[Cardiovascular pharmacotherapy in the era of RNA-based precision medicine]

In the pharmacotherapy of heart failure with reduced ejection fraction (HFrEF) in addition to the "fantastic four", a potential fifth pillar is emerging with low-dose digitoxin, while finerenone broadens the spectrum of mineralocorticoid receptor antagonists, particularly in HF with mildly reduced EF (HFmrEF)/HF with preserved EF (HFpEF). For HFpEF sodium-glucose linked transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists are coming to the foreground through gains in morbidity and quality of life. Further innovations include myosin inhibitors in hypertrophic cardiomyopathy, de-escalated dual antiplatelet therapy (DAPT) regimens after acute coronary syndrome (ACS) and factor XI inhibitors as a potentially safer option regarding the risk of bleeding. In prevention, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition including small interfering RNA (siRNA)-based approaches targeting lipoprotein (a) as well as RNA-based and aldosterone synthase-based hypertension therapy and microRNA targeting mark the path towards individualized cardiovascular precision medicine.