Overview
Over the past 50 years, progress has been made in the fight against cardiovascular disease by adopting lifestyle interventions and evidence-based medical treatments. However, despite the effectiveness of this strategy, problems with cardiovascular disease prevention and treatment have yet to be solved since every patient is unique, and each requires a personalized intervention, which traditional approaches fail to fulfill.
The magnitude of the issue continues to be significant. Research shows that there are currently 92.1 million adults in the United States alone. By 2030, at least 44% of the adult population will have cardiovascular disease. In addition, the disease remains the leading cause of death globally, accounting for about 32% of all deaths. By 2030, this number will increase to more than 23.6 million deaths annually.
This article discusses precision cardiovascular medicine as a new strategy for heart disease prevention, the role of genetics and genomics in heart disease, why the traditional approach to heart disease is not optimal, and the significance of the interactome networks.
Precision Cardiovascular Medicine: A New Strategy for Heart Disease Prevention That Considers Individual Differences
The Role of Genetics and Genomics in Heart Disease
Every patient is unique, and each requires a personalized intervention. Because our genetics and genomics play a massive role in determining how we respond to medical intervention, we are in a different boat regarding treatment outcomes, even when we show the same signs and symptoms of the disease.
Genetics in Heart Disease
Genetics plays a significant role in the development and treatment of heart disease. For example, genes mutated from birth can lead to certain heart conditions, such as congenital heart defects. Genetic factors may also increase a person’s risk of heart disease by impacting factors like inflammatory markers, blood pressure, and cholesterol levels.
Genetic information can help identify people at the highest risk for developing heart disease and aid in diagnosing and treating the condition. The use of statins to lower cholesterol levels in people at high risk is one example of how this data can help develop personalized approaches to heart disease prevention and treatment.
Genomics in Heart Disease
Genomics describes the study of the entire array of genetic material (the genome) in a cell or organism. For example, in heart disease, genomics is essential for understanding the underlying genetic causes of the condition and identifying potential treatment targets, making it a crucial area of research in cardiovascular medicine.
Thanks to genomics, scientists can better understand the genetic variations that increase a person’s risk of heart disease. For example, genetic testing can identify people at high risk for heart disease and develop preventive and therapeutic interventions. This data can also help design new diagnostic tools and treatment approaches.
Understanding Precision Cardiovascular Medicine
In the context of a personalized approach being in higher demand to increase the efficacy of cardiovascular disease treatment and aid in the diagnosis, prognosis, and prevention, precision medicine emerges as the number one strategy.
What Is It?
Precision cardiovascular medicine is an integrative approach to preventing and treating cardiovascular disease that considers a person’s genetics, lifestyle, and environmental exposures as determinants of cardiovascular health and disease characteristics.
Precision cardiovascular medicine eliminates the drawbacks of reductionism. As a conventional medical strategy, reductionism assumes that all patients with the same signs and symptoms of disease share a prognosis and should be treated similarly.
Although reductionism can lessen symptoms and influence how the disease develops, its outcomes are uncertain, especially in complex illnesses with multiple underlying causes. Therefore, we must understand the full scope of a condition at an individual level.
How Does It Work?
Precision cardiovascular medicine uses the combined analysis of multi-dimensional data to combine clinical and personal health record data, including:
- Genomics
- Transcriptomics
- Epigenomics
- Proteomics
- Metabolomics
- Microbiomics
Scientists can then examine these multi-dimensional data within molecular interaction (interactome) networks to identify potential drug-drug interactions, previously unknown disease characteristics, and disease-disease relationships.
Drug-drug interactions can affect the efficacy and safety of medications in cardiovascular diseases, making them a crucial factor in precision medicine. First, genetic testing determines each patient’s particular metabolic pathways, which helps anticipate possible drug interactions. This information can allow doctors to make informed decisions about selecting medications and dosing to reduce the risk of adverse reactions.
