Personalized Management of Cardiovascular Disorders

Abstract

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.

Keywords: Cardiovascular diseases; Coronary heart disease; Heart failure; Hypertension; Personalized cardiology; Personalized medicine.

Fig. 1

Integration of technologies for personalized cardiology. Several technologies are integrated for the development of personalized cardiology. These include “omics” such as genomics and proteomics, molecular diagnostics, and biological therapies such as cell and gene therapies. Both genetics and epigenetic factors contribute. Some of the concepts of personalized medicine are like those of systems biology. Copyright: Jain PharmaBiotech.

Fig. 2

Scheme of a personalized approach to the management of hypertension. The scheme is a stepwise guide to the evaluation of a patient with hypertension. Both routine laboratory chemistry and molecular diagnosis such as genotyping are used. Findings guide the selection of management strategies, which can be changed depending on the response to treatment. Pharmacogenetics and pharmacokinetics are taken into consideration in selection of the drugs and the treatment is monitored. BP, blood pressure; HPN, hypertension. Copyright: Jain PharmaBiotech