Heart Disease :: Genomics to play key role in prevention, therapy

Genetic factors are poised to take a leading role in the prevention and treatment of cardiovascular disease.

?There will be a (genetic test) panel available to tell us which families and which individuals within those families are candidates for myocardial infarct at a very young age,? predicted Eric Topol, M.D., chair of cardiovascular medicine and professor of medicine and genetics at Case Western Reserve University, Cleveland, during a Pre-Sessions Symposium on Resuscitation Science Saturday. ?That will give us the opportunity to change behavior and environmental factors and the course of progression to disease.?

In the past 18 months, genomic researchers have identified heritable links to diabetes, lupus, inflammatory bowel disease, Crohn?s disease, prostate cancer, macular degeneration and now CVD. ?What has changed is the technology needed to decode these relationships,? Dr. Topol said.

New technology has pushed the cost of sequencing a single genome from about $200 million in 2005 to $1.5 million in 2006. Population studies reinforce the notion that heritable factors play a significant role in cardiovascular disease. A report on more than 400 German families with a multigenerational history of myocardial infarct found that not only does the occurrence of MI run in families but so does the location of stenoses.

Researchers have already found four distinct polymorphisms related to the relative risk of myocardial infarct. Variations in the forms of Compliment Factor H, LRP8, the FLAP gene, and Leukotriene A4 hydrolase have been linked with both highly elevated and sharply lowered risk of MI.

Dr. Topol also predicted that genomics will turn the dream of personalized medicine into an everyday clinical reality. Researchers have recently found, for example, specific single nucleotide polymorphisms (SNPs) common to the 30 percent of Asians who exhibit no biological response to nitrates. SNPs related to the Cytochrome PC450 metabolism are linked to markedly differing response rates to clopidogrel and other pharmaceutical agents.

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