Genetic Basis of Tobacco Addiction: Implications for Cardiovascular Risk

Tobacco addiction is a complex process whose main component is the brain reward system, at the center of which lies nicotine-induced dopamine release. This mechanism is combined with behavioral and environmental factors that perpetuate the habit. Another key element of this addiction is genetic predisposition, which will be the focus of this review. We will describe how genetic studies—from early research in twins and families to candidate gene association studies and genome-wide association studies—have identified key pathways mediating the mechanisms of tobacco addiction. We will review the most important findings and how certain genetic variants, either alone or in combination with others, can modify the cardiovascular risk associated with tobacco use. In addition, we will explore the opportunities these studies offer in the field of personalized medicine for pharmacological cessation therapies. In the future, it is clear that a multidisciplinary approach—combining genetics, clinical practice, and social sciences—will be necessary to transform tobacco use management into a precision-based model and reduce its impact on public health.