Genetic modulation of adrenergic activity in the heart and vasculature: implications for perioperative medicine

The adrenergic system provides the primary control for cardiac, vascular, pulmonal, and metabolic functions. Seven of the nine adrenergic receptor subtypes display mutations that affect their function. Results from transgenic mouse models and from association studies in human populations allow to link protein dysfunctions to cardiovascular diseases or to risk for disease development. The disease contribution by single nucleotide polymorphisms may be small. Series of single nucleotide polymorphisms along a chromosome are combined in haplotypes and inherited together. Individual single nucleotide polymorphisms in a haplotype can influence each other and lead to new, unpredictable phenotypes. Haplotypes vary widely among different ethnic groups. In this review, we discuss the genetic organization of single nucleotide polymorphisms and haplotypes in the adrenergic system and their implications for the heart and vasculature with special reference to perioperative medicine. With the advent of powerful genomic technologies, genotyping may become standard in patient evaluation and will help to individualize therapeutic approaches.