Heart disease and stroke remain two of the most significant health challenges in the United States, with mortality and prevalence rates signaling an urgent public health concern.
Currently, heart disease is the leading cause of death in the U.S., responsible for roughly 697,000 deaths annually, accounting for 1 in every 4 deaths. Stroke adds another 160,000 deaths annually, making it the fifth leading cause of death in the country.
Together, these conditions contribute to nearly a third of all U.S. mortality. These conditions affect individuals across all racial and ethnic groups, although prevalence is highest among older adults.1-3
Future projections indicate these numbers are likely to increase due to aging populations and the rising prevalence of lifestyle risk factors leading to conditions such as obesity, hypertension, diabetes, and high cholesterol. According to the American Heart Association, nearly half of all adults in the U.S. are expected to have some form of cardiovascular disease by 2035.40
Additionally, the financial burden associated with these conditions is expected to explode, with estimates on annual healthcare costs for cardiovascular diseases to exceed $1.1 trillion by 2035.
But there is hope. Recent advances in genetic testing now enable healthcare providers to identify patients at higher risk due to inherited genetic factors. For patients with family histories of early cardiovascular events, genetic testing provides a powerful tool for more proactive, personalized risk management. 1-3
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Genetic testing and family history assessments can reveal crucial information about predispositions to heart disease. For example, specific genes influencing lipid levels, blood pressure, and even clotting factors can point to elevated risks.
Variants in genes like APOB, LDLR, and PCSK9 have been associated with familial hypercholesterolemia. Lifestyle, medications, and supplements might not eliminate these risks, but they can help manage them, offering a proactive approach to ward off early disease onset.
It’s key to understand that genetic risks are not about labeling patients with a disease; this allows patients the opportunity to take action, potentially avoiding unfavorable outcomes. For patients with family histories of cardiac events or those who are at high risk for events, adding genetic counseling to assist in therapy management can impact patient health outcomes.
Genetic testing panels like the Vibrant Wellness CardiaX offer a comprehensive approach to cardiovascular risk assessment, providing insights for targeted preventative strategies. For individuals with a family history of heart disease or high cholesterol, genetic testing can provide a proactive approach, supporting early intervention, like potential lifestyle modifications and therapeutic adjustments to reduce cardiovascular risks.
Let's take a quick peek at some of the most common markers to be aware of:
Heart disease can strike without warning, leaving families reeling from a sudden and devastating loss. It happened to me without warning on July 4, 2023. My father, a relatively healthy 65-year-old, was gone in a heartbeat. No second chances. No time to say goodbye.
Very quickly, grief mingled with shock, leading me to ask questions. When I began looking into our family history, the realization struck—I wasn’t the first son in my family to lose a father young. Every male in my father’s line had died in their 60s. It seemed like an unspoken family curse, a genetic shadow lurking in our lineage.
That discovery left me haunted, wondering why. What genetic factors made our family so vulnerable to heart disease, and was there anything I could do to escape this fate?
The answers lie hidden in our genes and in understanding the specific risks coded within us. I needed to learn what genetic markers to test for, how lifestyle and supplements could influence their expression, and what mechanisms I could utilize to help me take action, not only in reducing my risk but also the risk of others in similar situations.
After identifying specific risks with genetic testing, providers should take a comprehensive approach to managing cardiovascular health that includes both traditional and nontraditional medications.
Traditional medications, such as statins, ACE inhibitors, and antiplatelet agents, have long been the cornerstone of cardiovascular therapy. These pharmacological treatments are well-supported by extensive clinical research,29 demonstrating their effectiveness in lowering LDL cholesterol, reducing blood pressure, and preventing thrombotic events, ultimately lowering the risk of heart attacks and strokes.
On the other hand, nontraditional medications and supplements have gained attention for their ability to complement conventional therapies. Supplements such as omega-3 fatty acids, curcumin, and berberine have shown promise in reducing inflammation,4 improving lipid profiles, and enhancing vascular health. Emerging studies indicate that nontraditional options can provide additional benefits,28 particularly for patients who may not respond adequately to standard treatments or those looking for more holistic approaches to their cardiovascular health.
Integrating both traditional and nontraditional therapies can optimize patient outcomes, supporting cardiovascular health through multiple pathways. Understanding how these therapies work together can empower patients to make informed decisions about their health strategies.
