New Delhi: India faces a remarkably higher burden of cardiovascular diseases as compared to the global level. CVDs accounted for 26.6 per cent of all fatalities in 2017, a significant rise from the 15.2 per cent recorded in 1990 as per the research reported in The Lancet.
According to the World Health Organisation, cardiovascular diseases accounted for most non-communicable disease (NCDs) deaths, or 17.9 million people annually, followed by cancers (9.3 million), chronic respiratory diseases (4.1 million), and diabetes (2.0 million including kidney disease deaths caused by diabetes). Despite the awareness of probable causes of cardiovascular diseases and their risk factors, managing the huge burden remains an uphill task.
At this juncture, medical experts are hopeful that precision medicine may enable better preventive strategies on a population level. This will scale possibilities in the field of cardiovascular care, offering personalised treatment strategies based on an individual’s genetic, environmental, and lifestyle factors.
Already, precision cardiovascular medicine is significantly impacting the diagnosis and treatment of cardiovascular diseases as it enables tailored therapies to a patient’s specific genetic, molecular, and clinical profile by utilising advanced technologies and individual patient data.
Genetic information as the guiding tool
Genetic information is a powerful and crucial tool in guiding cardiovascular disease prevention and treatment. By analysing a patient’s genetic profile, healthcare providers can identify genes associated with heart conditions.
Dr Vivek Jawali, Chief, Cardiothoracic and Vascular, Chairman: Cardiovascular Sciences, Fortis Hospitals cluster, Bangalore, said, “The genetic knowledge helps create personalised prevention plans, such as lifestyle modifications or medication choices, optimising treatment outcomes while minimising side effects. This data-driven approach promotes evidence-based decision-making and continuous improvement in CVD prevention and management, ultimately benefiting patients.
Adding to it Dr Jay Shah, Senior Interventional Cardiologist, HCG Hospitals, Ahmedabad, commented that it enables early interventions, such as lifestyle modifications or more aggressive medication management, to reduce their risk of developing cardiovascular diseases.
Promising Application of Precision Cardiovascular Medicine
The experts further highlighted what they felt were some of the most promising applications of precision medicine in cardiovascular care.
According to Dr Jawali the most promising applications of precision medicine in cardiovascular care today involve the use of genomics and biomarkers. He said, “This approach allows for the identification of patients at higher risk for developing cardiovascular diseases, leading to more effective management and reduced healthcare costs. Genetic markers can pinpoint individuals with a predisposition to atrial fibrillation, prompting early intervention and lifestyle modifications. This benefits patients by enabling timely and tailored prevention strategies, reducing the likelihood of serious complications.”
Dr Shah responded by referring to pharmacogenomics, which analyses how an individual’s genetic makeup affects their response to medications, is gaining traction. “By identifying genetic variations impacting drug metabolism, we can prescribe more effective and safe medication for a particular patient. This improves treatment outcomes and minimises the risk of adverse drug reactions, benefiting patients by reducing side effects and hospitalisations,” he added.
Echoing similar thoughts on how precision medicine guides drug selection and dosage based on an individual’s response, Dr Ramesh Menon, Associate Director – Personal Genomics & Genomic Medicine, MedGenome explained, “This approach ensures that patients receive the most suitable and effective medications, optimising their cardiovascular treatment while minimising the risk of adverse effects from medication.”
Dr Menon also added that genetic testing plays a significant role in identifying hereditary cardiovascular conditions. If a patient is found to have a genetic predisposition, their family members can undergo genetic testing to assess their own risk. This allows for early intervention and preventive measures for at-risk family members, extending the benefits of precision medicine beyond the individual to their family’s cardiovascular health.
Precision Cardiology market growth in India
Antony Prashant, Partner, Deloitte India, believes that the precision cardiology market in India is still in its nascent stages compared to more developed markets in the West. However, he also discusses several trends that indicate a favourable environment for rapid growth in the uptake of Precision Cardiology in India.
Speaking about the constraints and challenges on the demand side he mentioned a low rate of awareness, acceptability, affordability, data privacy and security. Whereas he feels it is infrastructure, skilled workforce, regulatory challenges and lack of standardisation that stand as challenges on the supply side.
Preventive Approach to Improve Public Health
Precision cardiovascular medicine is closely tied to broader efforts to improve cardiovascular disease prevention and population health. By identifying high-risk individuals early and tailoring interventions to their specific needs can reduce the overall burden of cardiovascular diseases.
Dr Mohammed Rehan Sayeed, Senior Consultant – Cardiovascular and Thoracic Surgery, Heart Transplant Surgery, Robotic Cardiac Surgery, Manipal Hospital Yeshwanthpur pinpoints that the primary aim is to prioritise prevention over cure. “The reality is that performing surgery on the entire global population of nearly seven billion people is an insurmountable task due to limited resources. Genetic testing helps us better stratify risk, allowing for more effective preventive measures. Genetic testing significantly enhances our capacity for prevention, aligning with the global goal of improving overall public health,” he said.
Speaking on tailoring prevention and treatment strategies to the specific characteristics of individuals Dr Jawali expressed that precision medicine contributes to more effective CVD management, reduced healthcare costs, and ultimately, improved population health.
He further explained that the collection of genetic and health data from large populations can inform public health planning and policies, enabling more effective monitoring and surveillance of CVD trends and outbreaks. This information can inform public health responses, resource allocation, and health education and promotion efforts, empowering individuals to make informed choices about their cardiovascular health.
Experts strongly agree that precision medicine research contributes to understanding disease mechanisms and can inform public health strategies.
Future Outlook of Precision Cardiovascular Medicine
Healthcare experts believe that the future of precision cardiovascular medicine holds great promise. (Col) Dr Monik Mehta, Senior Consultant – Cardiology, Manipal Hospital, Gurugram said, “The future of precision cardiovascular medicine holds exciting prospects, including advancements in the identification of novel therapeutic targets, the development of more personalised drug regimens, and the use of artificial intelligence to analyse complex patient data. Breakthroughs in regenerative medicine and gene editing may also revolutionise the field.”
Dr Shah anticipates advancements in the understanding of cardiovascular diseases’ genetic and molecular basis, leading to the development of more targeted therapies and risk prediction models. He believes that breakthroughs in non-invasive diagnostics, such as advanced imaging techniques and biomarker analysis, will further enhance the ability to detect and monitor cardiovascular diseases.
“Additionally, artificial intelligence and machine learning advancements will help us make more accurate predictions and treatment recommendations based on complex patient data,” said Dr Shah.
We see a future where genetic information, combined with advanced technologies like artificial intelligence and big data analytics, will enable even more precise risk prediction, early disease detection, and treatment optimisation, voiced Dr Menon. Additionally, we look forward to further integration of genomic data into routine clinical practice, making it accessible and affordable for a broader population. Ultimately, we hope to see a substantial reduction in the burden of cardiovascular diseases through personalised prevention strategies and innovative treatments, leading to longer and healthier lives for patients worldwide, he added.
Collaboratively experts agreed that as knowled ge and technology continue to evolve, precision medicine will play a pivotal role in reducing the global impact of cardiovascular diseases and improving the overall health of populations.
