Farmakogenetika kardiovaskularnih lekova
Sažetak
Individualne varijacije u odgovoru bolesnika na primenjene lekove su čest i važan klinički problem koji se sreće u medicini i farmakologiji. Posebnu pažnju treba usmeriti ka kardiovaskularnim bolestima koje se odlikuju najvećom učestalošću u svetskoj populaciji, što čini kardiovaskularne lekove najpropisivanijom i najkorišćenijom grupom lekova. Savremena terapija je koncipirana tako da koristi od nje može imati najšira populacija bolesnika, iako će kod određenog broja osoba izostati adekvatan terapijski efekat ili će primenjena terapija dovesti do intoksikacije. Ispitujući genetsku osnovu koja uzrokuje individualne varijacije u odgovoru na lekove, farmakogenetika omogućava personalizaciju medikamentozne terapije, sa ciljem da u kliničkoj praksi ukaže na bolesnike koji su izloženi povećanom riziku od pojave ozbiljnih neželjenih efekata leka i na one kod kojih određeni lek neće ispoljiti maksimalnu efikasnost. Polimorfizmi gena koji kodiraju proteine u sastavu enzima učesnika metabolizma lekova, u najvećoj meri citohrom P450, zatim receptora i transportera lekova, utiču na farmakokinetiku ali i na farmakodinamiju lekova koji se često propisuju kod kardiovaskularnih bolesti, poput beta blokatora, ACE inhibitora, varfarina, klopidogrela i statina. Ovakav pristup u kardiološkoj praksi bi omogućio da se kod pacijenata sa polimorfizmima ovih gena prilagodi terapija, promenom doze postojećeg leka ili pak primenom leka drugog izbora. Iako uključivanje farmakogenetike u svakodnevnu kliničku praksu nosi sa sobom velike troškove dijagnostike, kao i potencijalne pravne i etičke dileme, veliki broj pacijenata, a samim tim društvo i zdravstveni sistem u celini, imaće značajnu korist od povećanja terapijskog efekta i smanjenja neželjenih dejstava primenjene terapije.
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