571Infl ammatory mediators, leukotrienes, are generated from arachidonic acid
(polyunsaturated n-6 fatty acid) by the enzyme 5-lipoxygenase. Variant 5-lipoxy-
genase genotypes have been found in persons with increased atherosclerosis sug-
gesting that dietary n-6 polyunsaturated fatty acids promote, whereas marine n-3
fatty acids inhibit, leukotriene- mediated infl ammation that leads to atherosclerosis
in these persons. Such fi ndings could lead to new dietary and targeted molecular
approaches for the prevention and treatment of cardiovascular disease according to
genotype, particularly in populations of non-European descent.
The signifi cance of risk factors and measures to counteract them vary consider-
ably from one individual to another. General advice to a person to modify all risk
factors may not be practical and the compliance is usually low. By identifying genetic
predisposition to disease, the physician could focus on risk assessment and develop
a comprehensive personalized plan to modify risk factors, and initiate preventive
strategies. A practical scenario in preventive medicine practice could be as follows:
A buccal smear sample can be taken in the physician’s offi ce for DNA analysis
and analysis may eventually be performed for a very reasonable cost to provide
information about predisposition to specifi c diseases. The physician can use this
information and draw up a personalized prevention plan taking into consideration
the life style of the individual.
Female Sexual Dysfunction
Female sexual dysfunction (FSD) is the broad term covering a number of disorders
from menarche to menopause, which result from an interaction of psychosocial and
biological factors modulating the expression of sexual symptoms and associated
distress. These are dependent on genetic and epigenetic mechanisms, including
acquired medical conditions. Personalized management of FSDs requires an under-
standing of psychological and environmental determinants as well as the genetic
basis to select the most effective intervention for an individual. However, there is a
paucity of studies of genetic contribution to FSD. and pharmacogenomics is still in
its infancy in the fi eld of sexual medicine as most of the data regarding genetic
polymorphisms of drug targets associated with susceptibility to sexual dysfunction
have been obtained in males. There is a need for pharmacogenomic studies of FSDs
to guide an individualized approach by predicting both therapeutic effects at vary-
ing dosages of hormonal and nonhormonal agents as well as, adverse drug reactions
and drug interactions (Nappi and Domoney 2013 ).
Hormone Replacement Therapy in Women
There is some controversy about the usefulness and risks of hormone replacement
therapy (HRT) in postmenopausal women.
Female Sexual Dysfunction