is timely to recognize that existing therapies could be markedly improved if based on available phenotyping. Blood pressure control, which is poor on a worldwide basis, is a major opportunity to reduce cardiovascular risk. There are many genetic variants that have a small effect on blood pressure, but specific therapies are not available for most of them. Individualized therapy for hypertension using plasma renin and aldosterone to identify the physiological drivers of hypertension can markedly improve blood pressure control. For patients with a high renin/high aldosterone phenotype, angiotensin receptor blockers are indicated. For those with a high aldosterone/low renin phenotype (a primary aldosteronism phenotype), aldosterone antagonists are best; for those with low renin/low aldosterone (a Liddle phenotype), amiloride is best. Effective antiplatelet therapy and anticoagulation, particularly with the new oral anticoagulants, can markedly reduce the risk of stroke. Metabolic B12 deficiency is very common, usually missed and easily treated; B vitamins to lower homocysteine can markedly reduce the risk of stroke, particularly among elderly patients with atrial fibrillation. A particularly useful phenotype is carotid plaque burden. In high-risk patients, intensive lipid lowering...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research