Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide. Genetics factors play a significant role in the development of CVDs, which may result from monogenic or polygenic influences. These genetic contributions can lead to various life-threatening conditions such as cardiomyopathies, aortopathies, dyslipidemias, and arrhythmias, many of which are associated with sudden cardiac death (SCD) in adults. Early genetic screening and diagnosis enable timely intervention, not only for affected individuals but also for at-risk family members. Advances in molecular genetics and pharmacogenomic are transforming the management of cardiovascular diseases. By identifying genetic variants that influence drug metabolism, clinicians can tailor drug selection and dosing to individual patients, paving the way for personalized treatment strategies. This review will explore the role of genetics and pharmacogenetics in cardiovascular medicine, with a focus on how genetic insights inform risk stratification and guide therapy. In particular, the review will examine the pharmacogenetic considerations in the use of anticoagulant, antiplatelet agents, lipid-lowering therapies, direct-acting vasodilators, antiarrhythmics, renin-angiotensin system inhibitors, and diuretics ultimately supporting the implementation of personalized clinical interventions to achieve optimal patient care outcomes.