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.

Pharmacological inhibition of histone deacetylase reduces NADPH oxidase expression, oxidative stress and the progression of atherosclerotic lesions in hypercholesterolemic apolipoprotein E-deficient mice; potential implications for human atherosclerosis

“…Accumulating evidence indicates that alterations in the gene expression linked to atheroma formation are typically driven by dysregulated epigenetic-based mechanisms acting in conjunction with specific transcription factors [47]. Thus, personalized treatment of atherosclerosis based on epigenetic understanding of patient disease has emerged as an important therapeutic strategy in reducing the burden of CVD [48].…”

Knockdown of lncRNA ENST00000609755.1 Confers Protection Against Early oxLDL-Induced Coronary Heart Disease

“…While the standard CHD medications (statins, antiplatelets, ACE inhibitors, beta blockers, etc.) greatly reduce the risk of complications arising from CHD, side-effects can greatly reduce quality of life (33). Evidence has shown that environmental factors, genomes, and epigenetics play crucial roles in it etiology (27).…”

Is Sex a Determinant of COVID-19 Infection? Truth or Myth?

“…Values are means ± SEM; n = 5-7/group exists, particularly with respect to sex. Understanding and identifying genes, gene products, and enzymatic activities involved in the differential responses to RAS inhibitors could improve our knowledge of how drugs differentially affect patients exposed to environmental stressors (e.g., airborne infectious agents such as SARS-CoV-2) by sex [129]. Ironically, RAS inhibition that enhances tissue ACE2 may be a means to protect the heart and lung.…”

“…While the RAS plays a key role in the development and progression of CVD, substantial variability in individual responses to ACEi and ARBs exists, particularly with respect to sex. Understanding and identifying genes, gene products, and enzymatic activities involved in the differential responses to RAS inhibitors could improve our knowledge of how drugs differentially affect patients exposed to environmental stressors (e.g., airborne infectious agents such as SARS-CoV-2) by sex [ 129 ].…”