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Precision Medicine in Cardiovascular Disease: A Systematic Review of Clinical Trials Evaluating Personalized Treatment Approaches
Corresponding Author(s) : Sajid A. Mulani
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 11 No. 3 (2023): 2023 Volume -11 - Issue 3
Abstract
Cardiovascular diseases (CVDs) have accounted for 93-% of all disease prevalence, 54-% of all deaths, with 60-% of debility-attuned living years over the prior three decades. Cardiovascular diseases (CVDs), a collective term for issues with the heart and blood vascular system, are the main cause of death and morbidity globally. The complexity of these diseases continues to pose a challenge for health care professionals and researchers, despite significant advancements in medical science and treatment approaches. New methods of prevention, diagnosis, and treatment are needed as CVD prevalence is on rise. With ischemic heart disease and stroke, CVDs now account for one in four fatalities in India. Precision medicine, a ground-breaking strategy that adapts treatment choices and patient outcomes to unique patient characteristics, has emerged as a promising path to transform cardiovascular care. Precision medicine, as opposed to conventional "one-size-fits-all" treatment approaches, customizes medical interventions to the particular genetic, molecular, and clinical characteristics of each patient. Individuals who are at a substantial gamble of acquiring circulatory diseases conceivably identified with the help of precision medicine. Biomarkers and genetic markers can help with risk assessment, enabling early intervention and preventive measures. A significant development in cardiovascular precision medicine, targeted therapies for cardiovascular disease herald a new era of treatment personalization based on unique patient characteristics. These therapies optimize treatment outcomes while minimizing side effects by utilizing genetic insights and molecular knowledge.
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- Sethi Y, Patel N, Kaka N, Kaiwan O, Kar J, Moinuddin A et al. Precision Medicine and the future of cardiovascular Diseases: A Clinically Oriented Comprehensive Review. J Clin Med. 2023;12(5):1799. doi: 10.3390/jcm12051799, PMID 36902588.
- Sreeniwas Kumar A, Sinha N. Cardiovascular disease in India: A 360-degree overview. Med J Armed Forces India. 2020;76(1):1-3. doi: 10.1016/j.mjafi.2019.12.005, PMID 32020960.
- Kumar A, Siddharth V, Singh SI, Narang R. Cost analysis of treating cardiovascular diseases in a super-specialty hospital. PLOS ONE. 2022;17(1):e0262190. doi: 10.1371/journal.pone.0262190, PMID 34986193.
- Olvera Lopez E, Ballard BD, Jan A; Updated 2023 August 7. Cardiovascular Diseases. In: StatPearls [internet]. Treasure Island, (FL): StatPearls Publishing; 2023 January-. Available from. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535419/.
- Precision. Medicine. U.S. Food and Drug Administration [cited Aug 31, 2023]. Available from: https://www.fda.gov/medical-devices/in-vitro-diagnostics/precision-medicine.
- Dai X, Shen L. Advances and trends in omics technology development. Front Med (Lausanne). 2022;9:911861. doi: 10.3389/fmed.2022.911861, PMID 35860739.
- Narang M, Dr Walia R, Dr Kaul U, Dr Sudhir K. Evolving paradigm of precision medicine in cardiovascular disease. Med Clin Res Open Access. 2021;2(1):1-8. doi: 10.52106/2766-3213.1021.
- Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: Current Epidemiology and Future Directions. Circulation. 2016;133(16):1605-20. doi: 10.1161/CIRCULATIONAHA.114.008729, PMID 27142605.
- Antman EM, Loscalzo J. Precision medicine in cardiology. Nat Rev Cardiol. 2016;13(10):591-602. doi: 10.1038/nrcardio.2016.101, PMID 27356875.
- Cook JC, Wu H, Aleo MD, Adkins K. Principles of precision medicine and its application toxicology. J Toxicol Sci. 2018;43(10):565-77. doi: 10.2131/jts.43.565, PMID 30298845.
