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Personalized Medicine in Cardiology: The Next Frontier in Individualized Care

Making medicine more personal for hearts around the world

As personalized medicine continues to drive immunotherapy development and biomarker discovery for oncology and other fields, one area of medicine still awaits its heyday for customized care: cardiovascular medicine. However, if new research is any indication, cardiologists could indeed see their own personalized renaissance very soon.

Such was the perspective of a 2015 journal penned in the aftermath of President Obama’s Precision Medicine Initiative, which originally focused on precision medicine’s applications to cancer and diabetes. But while the federal directive focused its efforts elsewhere, the author posited that personalized care would make a significant impact on the field of cardiology1 — and thus far, his prediction has been correct.

After all, just three years later, all signs point to 2018 and beyond as cardiology’s prime moment for personalized care — evidenced by a boon of new-generation initiatives and research to explore precision medicine’s impact on cardiovascular care for coronary artery disease2, hypertension3, and heart failure,4 among others.

That activity takes place amidst a $300 billion drug industry that only seems to work half the time, as reported in a recent American College of Cardiology essay that made the case for more targeted therapies in cardiovascular care. The author continued: Though we share 99.5 percent of our DNA with other humans, that mere .5 percent accounts for some 15 million genetic variations.5

So how exactly could cardiology adopt precision medicine approaches to make drugs work better — or prevent disease altogether? Expect these three trends to greatly accelerate cardiovascular care as medicine is made more personal for hearts around the world, and know that GE Healthcare intends to be at the forefront of this exciting new era: 

1. Predictive medicine

Driven by a greater understanding of the human genome, precision medicine enables a deeper look at the causes and manifestations of heart disease — and can help spot biomarkers that flag a future risk for issues like atherosclerosis, arrhythmia and heart failure.6

For example, researchers have found that up to 6 in 10 cases of coronary artery disease link back to a patient's genetics.7 Imagine the potential of biomarkers for such issues — found through less- or non-invasive diagnostics such as urine or blood tests — that could notify a patient of their future likelihood for developing cardiovascular problems. 

One exciting application of biomarkers is the opportunity to digitize them, like those aggregated by a new digital biomarker app under development by GE Healthcare to help spot early-stage Alzheimer’s patients who would be eligible for clinical trials.

If physicians could take proactive steps to care for their patients based on those genetic insights (especially if those insights were readily available by the tap of a smartphone button), the cardiac care model could see a larger shift overall. The result? More than likely, it would take the form of a hybrid approach that would balance the standard reliance on guidelines-based approaches with new insights gleaned from personalized care.

2. Behavior-based personalization

Genes aren’t the only players in the personalized medicine continuum — behavior plays a role, too. In fact, aggregated data relating to social, behavioral and environmental factors can tell us as much (or more) about ourselves, even without knowing a great deal about our DNA.

And that kind of information may even be more accessible and potentially more actionable, write the authors of a recent JAMA Cardiology paper who argued for more behavioral-based customization to bridge the gap between the United State’s healthcare spending (#1 in the world) and its life expectancy (#26 in the world).8 

But it’s the combination of genetic intel with behavioral patterns that could be most impactful for cardiac care — because by knowing a person’s genetic risk for disease, and then merging that with their predisposed risk for behavioral-based factors (like smoking or poor dietary choices), providers can offer a tailor-made solution best for each patient's individualized situation.

3. AI and big data

By analyzing population datasets like those in the GE Health Cloud, physicians can spot patterns and individualized needs outside of the one-size-fits-all care pathway — comparing one person’s genomic structure with those of thousands (or even millions) of other patients to find abnormalities, similarities and effective paths forward.

But how do you assess such mountains of data within compressed timelines — especially during cardiac events, when every moment matters? Through artificial intelligence (AI), which could someday sort through compiled datasets such as advanced imagery and generate an aggregated report of trends within seconds.

Though these technologies are still under active research, development and evaluation, the potential of machine-enabled data review and “Deep Learning” to predict treatment response and improve outcomes could upend the industry’s reliance on aging data — putting more real-time context around every patient workup.

Balancing genetics with population health

Of course, precision medicine’s foray into cardiology does have its own challenges to overcome, including valid dissenting viewpoints from the cardiology community, and such opinions point to the need for more balanced care9

Indeed, genetic insights are just one component to that picture — but they’re an essential part nonetheless. As an area of medicine that has for years relied on historical clinical trial data and a rotating series of guidelines directing treatment for the masses, cardiology deserves its heyday for precision medicine. Hearts do too.

References:

1. Pitt, Geoffrey S. “Cardiovascular precision medicine: hope or hype?” European Heart Journal 36.29 (2015): 1842-3. Web. 21 Mar. 2018.

2. Ladapo, Joseph A. et al. “Utility of a Precision Medicine Test in Elderly Adults with Symptoms Suggestive of Coronary Artery Disease.” Journal of the American Geriatrics Society 66.2 (2018): 309-315. Web. 21 Mar. 2018.

3. Savoia, Carmine et al. “Personalized Medicine—a Modern Approach for the Diagnosis and Management of Hypertension.” Clinical Science (London) 131.22 (2017): 2671–2685. PMC. Web. 22 Mar. 2018.

4. Nassif Michael E. et al. “Precision Medicine for Cardiac Resynchronization: Predicting Quality of Life Benefits for Individual Patients-An Analysis From 5 Clinical Trials.” Circulation: Heart Failure 10.10 (2017). Web. 22 Mar. 2018.

5. American College of Cardiology (2017) http://www.acc.org/latest-in-cardiology/articles/2017/11/20/14/29/argument-in-support-of-personalized-and-digital-medicine-is-the-answer (accessed 21 Mar. 2018)

6. Medical Xpress (2018) https://medicalxpress.com/news/2018-03-precision-medicine-cardiovascular-disease-older.html (accessed 21 Mar. 2018)

7. Vinkhuyzen, Anna AE. et al. “Estimation and Partitioning of Heritability in Human Populations Using Whole Genome Analysis Methods.” Annual Review of Genetics 47 (2013): 75–95. PMC. Web. 22 Mar. 2018.

8. Volpp Kevin G. et al. “Mass Customization for Population Health.” JAMA Cardiology (2018) [Epub ahead of print] 22 Mar. 2018.

9. American College of Cardiology (2017) http://www.acc.org/latest-in-cardiology/articles/2017/11/20/14/29/precision-medicine-a-second-opinion (accessed 21 Mar. 2018)