Pharmacogenomics of Atherosclerotic Plaque: Pathophysiological Background and Therapeutic Perspectives

Purpose of Review: Advances in pharmacogenomics have paved the way for personalized medicine. Cardiovascular diseases still represent the leading cause of mortality worldwide. This review aims to summarize the background, rationale, and evidence of pharmacogenomics in atherosclerosis, in particular, the use of antiplatelet and lipid-lowering drugs. Recent Findings: Atherosclerotic disease is strongly influenced by the patient’s genetic background. Randomized clinical trials have supported the role of a genotype-guided approach for antiplatelet therapy in patients with coronary heart disease undergoing percutaneous coronary intervention. Furthermore, there is growing evidence to support the association between some genetic variants and poor adherence to statin therapy, for example, due to the development of muscular symptoms. There is evidence for resistance to some drugs for the treatment of dyslipidemia, such as PCSK9 inhibitors. Summary: Pharmacogenomics can potentially improve patient care by enabling individualized therapy and facilitating the development of novel therapeutic strategies for cardiovascular disease. This is particularly relevant in a field characterized by high morbidity and mortality. These advances may translate into improved clinical outcomes, reduced healthcare costs, and lower cardiovascular mortality.