Precision Medicine for Cardiovascular Prevention and Population Health: A Bridge Too Far?

Overview

Journal Circulation

Specialty Cardiology & Vascular Diseases

Date 2024 Nov 18

PMID 39556656

Authors

Fernando R Giugni

Jarett D Berry

Amit Khera

Amil M Shah

James A de Lemos

Affiliations

Soon will be listed here.

Abstract

Precision medicine aims to provide personalized clinical care guided by tools that reflect underlying pathophysiology. The need for such an approach has never been greater in cardiovascular medicine, given the large number of guideline-directed medical therapies available. However, progress has been modest to date with few precision tools available for clinicians. Arguably, cardiovascular prevention and population health are poised for innovation to guide evaluation and management, as these areas are already informed by risk-assessment, but limited by the use of crude assessment tools with marginal performance. Risk assessment in prevention and population health may be improved with the use of genetics, circulating biomarkers, and imaging, leading to outcome-specific risk-prediction and enhanced phenotyping. Personalized management matching therapy to risk profile can be then implemented for either individuals or groups, improving cost-effectiveness and risk-benefit. Here, we explore this precision-like approach, including available tools, potential applications, and future perspectives for cardiovascular prevention and population health management.

References

Mora S, Wenger N, Cook N, Liu J, Howard B, Limacher M . Evaluation of the Pooled Cohort Risk Equations for Cardiovascular Risk Prediction in a Multiethnic Cohort From the Women's Health Initiative. JAMA Intern Med. 2018; 178(9):1231-1240. PMC: 6142964. DOI: 10.1001/jamainternmed.2018.2875. View

Pandey A, Vaduganathan M, Patel K, Ayers C, Ballantyne C, Kosiborod M . Biomarker-Based Risk Prediction of Incident Heart Failure in Pre-Diabetes and Diabetes. JACC Heart Fail. 2021; 9(3):215-223. PMC: 11229674. DOI: 10.1016/j.jchf.2020.10.013. View

Bozkurt B, Ahmad T, Alexander K, Baker W, Bosak K, Breathett K . Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. J Card Fail. 2023; 29(10):1412-1451. PMC: 10864030. DOI: 10.1016/j.cardfail.2023.07.006. View

Mortensen M, Blaha M . Is There a Role of Coronary CTA in Primary Prevention? Current State and Future Directions. Curr Atheroscler Rep. 2021; 23(8):44. DOI: 10.1007/s11883-021-00943-2. View

Patel A, Wang M, Ruan Y, Koyama S, Clarke S, Yang X . A multi-ancestry polygenic risk score improves risk prediction for coronary artery disease. Nat Med. 2023; 29(7):1793-1803. PMC: 10353935. DOI: 10.1038/s41591-023-02429-x. View

de Lemos J, Ayers C, Levine B, deFilippi C, Wang T, Hundley W . Multimodality Strategy for Cardiovascular Risk Assessment: Performance in 2 Population-Based Cohorts. Circulation. 2017; 135(22):2119-2132. PMC: 5486874. DOI: 10.1161/CIRCULATIONAHA.117.027272. View

Neeland I, Drazner M, Berry J, Ayers C, deFilippi C, Seliger S . Biomarkers of chronic cardiac injury and hemodynamic stress identify a malignant phenotype of left ventricular hypertrophy in the general population. J Am Coll Cardiol. 2012; 61(2):187-95. PMC: 3547631. DOI: 10.1016/j.jacc.2012.10.012. View

Emdin C, Khera A, Natarajan P, Klarin D, Baber U, Mehran R . Evaluation of the Pooled Cohort Equations for Prediction of Cardiovascular Risk in a Contemporary Prospective Cohort. Am J Cardiol. 2017; 119(6):881-885. DOI: 10.1016/j.amjcard.2016.11.042. View

Ramaswami R, Bayer R, Galea S . Precision Medicine from a Public Health Perspective. Annu Rev Public Health. 2017; 39:153-168. DOI: 10.1146/annurev-publhealth-040617-014158. View

10.

Ridker P, MacFadyen J, Everett B, Libby P, Thuren T, Glynn R . Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled trial. Lancet. 2017; 391(10118):319-328. DOI: 10.1016/S0140-6736(17)32814-3. View

11.

Pirruccello J, Chaffin M, Chou E, Fleming S, Lin H, Nekoui M . Deep learning enables genetic analysis of the human thoracic aorta. Nat Genet. 2021; 54(1):40-51. PMC: 8758523. DOI: 10.1038/s41588-021-00962-4. View

12.

Rose G . Sick individuals and sick populations. Int J Epidemiol. 2001; 30(3):427-32; discussion 433-4. DOI: 10.1093/ije/30.3.427. View

13.

Grundy S, Stone N, Bailey A, Beam C, Birtcher K, Blumenthal R . 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018; 139(25):e1082-e1143. PMC: 7403606. DOI: 10.1161/CIR.0000000000000625. View

14.

den Ruijter H, Peters S, Anderson T, Britton A, Dekker J, Eijkemans M . Common carotid intima-media thickness measurements in cardiovascular risk prediction: a meta-analysis. JAMA. 2012; 308(8):796-803. DOI: 10.1001/jama.2012.9630. View

15.

Heidenreich P, Bozkurt B, Aguilar D, Allen L, Byun J, Colvin M . 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145(18):e895-e1032. DOI: 10.1161/CIR.0000000000001063. View

16.

Ridker P, Cook N . Statins: new American guidelines for prevention of cardiovascular disease. Lancet. 2013; 382(9907):1762-5. DOI: 10.1016/S0140-6736(13)62388-0. View

17.

Collins F, Varmus H . A new initiative on precision medicine. N Engl J Med. 2015; 372(9):793-5. PMC: 5101938. DOI: 10.1056/NEJMp1500523. View

18.

Lundberg S, Erion G, Chen H, DeGrave A, Prutkin J, Nair B . From Local Explanations to Global Understanding with Explainable AI for Trees. Nat Mach Intell. 2020; 2(1):56-67. PMC: 7326367. DOI: 10.1038/s42256-019-0138-9. View

19.

Leopold J, Loscalzo J . Emerging Role of Precision Medicine in Cardiovascular Disease. Circ Res. 2018; 122(9):1302-1315. PMC: 6021027. DOI: 10.1161/CIRCRESAHA.117.310782. View

20.

Ledwidge M, Gallagher J, Conlon C, Tallon E, OConnell E, Dawkins I . Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial. JAMA. 2013; 310(1):66-74. DOI: 10.1001/jama.2013.7588. View