Whether you’re being seen for strep throat or shortness of breath, there’s a standard of care providing the foundation on which doctors build your treatment. But in many ways medicine is moving beyond the standard, finding new ways to customize care to fit individual people rather than populations. It’s called precision medicine.
Using information about a person’s genes to prevent, diagnose and guide treatment has already changed the landscape of some areas of medicine, including oncology care. Now, precision medicine is increasingly changing how physicians care for the heart.
Defining heart disease
In the U.S., heart disease is the leading cause of death for both women and men. Every 38 seconds there’s a death related to cardiovascular disease. Tom Stys, M.D., a world-renowned interventional cardiologist at Sanford Health, stresses that the disease has a huge impact on not only individuals but also society as a whole.
“It’s the number one problem in adult medicine,” Dr. Stys said. “If you consider that there are more than 90 million Americans with cardiovascular disease, that impact on society is huge.”
Lifestyle habits — a person’s dietary choices, weight and even environmental factors — fuel up to 80 percent of heart disease. But unfortunately, managing these risk factors doesn’t always guarantee that a person’s risk of developing heart disease will be lowered.
“There are limitations to using general observances to address an entire population,” Dr. Stys said. “On average it will be accurate, but never precise.”
Identifying genetic causes
This is where genetic medicine comes into play. Physicians can use your precise genetic makeup to better understand your risk for certain diseases and how best to treat you based on that information.
“We know there’s a genetic component to heart disease,” said Cassie Hajek, M.D., clinical geneticist at Sanford Health. “If my dad had heart disease at a younger age, I’m at an increased risk. Using genetic data, we can even more accurately quantify that risk and then use that to guide treatment and screening. That’s something we’re very excited about and working to start to implement for our patients.”
As with many aspects of health care, physicians can use a number of components in genetic medicine to improve prevention and treatment of disease.
“This is something that’s only going to get bigger and have an increasing clinical application,” Dr. Hajek said. “So I think we’re really fortunate to be in a health care system where there’s an emphasis on it, and we’re fortunate to be able to offer this to our patients.”
Illuminating the future
This type of precision medicine will continue to evolve but has been used in some way now for many years. Sanford Health has been using genetic information when prescribing a common blood thinner.
“When a patient has a stent put in place, they need medication that allows the stent to heal up,” Dr. Stys said. “Without that medication, patients are at risk of having a clot form in the stent and cause a heart attack. But we have identified up to a third of our patients that receive a stent are poor responders to that medication. Because of pharmacogenetic testing, those patients are promptly switched to a medication that will work for them. If this switch is not made, they are at risk of having major consequences.”
Closing the gaps
Sanford Health continues to customize treatments with precision medicine, specifically with pharmacogenetics and genetic counselors who help patients understand the medical, psychological and familiar effects of genomics in the disease process.
But up to 20 percent of people who have heart disease are missed by clinical risk assessments, indicating there are markers that are still largely unaccounted for.
“It’s extremely important to realize the scope of the problem is huge,” Dr. Stys said. “The issues are just huge to individuals, to families, to society. Economically speaking, cardiovascular disease currently is among the most expensive syndromes to treat for our society. It’s also the most devastating disease. I believe that cardiogenetic programs will be the next big milestone as far as understanding and treatment of cardiovascular disease, and I think that we have a potential to make an impact.”
It’s never too early
So when should we start thinking about our heart health? According to the experts, it’s earlier than you might think.
“Interestingly, we do get a question from a lot of our patients, how early do I start worrying about heart disease and are my children at risk?” Dr. Stys said.
“And my answer is always, it’s never too early to worry about heart disease. For instance, child obesity is an increasing problem that puts children at risk for cardiovascular disease in their future. Now through the study of their genetic makeup, we have a very precise way to predict and determine an individual’s risk. Patients identified through genetic screening as being at a high risk in the early stages of their lives can be treated for those multiple risk factors and help prevent cardiovascular disease.”
More stories about precision medicine
- Sanford Chip FAQs (with videos)
- Genetic test: My journey to some peace of mind (with video)
- Discovering me with the Sanford Chip genetic test (with video)