Cytochrome P450: another player in the myocardial infarction game?

Cytochrome P450 (CYP) enzymes are the major phase I enzymes in drug metabolism but may also exert important functions in physiological and pathophysiological processes. This becomes especially evident, when genetic variations, drug interactions, pathophysiological or environmental factors cause reduced, absent, or increased enzymatic activity. CYP enzymes and myocardial infarction (MI) are intertwined at basically two levels: 1. Atherosclerosis, the major underlying pathophysiological substrate in MI, has a multifactorial etiology involving vascular cells, lipid metabolism, inflammatory mediators, and tissues and processes influenced by CYP activity. Thus, various CYP enzymes may influence pathogenesis or progression of MI. 2. Patients at risk for MI or included in secondary prevention regimes usually take a multitude of different drugs that are primarily metabolized by hepatic or intestinal CYPs. Inherited differences or acquired changes in enzyme activity may, therefore, influence therapeutic outcome or the incidence of adverse drug reactions. This chapter will provide an overview of both aspects of CYP interaction with MI and summarizes the current knowledge on variable CYP activities and their potential impact on pathogenesis, progression, risk assessment, and therapy of cardiovascular disease.