Genetic Risk, Adherence to a Healthy Lifestyle, and Ischemic Heart Disease
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Purpose of Review
The purpose of this review is to investigate and discuss two aspects of coronary artery disease (CAD)—genetic risk and therapeutic lifestyle change (TLC)—both of which have key importance for patients and their care but which actually receive inadequate attention.
Genetic risk has generally been relegated to a broad association with the presence of one or more inherited cardiovascular (CV) risk factors such as hypercholesterolemia, family history of atherosclerosis, hypertension, and diabetes mellitus. However, the future of genetic risk is an understanding of specific genes, a genetic risk score, specific genetic loci known as selective nucleotide polymorphisms (SNPs), specific alleles, and microribonucleic acids (miRNAs). Healthy lifestyle is fashionably referred to as TLC and encompasses physical fitness, exercise, behavioral modification, diet, and stress reduction.
In the past decade, aggressive treatment of cholesterol with statins has received the major emphasis for CV risk reduction. Genetics, of course, can only be modified by factors that influence epigenetics, and TLC could have an effect on genetics by this mechanism. On the other hand, each individual component of TLC has been shown to contribute to a reduction of CV risk. Although aggressive pharmaceutical approaches are now in vogue, whatever TLC can contribute, depending on the degree of individual patient adherence, should never be forgotten.
KeywordsAtherosclerosis Coronary artery disease Genetics Hyperlipoproteinemias Lipoprotein (a) Low-density lipoprotein cholesterol Therapeutic lifestyle change
Coronary artery disease
Carotid intima-media thickness
Colony-stimulating factor 1
Computed tomography angiography
Cell-derived factor 1
Genetic risk score
Health Heart Score
High sensitivity C-reactive protein
Low-density lipoprotein cholesterol
Peripheral arterial disease
Percutaneous coronary intervention
Proprotein convertase subtilisin/kexin type 9
Sudden cardiac death
Selective nucleotide polymorphisms
Therapeutic lifestyle change
The authors thank Colleen McMullen, MA, MBA, for her excellent editorial critique.
Compliance with Ethical Standards
Conflict of Interest
Thomas F. Whayne, Jr. and Sibu P. Saha confirm that there are no conflicts of interest involving any pharmaceutical or medical device company or any other possible conflict.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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