Muthiah Vaduganathan, Geoffrey S. Ginsburg, Arman Qamar and Krishna Aragam (2017). Preparing Fellows for Precision Cardiology: Are We Ready? Journal of the American College of Cardiology, 70(13).
Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, North Carolina
During his 2015 State of the Union address, former U.S. President Barack Obama launched the Precision Medicine Initiative, an innovative and ambitious effort to collect genetic and other health data on 1 million individuals nationwide to spur the development of tailored, patient-specific therapies. On December 13, 2016, the former President signed the 21st Century Cures Act into law, securing $4.8 billion in federal funding to further efforts in building a precision medicine infrastructure. This initiative, together with dedicated funding, has promoted interest in personalized approaches to clinical care and research across disciplines of medicine. Targeted biological therapies are now available in the treatment of various lung cancers and leukemia, while pharmacogenomics have enabled the selection of antiretroviral therapies with minimal side-effect profiles for patients with human immunodeficiency virus.
Similar, but more modest, trends toward precision medicine have been observed in cardiology (1,2). Clinically relevant examples include the discovery of common genetic variants affecting the response to certain cardiovascular drugs (e.g., variation in the SLCO1B1 gene influencing rates of statin-induced myopathy, and variation in the CYP2C19 gene contributing to poor clopidogrel metabolism) (3). Further advancements in next-generation sequencing, other “-omic” sciences, and systems biology and network medicine have shifted the focus beyond single genes and have facilitated a broader integrative understanding of biological pathways influencing therapeutic response. Similarly, our ability to capture dynamic patient data with electronic health records (EHR) and mobile health technologies has furthered the promise of personalized clinical approaches. Despite this progress, the application of these resources and information by practicing cardiologists to individualize therapies has been less robust. It is plausible that providing a more structured training environment may better prepare the next generation of cardiologists to understand the role, limitations, and potential of “precision cardiology” and promote its application into mainstream practice. We identify gaps in the current cardiology fellowship paradigm and discuss potential future directions in advancing training in precision medicine.