Precision medicine in cardiology

Antman, Elliott M.; Loscalzo, Joseph

doi:10.1038/nrcardio.2016.101

Cited by 190 publications

(145 citation statements)

References 130 publications

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“…A final consideration is that pro-efferocytic therapies may provide an actionable opportunity for the oft-mentioned concept of precision cardiovascular medicine 83 . Genetic studies pursuing the heritable component of cardiovascular disease have shown that the majority of genome-wide significant loci confer risk for myocardial infarction independently of all classical risk pathways, suggesting a novel mechanism of action which is not being addressed by lipid lowering or antihypertensive therapies 38, 84, 85 .…”

Section: Opportunities For Translationmentioning

confidence: 99%

The Role of Efferocytosis in Atherosclerosis

2017

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The necrotic core has long been a hallmark of the vulnerable atherosclerotic plaque. While apoptotic cells are cleared very quickly in almost all other tissue beds, their removal appears to be significantly impaired in the diseased blood vessel. Emerging evidence indicates that this phenomenon occurs due to a defect in ‘efferocytosis’, the process by which apoptotic tissue is recognized for engulfment by phagocytic cells such as macrophages. Genetic and experimental data suggest that efferocytosis is impaired during atherogenesis due to dysregulation of so-called ‘eat me’ ligands which govern the ‘edibility’ of cells undergoing programmed cell death. Highlighted below is a summary of recent data indicating that efferocytosis is a major unappreciated driver of lesion expansion, but also a reversible defect that can potentially be targeted as a means to prevent plaque progression.

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Section: Opportunities For Translationmentioning

confidence: 99%

The Role of Efferocytosis in Atherosclerosis

2017

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“…The introduction of new technologies such as high-resolution CT coronary imaging with fractional flow reserve, virtual reality, vascular robotic systems, and 3-D printing can be incorporated into personalized care to improve the efficacy as well as the safety of the treatment of patients with CVD [57] . Cardiologists can use their experience in personalized medicine to improve the efficiency of clinical research and provide more precise information to improve the health of individuals as well as populations [58] . In the future, artificial intelligence/ machine learning will likely assist physicians with differential diagnosis of the disease, suggest treatment options or recommendations, and provide cues for image interpretation to facilitate the practice of personalized medicine.…”

Section: Concluding Remarks and The Future Of Personalized Cardiologymentioning

confidence: 99%

Personalized Management of Cardiovascular Disorders

Jain¹

2017

Med Princ Pract

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Personalized management of cardiovascular disorders (CVD), also referred to as personalized or precision cardiology in accordance with general principles of personalized medicine, is selection of the best treatment for an individual patient. It involves the integration of various “omics” technologies such as genomics and proteomics as well as other new technologies such as nanobiotechnology. Molecular diagnostics and biomarkers are important for linking diagnosis with therapy and monitoring therapy. Because CVD involve perturbations of large complex biological networks, a systems biology approach to CVD risk stratification may be used for improving risk-estimating algorithms, and modeling of personalized benefit of treatment may be helpful for guiding the choice of intervention. Bioinformatics tools are helpful in analyzing and integrating large amounts of data from various sources. Personalized therapy is considered during drug development, including methods of targeted drug delivery and clinical trials. Individualized recommendations consider multiple factors - genetic as well as epigenetic - for patients' risk of heart disease. Examples of personalized treatment are those of chronic myocardial ischemia, heart failure, and hypertension. Similar approaches can be used for the management of atrial fibrillation and hypercholesterolemia, as well as the use of anticoagulants. Personalized management includes pharmacotherapy, surgery, lifestyle modifications, and combinations thereof. Further progress in understanding the pathomechanism of complex cardiovascular diseases and identification of causative factors at the individual patient level will provide opportunities for the development of personalized cardiology. Application of principles of personalized medicine will improve the care of the patients with CVD.

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“…10 Precision medicine ( Figure 1) implies targeting treatments to the needs of individual patients on the basis of genetic, phenotypic and psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations. 11 Inherent to this definition is the concept of integrating (in electronic health records) individual-level information (e.g.…”

Section: The Promise Of Precision Medicinementioning

confidence: 99%

“…Handling the information gathered: descriptive statistical associations will not necessarily advance (10), (11), (42), areas of research the information of how molecules interact mechanistically to produce diseases or lead to rational therapies. (78), (79), (80) N-of-1 trials: the inclusion of N-of-1 trial data into randomized controlled trial meta-analyses improves the precision of yielded treatment effects.…”

Section: Identifying Newmentioning

confidence: 99%