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Health Insurance And Precision Medicine: Tailoring Treatments In Europe
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Engineering Precision Medicine
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By Yashendra Sethi Yashendra Sethi Scilit Preprints.org Google Scholar 1, 2, †, Neil Patel Neil Patel Scilit Preprints.org Google Scholar 1, 3, †, Nirja Kaka Nirja Kaka Scilit Preprints.org Google Scholar 1, 3, *, † , Oroshay Kaiwan Oroshay Kaiwan Scilit Preprints.org Google Scholar 1, 4, Jill Kar Jill Kar Scilit Preprints.org Google Scholar 1, 5, Arsalan Moinuddin Arsalan Moinuddin Scilit Preprints.org Google Scholar 6, * , Ashish Goel Ashish Goel Scilit Preprints. org Google Scholar 2, Hitesh Chopra Hitesh Chopra Scilit Preprints.org Google Scholar 7 and Simona Cavalu Simona Cavalu Scilit Preprints.org Google Scholar 8, *
Received: 1 February 2023 / Revised: 17 February 2023 / Accepted: 20 February 2023 / Published: 23 February 2023
Health Care: Breathing New Life Into The Sector
Heart disease accounts for a large share of the global disease burden, due to the paradigm shift to non-communicable diseases from communicable diseases. The prevalence of CVD has almost doubled, increasing from 271 million in 1990 to 523 million in 2019. In addition, the global trend for years lived with disability has doubled, increasing from 17.7 million to 34.4 million during the same period. The emergence of precision medicine in cardiology has sparked new possibilities for individualized, integrative, and patient-centred approaches to disease prevention and treatment, combining standard clinical data with state-of-the-art “omics”. These data assist with the individualization of phenotypically decided treatment. The primary goal of this review is to develop an evolving clinically relevant precision medicine tool that can assist the appropriate, evidence-based management of individual heart disease with the highest DALY. The field of cardiology is evolving to provide targeted therapies, tailored to “omics”, involving genomics, transcriptomics, epigenomics, proteomics, metabolomics, and microbiology, for deep phenotypes. Research for individualized therapy of heart disease with the highest DALYs has helped identify new genes, biomarkers, proteins, and technologies to aid early diagnosis and treatment. Precision medicine has aided in targeted management, enabling early diagnosis, timely intervention, and minimal exposure to side effects. Despite this major impact, overcoming barriers to implementing precision medicine requires addressing economic, cultural, technical and socio-political issues. Precision medicine is proposed to be the future of cardiovascular medicine and has the potential to be a more efficient and personalized approach to the management of cardiovascular disease, as opposed to the standard blanket approach.
Over the past three decades, cardiovascular diseases (CVDs) have dominated the global disease burden––93% prevalence, 54% mortality, and 60% in disability-adjusted life years (DALY) [1, 2, 3]. This is further compounded by disparities in disease burden between and within continents, costing USD 216 billion and USD 147 billion annually in health care and lost productivity respectively [4, 5, 6].
The truth of medicine has always emphasized treating the patient rather than the disease. Medicine today is honing itself to be more precise and patient-centered. Precision medicine is an innovative clinical approach that uses genomic, environmental, and individual lifestyle information to guide medical management. This has revolutionized oncology [7]; CVD form their current epicenter due to their heterogeneity and multi-causality, which lead to changes in response to treatment for each patient. Old medical principles are underpinned by technological evolution in “omics”—genomics, transcriptomics, epigenomics, metabolomics, proteomics, and microbiomics—which, together, help frame the positions of future medicine [8]. “Omics” is aided by advanced “big data” analysis, which has assisted in the development of in-depth clinical, biological and molecular phenotypes, promoting better integrated healthcare with early diagnosis, improved risk stratification, and disease management with minimal possible side effects [9].
Most CVD originates from a complex interplay of modifiable and non-modifiable factors that exacerbate established “omic” tendencies. In contemporary cardiology, most of the diagnostic criteria and therapeutic approaches rely on population-based studies, with little focus on approaches tailored to individual patient care [10]. Thus, comprehensive phenotypic and “omics” analyzes can help segment patient groups that mask differences, while strengthening patient-centered clinical care. Furthermore, it will improve patient quality of life (QOL) and help reduce complications through new biomarkers, better AI-assisted diagnostics, targeted therapy, and appropriate long-term risk assessment [11].