Meanwhile, disease-disease relationships are the complex interplay between different conditions and the underlying factors, like genetics. This understanding is vital as many patients may have multiple conditions requiring coordinated management. By considering these connections, doctors can provide patients with a better approach to their care, improving health outcomes and reducing the risk of side effects.
What Is Its Goal?
Precision cardiovascular medicine aims to determine the best treatment for a specific patient based on their profile rather than the general population. Its power lies in the data, which requires synthesizing rapidly evolving datasets from traditional clinical testing to next-generation studies and historical health record data.
Data from these sources may also be examined using cutting-edge systems biology and network analysis techniques to find new and unbiased relationships between factors affecting health and disease. The ideal data will also be flexible enough to help prevent, diagnose, and treat various cardiovascular diseases.
What Are the Molecular Interaction (Interactome) Networks?
Interactome networks describe how proteins and other biological molecules interact within a cell. Protein-protein interactions are an example of a direct physical association between molecules. However, indirect interactions can also occur when small molecules or other proteins control a protein’s activity.
In precision cardiovascular medicine, interactome networks refer to the mapping of interactions between different biological molecules related to cardiovascular diseases and how these interactions affect the onset and course of these diseases.
This network-based approach aims to pinpoint important molecules and interactions that play a crucial role in disease pathogenesis and help prompt the development of new treatments. For example, more individualized therapies are being developed for patients with cardiovascular diseases using the data from interactome networks.
Advantages of Precision Cardiovascular Medicine
Early Detection and Diagnosis
Precision cardiovascular medicine has several advantages in the early detection and diagnosis of cardiovascular diseases. First, precision medicine enables more precise diagnoses and effective treatments by utilizing a patient’s genetic, lifestyle, and environmental data to identify the underlying cause of a disease.
Besides, precision medicine can identify cardiovascular diseases in their early stages utilizing advanced technology and molecular markers, enabling earlier and more effective interventions. Diagnostic accuracy can also be higher, and misdiagnoses can be lower with the implementation of precision medicine.
Personalized Treatment Plans
With early detection and accurate diagnoses, patients with cardiovascular diseases can receive appropriate and personalized treatment plans, improving outcomes and better managing their conditions. Early detection and diagnosis can also lower the need for more extensive and expensive treatments, resulting in lower healthcare costs.
Utilizing genetic testing to identify people at a higher risk of developing heart disease is one instance of precision cardiovascular medicine. Then, treatment plans and lifestyle changes can be made using this data, like a customized diet and exercise routine. As a result, healthcare professionals can enhance patient outcomes and lower the risk of severe heart conditions, such as heart attacks and strokes, by adopting a precision approach.
Bottom Line: The Next Revolution in Cardiovascular Medicine
Like in oncology, precision medicine and its application to cardiovascular disease promise to improve health and revolutionize prevention and treatment options; thus, it is regarded as the “art and science” of individualized health and disease assessments.
Precision medicine moves the field away from applying the same medical treatment, lifestyle intervention, or behavioral modification to a group of people assumed to share the same disease characteristics. Instead, it comes closer to personalizing treatments intended to prevent illness, promote health, and treat disease.
However, while this concept has been successful in oncology, patient adherence to precision cardiovascular medicine still needs to be revised. As per estimates, about half of all prescription medications are not taken as directed, and patients with chronic conditions like cardiovascular disease only take 50% of the recommended medication.
Precision medicine is heralding the next major shift in cardiovascular disease management. The advantages of this strategy are numerous, such as allowing the selection of the best drugs or therapies with maximum efficacy, expanding clinical trial participants, increasing adherence, and saving disease treatment and management costs.
References
Vidal, M. et al. (2011). Interactome Networks and Human Disease.
Ganesh, S. et al. (2013). Genetics and Genomics for the Prevention and Treatment of Cardiovascular Disease.
Leopold, J. & Loscalzo, J. (2018). The Emerging Role of Precision Medicine in Cardiovascular Disease.
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