- Upadhyay RK. Emerging risk biomarkers in cardiovascular diseases and disorders. J Lipids. 2015;2015:971453. doi: 10.1155/2015/971453, PMID 25949827.
- Grundy SM. Use of emerging lipoprotein risk factors in assessment of cardiovascular risk. JAMA. 2012;307(23):2540-2. doi: 10.1001/jama.2012.6896, PMID 22797454.
- FDA-NIH Biomarker Working Group, BEST. Resource. Silver Spring, (MD): Food and Drug Administration (US). Bethesda: National Institutes of Health. US; 2016. (Biomarkers, EndpointS, and Other Tools), [accessed Sep 22, 2017]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK326791/.
- Ghantous CM, Kamareddine L, Farhat R, Zouein FA, Mondello S, Kobeissy F et al. Advances in cardiovascular biomarker discovery. Biomedicines. 2020;8(12):552. doi: 10.3390/biomedicines8120552, PMID 33265898.
- Sequeira-Antunes B, Ferreira HA. Urinary biomarkers and point-of-care urinalysis devices for early diagnosis and management of disease: a review. Biomedicines. 2023;11(4):1051. doi: 10.3390/biomedicines11041051, PMID 37189669.
- Weeke P, Roden DM. Pharmacogenomics and cardiovascular disease. Curr Cardiol Rep. 2013;15(7):376. doi: 10.1007/s11886-013-0376-0, PMID 23689943.
- Archacki S, Wang Q. Expression profiling of cardiovascular disease. Hum Genomics. 2004;1(5):355-70. doi: 10.1186/1479-7364-1-5-355, PMID 15588496.
- Passacquale G, Sharma P, Perera D, Ferro A. Antiplatelet therapy in cardiovascular disease: current status and future directions. Br J Clin Pharmacol. 2022;88(6):2686-99. doi: 10.1111/bcp.15221, PMID 35001413.
- Roshandel G, Khoshnia M, Poustchi H, Hemming K, Kamangar F, Gharavi A et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial. Lancet. 2019;394(10199):672-83. doi: 10.1016/S0140-6736(19)31791-X, PMID 31448738.
- Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849-60. doi: 10.1016/S0140-6736(09)60503-1, PMID 19482214.
- Gaziano JM, Brotons C, Coppolecchia R, Cricelli C, Darius H, Gorelick PB et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392(10152):1036-46. doi: 10.1016/S0140-6736(18)31924-X, PMID 30158069.
- McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509-18. doi: 10.1056/NEJMoa1805819, PMID 30221597.
- Bouhairie VE, Goldberg AC. Familial hypercholesterolemia. Cardiol Clin. 2015;33(2):169-79. doi: 10.1016/j.ccl.2015.01.001, PMID 25939291.
- Kaddoura R, Orabi B, Salam AM. PCSK9 monoclonal antibodies: an overview. Heart Views. 2020;21(2):97-103. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_20_20, PMID 33014302.
- Libby P. Interleukin-1beta as a target for atherosclerosis therapy. J Am Coll Cardiol. 2017;70(18):2278-89. doi: 10.1016/j.jacc.2017.09.028, PMID 29073957.
- Mascolo A, di Mauro G, Cappetta D, De Angelis A, Torella D, Urbanek K et al. Current and future therapeutic perspective in chronic heart failure. Pharmacol Res. 2022;175:106035. doi: 10.1016/j.phrs.2021.106035, PMID 34915125.
- Rincon MY, VandenDriessche T, Chuah MK. Gene therapy for cardiovascular disease: advances in vector development, targeting, and delivery for clinical translation. Cardiovasc Res. 2015;108(1):4-20. doi: 10.1093/cvr/cvv205, PMID 26239654.
- Su C-H, Wu Y-J, Wang H-H, Yeh H-I. Nonviral gene therapy targeting cardiovascular system. Am J Physiol Heart Circ Physiol. 2012;303(6):H629-38 H638. doi: 10.1152/ajpheart.00126.2012, PMID 22821991.
