This article is part of our special report Cardiovascular health in the UK.
Doctors are already able to calculate patients’ risk of getting cardiovascular disease based on their electronic medical records, including age, gender and smoking habits. Adding genetic assessments to the mix will make their job easier.
The concept of personalised medicine is not new. Physicians have always sought to tailor treatment to individual patients. What is new is the rapid development of pharmacogenomics that enables doctors to predict how their patients might respond to a new medication.
New capabilities in genomics-based technologies are guiding physicians toward therapies and screening regimens that are tailored to their patients’ individual genetics and disease risk.
Treatment for cardiovascular conditions in the UK and elsewhere is likely to be in the first line of beneficiaries along with those for cancer and asthma.
Genetic assessments, combined with assessment of lifestyle risk factors, for example, can help those with a family history of cardiovascular disease determine if they are at greater risk for future health complications, plus provide steps they can take to lower their risk.
Cancer at the forefront
Cancer is one condition where a personalised approach is already more common place. Since all cancer has a genetic base, physicians can offer a genomic, or ‘molecular’ diagnosis, helping them to select the most effective treatment. This can be used for a wide range of cancers such as melanoma (skin cancer), leukaemia, colon, brain and breast cancers.
This understanding means that cancer patients can be stratified according to what will be most effective for their condition
In its ‘Improving outcomes through personalised medicine’ report in September, NHS England predicted that diseases will be classified by their underlying genetic cause by 2025.
For the moment, pharmacogenetics has had more impact in the lab than in new drugs hitting the market. At present, about 20% of the drug market has been impacted by pharmacogenomics so far.
For many medications, a pharmacogenomics link has either not been found yet or doesn’t exist.
Research published last week by the universities of Surrey, Reading and Cologne found that the natural mutation single nucleotide polymorphism (SNP) can protect patients against cardiovascular disease.
“This breakthrough could have a revolutionary impact on healthcare,” said Dr Brendan Howlin, Director of Postgraduate Research at the University of Surrey, adding that “since the initial research, we have been developing a series of drugs that prevent the activation process, and are now working on bringing these drugs to market.”
NHS and the ‘one size fits all’ approach
One of the common criticisms of the NHS is that its ‘one size fits all’ does not sit naturally with personalised medicine and treatments.
However, doctors are already expected to calculate patients’ risk of getting CVD based on their electronic medical records, including age, gender and smoking habits, and adding genetic assessments to this mix will make their job easier.
Personalised treatment should also be cheaper and involve less wastage of medicine, since all patients with the same condition receive the same first line treatment even though it may be only 30% to 60% effective. That could have a positive impact on the £15billion that the NHS currently spends on drugs each year.
The NHS launched its Personalised Medicine Strategy in September 2015. Sir Bruce Keogh, the NHS’s National Medical Director, promised “improved prevention based on underlying predisposition, earlier diagnosis of disease as a result of identifying abnormality earlier (and) more precise diagnosis based on cause”.
It has also launched a 100,000 Genomes Project and 13 Genomic Medicine Centres across England.
Personalised medicine is likely to change the face of cardiovascular treatment. The question is whether the UK will be one of Europe’s leaders or laggards in the field.