An increasingly personalised approach to medicine

Risposta: In recent years, medicine has emphasised the concept of not merely treating a disease, but of caring for the person affected by that disease, taking into account their complexity, age and life experiences. Personalised medicine stems precisely from this principle: every patient is different. Every patient is different because the same condition, when characterised in depth, can reveal different prognostic aspects. Furthermore, two patients with the same diagnosis may have very different clinical outcomes, as an individual’s overall clinical profile can vary significantly. Even today, key treatment decisions are based on general guidelines, developed from large patient populations. These guidelines remain fundamental, but are increasingly being supplemented by a precise assessment of the individual patient. In fact, cardiologists take numerous factors into account in their clinical decisions: from age and gender, to comorbidities and functional status, to the presence of specific disease biomarkers and, in some cases, the patient’s genetic profile.

From a pharmacological perspective, any decision must take into account the presence of any comorbidities, which may alter both the patient’s risk profile and the expected benefit of treatment. Associated conditions, such as kidney failure, lung diseases or other chronic illnesses, can influence the choice of medication, the dosage and the most appropriate treatment strategy. Treatment must therefore be tailored to the individual, taking into account the balance between efficacy, safety and quality of life. The intensity of treatment must also be tailored to individual risk. One example is cholesterol management: we now have medicines that are highly effective at reducing so-called ‘bad cholesterol’, but the level of treatment must be proportionate to the individual patient’s overall cardiovascular risk. A person who has already had a heart attack will have stricter and more demanding treatment targets than someone with no previous cardiovascular history. Treatment is therefore tailored to the individual, taking into account the expected benefit and the balance between efficacy and safety.

This approach applies not only to drug therapies, but also to the choice of the most appropriate interventional treatments. In recent years, particularly in the management of valvular heart disease, the range of percutaneous treatment options – which are less invasive than traditional surgery – has expanded considerably. In certain age groups, there is now genuine competition between different treatment strategies, making the decision-making process more complex and personalised. The patient’s case, for example, is discussed within the Heart Team, a collaborative forum bringing together professionals with complementary expertise, who integrate clinical data, radiological images and detailed anatomical information specific to the individual patient. This multidisciplinary discussion, combined with the centre’s expertise, enables the most appropriate treatment to be identified, whilst also taking the patient’s preferences into account when several options are available. Personalised medicine therefore does not simply mean choosing the most suitable medication or procedure, but rather developing a shared treatment plan.

Personalisation also stems from the growing ability to characterise the disease in individual patients with ever-greater precision. One example is the genetic characterisation of certain conditions, such as cardiomyopathies, which allows for a more accurate diagnosis and a better assessment of the risk associated with specific mutations, providing information that was not available until a few years ago. Genetics can also, in some cases, help to predict the response to certain drug therapies, such as some antiplatelet therapies, making it possible to integrate this information with the patient’s clinical profile and their risk of ischaemia or haemorrhage.

Technological and biological progress is constantly evolving, and cardiology in the future will be increasingly focused on personalised care, through the integration of clinical data, biomarkers, genetics and digital technologies.