Personalized medicine implies a tailored approach to patients that offers more effective therapy for each individual, reduces risks and avoids unnecessary treatments or diagnostic interventions. Treatment of patients with cardiovascular diseases (CVDs) has markedly improved through the evaluation of new therapy concepts in large, controlled trials that provide evidence-based guidance. While this approach has, e.g. reduced morbidity and mortality in acute coronary artery disease and extended significantly life expectancy in chronic ischaemic heart disease and heart failure, there remains a high, and increasing, burden of CVD. Conditions such as atrial fibrillation, acute heart failure, or sudden cardiac death still cause unacceptable morbidity and mortality in the population. Furthermore, patients who survive acute cardiac events often require long-term treatment for chronic conditions. The development and implementation of a more personalized management offer potential to significantly improve outcome. Controlled trials by nature apply the same approach and therapy to patients with the same disease entity, even if with different disease stages and manifestations. Yet clinical cardiological practice aims to take into account differences between individual patients into therapeutic decisions. Initial concepts of personalized medicine focused heavily on genetic markers, particularly in oncology, but equally in CVD where genomics was the first marker which was considered.1,2 This has yielded interesting insights for some areas, such as unwanted drug effects,3 but this one-sided approach has limitations and a more comprehensive strategy is needed.4 Application of risk stratification based on clinical, biochemical, imaging, and/or genomic markers is already used to tailor therapy, but remains fragmented and research often focuses on single aspects of personalization. Based on a workshop held by the European Society of Cardiology, this report summarizes the current state of stratified cardiovascular care and examines the available and required tools to progress towards more personalized cardiovascular medicine. Actions are proposed that are necessary to expand and implement personalized medicine in CVDs and overcome potential hurdles.

The continuum of personalized cardiovascular medicine: a position paper of the European Society of Cardiology

PRIORI, SILVIA GIULIANA
2014-01-01

Abstract

Personalized medicine implies a tailored approach to patients that offers more effective therapy for each individual, reduces risks and avoids unnecessary treatments or diagnostic interventions. Treatment of patients with cardiovascular diseases (CVDs) has markedly improved through the evaluation of new therapy concepts in large, controlled trials that provide evidence-based guidance. While this approach has, e.g. reduced morbidity and mortality in acute coronary artery disease and extended significantly life expectancy in chronic ischaemic heart disease and heart failure, there remains a high, and increasing, burden of CVD. Conditions such as atrial fibrillation, acute heart failure, or sudden cardiac death still cause unacceptable morbidity and mortality in the population. Furthermore, patients who survive acute cardiac events often require long-term treatment for chronic conditions. The development and implementation of a more personalized management offer potential to significantly improve outcome. Controlled trials by nature apply the same approach and therapy to patients with the same disease entity, even if with different disease stages and manifestations. Yet clinical cardiological practice aims to take into account differences between individual patients into therapeutic decisions. Initial concepts of personalized medicine focused heavily on genetic markers, particularly in oncology, but equally in CVD where genomics was the first marker which was considered.1,2 This has yielded interesting insights for some areas, such as unwanted drug effects,3 but this one-sided approach has limitations and a more comprehensive strategy is needed.4 Application of risk stratification based on clinical, biochemical, imaging, and/or genomic markers is already used to tailor therapy, but remains fragmented and research often focuses on single aspects of personalization. Based on a workshop held by the European Society of Cardiology, this report summarizes the current state of stratified cardiovascular care and examines the available and required tools to progress towards more personalized cardiovascular medicine. Actions are proposed that are necessary to expand and implement personalized medicine in CVDs and overcome potential hurdles.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11571/961835
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