- Hajjar RJ. Potential of gene therapy as a treatment for heart failure. J Clin Invest. 2013;123(1):53-61. doi: 10.1172/JCI62837, PMID 23281410.
- Di Pasquale E, Latronico MV, Jotti GS, Condorelli G. Lentiviral vectors and cardiovascular diseases: a genetic tool for manipulating cardiomyocyte differentiation and function. Gene Ther. 2012;19(6):642-8. doi: 10.1038/gt.2012.19, PMID 22378345.
- Cooray S, Howe SJ, Thrasher AJ. Retrovirus and lentivirus vector design and methods of cell conditioning. In: Gene transfer vectors for clinical application; 2012. p. 29-57. doi: 10.1016/B978-0-12-386509-0.00003-X, PMID 22365768.
References
Sethi Y, Patel N, Kaka N, Kaiwan O, Kar J, Moinuddin A et al. Precision Medicine and the future of cardiovascular Diseases: A Clinically Oriented Comprehensive Review. J Clin Med. 2023;12(5):1799. doi: 10.3390/jcm12051799, PMID 36902588.
Sreeniwas Kumar A, Sinha N. Cardiovascular disease in India: A 360-degree overview. Med J Armed Forces India. 2020;76(1):1-3. doi: 10.1016/j.mjafi.2019.12.005, PMID 32020960.
Kumar A, Siddharth V, Singh SI, Narang R. Cost analysis of treating cardiovascular diseases in a super-specialty hospital. PLOS ONE. 2022;17(1):e0262190. doi: 10.1371/journal.pone.0262190, PMID 34986193.
Olvera Lopez E, Ballard BD, Jan A; Updated 2023 August 7. Cardiovascular Diseases. In: StatPearls [internet]. Treasure Island, (FL): StatPearls Publishing; 2023 January-. Available from. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535419/.
Precision. Medicine. U.S. Food and Drug Administration [cited Aug 31, 2023]. Available from: https://www.fda.gov/medical-devices/in-vitro-diagnostics/precision-medicine.
Dai X, Shen L. Advances and trends in omics technology development. Front Med (Lausanne). 2022;9:911861. doi: 10.3389/fmed.2022.911861, PMID 35860739.
Narang M, Dr Walia R, Dr Kaul U, Dr Sudhir K. Evolving paradigm of precision medicine in cardiovascular disease. Med Clin Res Open Access. 2021;2(1):1-8. doi: 10.52106/2766-3213.1021.
Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: Current Epidemiology and Future Directions. Circulation. 2016;133(16):1605-20. doi: 10.1161/CIRCULATIONAHA.114.008729, PMID 27142605.
Antman EM, Loscalzo J. Precision medicine in cardiology. Nat Rev Cardiol. 2016;13(10):591-602. doi: 10.1038/nrcardio.2016.101, PMID 27356875.
Cook JC, Wu H, Aleo MD, Adkins K. Principles of precision medicine and its application toxicology. J Toxicol Sci. 2018;43(10):565-77. doi: 10.2131/jts.43.565, PMID 30298845.
Upadhyay RK. Emerging risk biomarkers in cardiovascular diseases and disorders. J Lipids. 2015;2015:971453. doi: 10.1155/2015/971453, PMID 25949827.
Grundy SM. Use of emerging lipoprotein risk factors in assessment of cardiovascular risk. JAMA. 2012;307(23):2540-2. doi: 10.1001/jama.2012.6896, PMID 22797454.
FDA-NIH Biomarker Working Group, BEST. Resource. Silver Spring, (MD): Food and Drug Administration (US). Bethesda: National Institutes of Health. US; 2016. (Biomarkers, EndpointS, and Other Tools), [accessed Sep 22, 2017]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK326791/.
