Coronary heart disease - At the interface of molecular genetics and preventive medicine

Background: Susceptibility to common chronic diseases such as coronary hear t disease (CHD) appears to be influenced by "context-dependent effects," wh ich include interactions among genes (genetic epistasis) and among genes an d environmental factors (gene-environment interactions). Methods: A synthesis of current knowledge and research findings demonstrate s the importance of integrating genetic research on cardiovascular disease with preventive medicine and public health initiatives. Results: A variety of candidate genes have been implicated in risk for CIID , but only limited examples of context-dependent effects have been describe d. Interactions between genetic and environmental factors appear to influen ce lipid metabolism, plasma homocysteine levels, and pharmacologic response to many commonly prescribed medications. Quantification of genetic effects associated with increased disease risk that are modifiable by intervention s such, as diet, exercise, and smoking cessation is an important: interface between molecular genetics and preventive medicine. Conclusions: As a primary focus of preventive medicine expands to encompass early detection and treatment of asymptomatic individuals at risk for dise ase, the ability to quantify tie influence of context-dependent effects on disease risk will be critical for determining drug safety and effectiveness in diverse patient populations and for implementing effective prevention a nd treatment programs.