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

Abstract

There is strong need to develop the current stratified practice of CVD management into a better personalized cardiovascular medicine, within a broad framework of global patient care. Clinical information obtained from history and physical examination, functional and imaging studies, biochemical biomarkers, genetic/epigenetic data, and pathophysiological insights into disease-driving processes need to be integrated into a new taxonomy of CVDs to allow personalized disease management. This has the potential for major health benefits for the population suffering from cardiovascular diseases.

Figure 1

A roadmap from current clinical to personalized cardiovascular medicine. The left two images illustrate the current practice, namely using clinical parameters and risk factors as the basis for therapeutic decisions, recently enhanced by the use of cardiac or vascular imaging modalities. A better understanding of the molecular disease mechanisms and markers that can identify specific mechanisms in patients—especially in the common, chronic, and multifactorial cardiovascular diseases such as heart failure, atrial fibrillation, or coronary artery disease—is needed to design new and better targeted therapies to reverse disease processes. This is exemplified by the schematic of a cardiomyocyte (third image, top) and vessel wall and blood components (third image, bottom). Integrating these insights into the current practice of clinical and imaging-based cardiovascular medicine, through the application of new biological markers and new disease classifications, will allow a personalized approach to cardiovascular medicine in the near future.