Ghantous CM, Kamareddine L, Farhat R, Zouein FA, Mondello S, Kobeissy F et al. Advances in cardiovascular biomarker discovery. Biomedicines. 2020;8(12):552. doi: 10.3390/biomedicines8120552, PMID 33265898.
Sequeira-Antunes B, Ferreira HA. Urinary biomarkers and point-of-care urinalysis devices for early diagnosis and management of disease: a review. Biomedicines. 2023;11(4):1051. doi: 10.3390/biomedicines11041051, PMID 37189669.
Weeke P, Roden DM. Pharmacogenomics and cardiovascular disease. Curr Cardiol Rep. 2013;15(7):376. doi: 10.1007/s11886-013-0376-0, PMID 23689943.
Archacki S, Wang Q. Expression profiling of cardiovascular disease. Hum Genomics. 2004;1(5):355-70. doi: 10.1186/1479-7364-1-5-355, PMID 15588496.
Passacquale G, Sharma P, Perera D, Ferro A. Antiplatelet therapy in cardiovascular disease: current status and future directions. Br J Clin Pharmacol. 2022;88(6):2686-99. doi: 10.1111/bcp.15221, PMID 35001413.
Roshandel G, Khoshnia M, Poustchi H, Hemming K, Kamangar F, Gharavi A et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial. Lancet. 2019;394(10199):672-83. doi: 10.1016/S0140-6736(19)31791-X, PMID 31448738.
Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849-60. doi: 10.1016/S0140-6736(09)60503-1, PMID 19482214.
Gaziano JM, Brotons C, Coppolecchia R, Cricelli C, Darius H, Gorelick PB et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392(10152):1036-46. doi: 10.1016/S0140-6736(18)31924-X, PMID 30158069.
McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509-18. doi: 10.1056/NEJMoa1805819, PMID 30221597.
Bouhairie VE, Goldberg AC. Familial hypercholesterolemia. Cardiol Clin. 2015;33(2):169-79. doi: 10.1016/j.ccl.2015.01.001, PMID 25939291.
Kaddoura R, Orabi B, Salam AM. PCSK9 monoclonal antibodies: an overview. Heart Views. 2020;21(2):97-103. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_20_20, PMID 33014302.
Libby P. Interleukin-1beta as a target for atherosclerosis therapy. J Am Coll Cardiol. 2017;70(18):2278-89. doi: 10.1016/j.jacc.2017.09.028, PMID 29073957.
Mascolo A, di Mauro G, Cappetta D, De Angelis A, Torella D, Urbanek K et al. Current and future therapeutic perspective in chronic heart failure. Pharmacol Res. 2022;175:106035. doi: 10.1016/j.phrs.2021.106035, PMID 34915125.
Rincon MY, VandenDriessche T, Chuah MK. Gene therapy for cardiovascular disease: advances in vector development, targeting, and delivery for clinical translation. Cardiovasc Res. 2015;108(1):4-20. doi: 10.1093/cvr/cvv205, PMID 26239654.
Su C-H, Wu Y-J, Wang H-H, Yeh H-I. Nonviral gene therapy targeting cardiovascular system. Am J Physiol Heart Circ Physiol. 2012;303(6):H629-38 H638. doi: 10.1152/ajpheart.00126.2012, PMID 22821991.
Hajjar RJ. Potential of gene therapy as a treatment for heart failure. J Clin Invest. 2013;123(1):53-61. doi: 10.1172/JCI62837, PMID 23281410.
Di Pasquale E, Latronico MV, Jotti GS, Condorelli G. Lentiviral vectors and cardiovascular diseases: a genetic tool for manipulating cardiomyocyte differentiation and function. Gene Ther. 2012;19(6):642-8. doi: 10.1038/gt.2012.19, PMID 22378345.
Cooray S, Howe SJ, Thrasher AJ. Retrovirus and lentivirus vector design and methods of cell conditioning. In: Gene transfer vectors for clinical application; 2012. p. 29-57. doi: 10.1016/B978-0-12-386509-0.00003-X, PMID 22365768.