The Challenge and Importance of Integrating Drug–Nutrient–Genome Interactions in Personalized Cardiovascular Healthcare

Abstract

Despite the rich armamentarium of available drugs against different forms of cardiovascular disease (CVD), major challenges persist in their safe and effective use. These include high rates of adverse drug reactions, increased heterogeneity in patient responses, suboptimal drug efficacy, and in some cases limited compliance. Dietary elements (including food, beverages, and supplements) can modulate drug absorption, distribution, metabolism, excretion, and action, with significant implications for drug efficacy and safety. Genetic variation can further modulate the response to diet, to a drug, and to the interaction of the two. These interactions represent a largely unexplored territory that holds considerable promise in the field of personalized medicine in CVD. Herein, we highlight examples of clinically relevant drug–nutrient–genome interactions, map the challenges faced to date, and discuss their future perspectives in personalized cardiovascular healthcare in light of the rapid technological advances.

Potential Drug–Nutrient Interactions of 45 Vitamins, Minerals, Trace Elements, and Associated Dietary Compounds with Acetylsalicylic Acid and Warfarin—A Review of the Literature

“…Omics could bring new insights into the importance of personalized therapeutic nutrition [410]. Drug-nutrient-genome interactions are being explored in cardiology [411]. Polymorphisms in the vitamin K epoxide reductase complex (VKOR) have been found to impact the interaction between warfarin and K vitamin through drug-nutrient-genome analysis [412].…”

Drug–Drug–Gene Interactions in Cardiovascular Medicine

“…Avoid unnecessary polypharmacy with tools such as STOPP/START, 178 ensure an accurate drug history to identify all drugs (including over-the-counter medicines, some dietary elements and herbal therapies) 179 and deprescribe if necessary.…”

Nutraceuticals in Personalized and Precision Medicine – a preliminary scoping review indicates efficacy for disease treatment, general wellbeing, and defense against Covid-19

“…Therefore 30 unique papers are found. Of these, 18 are review articles covering a wide range of disease and non-disease states, e.g., cancer [23][24][25], cardiovascular disease (CVD) [26], autism [19], type 2 diabetes [27]. Notably, five review papers focussed on the microbiome [25,[28][29][30][31].…”

“…Finally, we draw attention to the review just published (2022) on drugnutrient-genome-interactions and their impact on treatment for patients with CVD [26]. In particular, the authors discuss evidence for nutraceutical interaction with drugs commonly prescribed for CVD.…”

“…In another instance, they discuss the impact of genetically determined specific membrane transporter profiles on nutraceutical-drug interactions, emphasizing the possible impact of the individual's genomic background. They conclude that genetically guided nutritional advice would be necessary in order to mitigate potential adverse interactions, but can also be potent in enhancing beneficial nutraceutical-drug interactions in CVD treatment [26].…”