Personalized Medicine in Cardiology: State, Problems and Prospects

Abstract

ФАРМАКОГЕНЕТИКАВозможность владеть генетической информацией позволила начать внедрение персонализированной медицины в клиническую практику. Генетические иссле-дования начали показывать, что некоторые лекарства в определенных условиях очень эффективны для одних пациентов и неэффективны, а иногда даже опасны -для других. Поэтому на стыке фармакологии и генетики воз-никла фармакогенетика -наука, изучающая роль генети-ческих факторов в формировании фармакологического ответа организма человека на лекарственное средство [1]. Это может дать возможность врачу персонализиро-ванно выбрать как само лекарство, так и дозу у конкрет-ного больного и обеспечить максимальную эффектив-ность и безопасность препарата.Роль наследственности в формировании индивиду-ального ответа на лекарственные средства была известна давно, понимание механизмов влияния гене-тических факторов на эффективность и безопасность фармакотерапии стало возможным лишь с развитием методов молекулярной биологии и реализацией меж-дународной программы «Геном человека». Последние данные, имеющиеся о строении генома человека, явно показывают, что существует множество вариаций генов, которые объясняют различия в абсорбции пре-парата, распределении, метаболизме, выведении и в итоге ответную реакцию организма на фармацевтиче-ский препарат. Такие предварительные успехи дали понять, что подобное исследование позволит получить такую медицину, которая окажется и индивидуальной, и точной. Personalized medicine appeared about three decades ago. Even then many scientists, researchers, doctors were interested into it. However, only after the full opening of the human genome in 2001, personalized medicine could to give the opportunity for some pathologies (oncology, rheumatology, cardiology) to choose the most effective treatment with minimal adverse drug reactions for a specific patient. The opportunity to own genetic information gives the chance to suspect, to predict, to expect the onset of the disease. Personalized medicine is able in some cases to say exactly whether the drug can work for the patient, moving us to «treat not a disease, but the patient.» But doctors to this day when determining risk factors focus on individual characteristics of the patient, such as age, gender, body weight, co-morbidities, and based on that prescribe medications, correct dose and in case of ineffectiveness change the treatment regimen. Apparently they don't believe in personalized medicine, afraid of it and I don't want to associate with it, because as many think on the basis of their experience and knowledge they can decide which drug and what dose to prescribe. Also, there are a number of reasons related to privacy, security, problem of training, which will soon need to be addressed.

Medico – Social Substantiation of the Concept of Personalized Medicine in the Prevention of Arterial Hypertension Among the Adult Population At the Regional Level

“…Therefore, the system of prevention of AH should be aimed not only at each individual, who has his own individual differences in genes, in the way of life, but also at the population as a whole, which forms his environment. In this aspect, it is the concept of personalized medicine (Precision medicine) that is the tool that will allow influencing each individual in the population [2,9]. In early 2015, the concept of personalized medicine was defined as one of the strategic directions of fundamental research by the US National Institutes of Health, the goal of which is to ensure the health of an individual and increase his life expectancy through the use of preventive or therapeutic measures taking into account individual differences in the genes, environment and lifestyle of the patient.…”

“…Currently, the definition of "ideal cardiovascular health" is well known and is characterized by the simultaneous presence of 4 criteria for "healthy" behavior: abstaining from smoking during the last year, ideal body mass index [<25 kg/m 2 ], recommended physical activity, consumption an appropriate set of products that prevent the development of CVD and 3 favorable health factors: total cholesterol <200 mg / or (4.5 mmol/l), blood pressure <120/<80 mm Hg, the absence of diabetes mellitus and clinical manifestations of CSD, including coronary heart disease (CHD), stroke, heart failure, etc. [7,8,9].…”