Precision medicine for cardiovascular disease : Learning lessons from cardiomyopathies

Area of Science:

• Cardiovascular Medicine
• Precision Medicine
• Genomics and Phenomics

Background:

• Evidence-based medicine has advanced cardiovascular disease (CVD) treatment through large trials.
• Current "one size fits all" approaches neglect individual patient genetic and phenotypic variability.
• Recent large-scale trials show small clinical efficacies, limiting practical implementation.

Purpose of the Study:

• To highlight the limitations of uniform treatment protocols in cardiovascular medicine.
• To propose a paradigm shift towards individualized treatment strategies for cardiovascular diseases.
• To explore the potential of precision medicine, exemplified by rare cardiomyopathies, for future CVD management.

Main Methods:

• Review of evidence-based medicine implementation and outcomes of large interventional trials in CVD.
• Analysis of the challenges posed by small overall efficacies in resource-intensive "mega" trials.
• Exploration of deep and precise phenotyping using multimodal approaches for individual patient assessment.

Main Results:

• Uniform treatment strategies, while effective for prevalent CVD, fail to account for patient individuality.
• Large-scale trials often yield statistically significant but clinically marginal improvements.
• Rarer conditions like cardiomyopathies demonstrate the feasibility of "one treatment for many" or "one treatment for some" approaches.

Conclusions:

• A transition from "one size fits all" to personalized medicine is crucial for advancing cardiovascular disease care.
• Deep phenotyping and targeted therapies are essential for developing effective individualized treatment strategies.
• The principles learned from rare cardiomyopathies can guide the future of precision cardiovascular medicine.