Jawad Salim On The Power Of Personalized Medicine
With technological advances in data science and machine learning, the application of precision medicine in CVD seems within reach, especially with the literature which has continued to expand significantly over the last decade. We therefore aim to: 1. collect clinically relevant information on precision medicine in cardiology, and 2. provide a comprehensive synthesis of the relevant literature to date. As such, it will assist with appropriate evidence-based management of heart disease and identification of possible challenges.
The emergence of precision medicine has the potential to revolutionize the future of cardiovascular disease (CVD) healthcare through its application through “omics” in cardiology (Figure 1). This empowers doctors to treat heart disease on an individual basis—based on a patient’s unique profile. Recently there has been an increasing body of literature highlighting the application of precision medicine in cardiology. Table 1 presents a compilation highlighting the clinical significance of all published “reviews” over the past decade on the same subject, while Table 2, Table 3 and Table 4 present a compilation of omic and disease-specific graded literature for myocardial infarction, hypertension, and heart failure, each. Thus, precision medicine in cardiology holds the promise of improving health and revolutionizing management previously embodied in oncology. The evolution of precision medicine in cardiology has been remarkable (Figure 2). Its application can have the best impact when applied to the diseases with the highest impact (associated with the highest DALYs), these include—myocardial infarction, hypertension, and heart failure.
Myocardial infarction (MI) is the leading cause of death globally—16% of total deaths. The pathogenesis is distinctive in terms of heterogeneous causality and highly variable genetic predisposition. MI is a critical medical emergency, according to the scientific adage “Time equals Myocardium”. Proper diagnosis with sensitive markers, optimal intervention, and prevention of complications and recurrences are essential. Precision medicine can find application in all of these areas (Table 2) and can guide drug research and development to augment the pharmacotherapeutic armamentarium for these diseases [29, 30].
Biological sex (sex chromosomes, hormones, body size, social behavior, etc.) influences the incidence of Chronic Coronary Syndrome (CCS).
Making Precision Medicine A Reality
NrF2 activation by bFGF reduces oxidative stress. This can significantly reduce cardiomyocyte apoptosis and MI-induced infarct size, thereby reducing cardiac damage.
In-depth phenotyping data, blood biobank, cardiac-MRI stress test, and identified candidate biomarkers (such as miRNA, troponin, CRP, etc.) will be used to derive specific biomarkers for ischemia.
A patient-specific treatment plan for MINOCA requires determining the cause. Some of the diagnostic tools for this purpose include electrocardiogram (ECG), cardiac enzymes, echocardiography, coronary angiography, left ventricular angiography, coronary vasomotion, and intravascular imaging techniques.
Biomechanical aspects of left ventricular function, such as contractility, stiffness, strain, and pressure, which are related to left ventricular pump performance and, consequently, prognosis, can be studied through computational modeling.
Practice Barriers Thwart Wider Use Of Personalized Medicine
When deciding whether to continue DAPT therapy (in patients 1 year after acute MI), prognostic factors such as demographics, behavior, cardiovascular history, non-cardiovascular history, biomarkers, and medications must be considered.
MiRNAs can be used to diagnose acute MI, MI risk stratification, and other medical conditions. After MI, circulating miRNA levels have some prognostic value, and the diagnostic value of BNP is enhanced.
AT2R has a protective role in the heart after MI, leading to improved cardiovascular health. Protective functions include increased left ventricular contractility, protection from premature left ventricular dilatation, and antifibrotic effects under certain conditions.
Epoxyeicosatrienoic acids (EETs) have cardioprotective effects because they exert anti-inflammatory, vasodilatory, fibrinolytic, and anti-apoptotic effects. They can be used as a treatment for acute MI.
Precision Health Transformation Journey
Better diagnostic capabilities are provided by imaging methods such as myocardial perfusion computed single photon emission tomography or cardiac magnetic resonance. Infarct size, left ventricular ejection fraction, history of diabetes, CAD, and others
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