Below are traditional and nontraditional ways to approach patient care focused on genetic markers:
| Gene/Pathway | Medications | Supplements |
|
PCSK9 |
PCSK9 inhibitors such as alirocumab and evolocumab are shown to significantly lower LDL cholesterol and reduce cardiovascular events in high-risk populations. Studies such as the FOURIER trial demonstrate that PCSK9 inhibitors reduce LDL cholesterol levels by 50-60% and effectively prevent cardiovascular events, especially for statin-intolerant patients or those with familial hypercholesterolemia.¹⁹,²⁰ |
Berberine, which has shown PCSK9-lowering effects in animal studies, could be an adjunct to traditional therapies. Berberine’s potential to upregulate LDL receptors and lower cholesterol has been explored in various studies. However, further research is needed in human populations to validate its effect as an adjunct treatment.²¹ |
|
CETP |
CETP inhibitors like anacetrapib and evacetrapib target HDL and LDL levels, though their efficacy varies. The REVEAL trial showed that anacetrapib raises HDL and lowers LDL, though results on cardiovascular outcomes are mixed, indicating that CETP inhibition may be beneficial for select patients.²²,²³ |
Niacin (vitamin B3) is an HDL-raising supplement that may have a role similar to CETP inhibitors. It is recommended to start with lower doses to minimize flushing. Niacin has been shown to increase HDL levels and reduce triglycerides at high doses, but the benefits on cardiovascular outcomes remain debated.²⁴ |
|
Inflammation-Related Genes (MRAS, SLC22A4, TRIB1, ADAMTS7) |
Statins are widely used to address inflammation and reduce cardiovascular risk. Statins are shown to not only reduce LDL but also lower C-reactive protein (CRP), an inflammatory marker associated with heart disease, which is especially useful for patients with inflammatory genetic markers.²⁵ |
Curcumin and omega-3 fatty acids (EPA/DHA) have demonstrated anti-inflammatory effects. Curcumin reduces CRP and other inflammatory markers, while omega-3 fatty acids have been shown to reduce inflammation and improve lipid profiles, potentially lowering cardiovascular risk.²⁶,²⁷ |
|
Lipid Metabolism Genes (LIPA, SH2B3) |
Statins remain the primary choice for lipid management, often combined with ezetimibe for additional LDL reduction. Statins combined with ezetimibe have been shown to enhance LDL lowering and improve cardiovascular outcomes in high-risk patients.²⁸ |
Plant sterols and red yeast rice can support lipid metabolism as adjuncts to traditional therapy. Plant sterols lower LDL by reducing cholesterol absorption, while red yeast rice, a natural statin, is used in some populations, though its dosage may vary.²⁹ |
|
Vascular Health and Smooth Muscle Genes (SORT1, RASD1, CYP17A1) |
ACE inhibitors and ARBs such as lisinopril and losartan are used to improve vascular health. ACE inhibitors and ARBs improve endothelial function and reduce the risk of cardiovascular events, benefiting patients with genetic predispositions to vascular issues.³⁰ |
Coenzyme Q10 (CoQ10) supports vascular health and may benefit patients on statins.CoQ10 has demonstrated modest blood pressure-lowering effects and vascular health support, particularly for individuals with smooth muscle and endothelial genetic risks.³¹ |
|
Coagulation Genes (ZEB2, PLG) |
Aspirin or clopidogrel is used for managing coagulation risk, with warfarin or rivaroxaban prescribed for higher-risk individuals. Antiplatelet agents like aspirin and clopidogrel reduce clot formation, which is especially important for patients with coagulation gene variants.³² |
Nattokinase is a fibrinolytic enzyme, while vitamin E offers mild anticoagulant properties. Studies suggest that nattokinase improves blood flow and may reduce clotting risk, while vitamin E requires careful use to avoid bleeding complications.³³ |
|
Hypertension-Related Genes (ADRB2, ACE I/D) |
Beta-blockers and ACE inhibitors are recommended for genetic hypertension predispositions. These medications manage blood pressure effectively, reducing cardiovascular risks associated with genetic markers for hypertension.³⁴ |
Magnesium and CoQ10 may help lower blood pressure. Magnesium and CoQ10 have been shown to modestly reduce blood pressure in some individuals, potentially benefiting those with genetic predispositions to hypertension.³⁵ |
|
Predictive Genetic Marker (9p21) |
Statins remain essential for managing LDL and preventing cardiovascular events in patients with the 9p21 risk allele. Statins lower LDL and inflammation, reducing overall cardiovascular risk, particularly in high-risk individuals with the 9p21 genetic marker.³⁶ |
Resveratrol (100–200 mg daily) and omega-3 fatty acids are considered supportive for vascular health. Resveratrol shows anti-inflammatory and vascular benefits, while omega-3s are known for lipid-lowering effects, contributing to broader cardiovascular health support.³⁷ |
Genetic testing plays a critical role in breaking cycles of familial heart disease. By embracing personalized medicine and the insights provided by genetic markers, individuals can take proactive steps to manage their heart health, thereby breaking cycles of familial heart disease. Integrating traditional medications, such as statins, with nontraditional approaches, including dietary supplements and lifestyle changes, offers a comprehensive strategy for promoting cardiovascular wellness.
Dr. Logan Morse, PharmD, ABAAHP, FAAFRM, FACA, is an accomplished pharmacist and co-owner at Keystone Compounding Pharmacy in Grand Rapids, Michigan. He holds a Doctorate in Pharmacy from Ferris State University and is board-certified in anti-aging and functional medicine through the American Academy of Anti-Aging Medicine. Dr. Morse specializes in integrative and functional medicine. He works closely with patients on personalized health strategies, particularly in hormone replacement therapy, adrenal health, chronic fatigue, and sports medicine. Dr. Morse also serves in the United States Air National Guard, demonstrating his commitment to both his profession and his community. He is a passionate advocate for patient-centered care and is known for his deep dedication to helping patients achieve better health outcomes. Through tailored treatment plans and education on new treatment options, he aims to provide customized solutions tailored to improve patient outcomes.
Regulatory Statement:
The information presented in case studies have been de-identified in accordance with the HIPAA Privacy protection.
The general wellness test intended uses relate to sustaining or offering general improvement to functions associated with a general state of health while making reference to diseases or conditions. This test has been laboratory developed and its performance characteristics determined by Vibrant America LLC and Vibrant Genomics, a CLIA-certified and CAP-accredited laboratory performing the test. The lab tests referenced have not been cleared or approved by the U.S. Food and Drug Administration (FDA). Although FDA does not currently clear or approve laboratory-developed tests in the U.S., certification of the laboratory is required under CLIA to ensure the quality and validity of the test