Genetics May Revolutionize Cardiovascular Medicine
With further advancements in genetics, early warnings may come for people at risk for CVD.
Researchers have begun to understand the link between certain genetic traits and an increased risk for myocardial infarction (MI), according to Eric Topol, MD, formerly the Chairman of Cardiovascular Medicine at The Cleveland Clinic and recently named Chief Academic Officer and Director of Translational Sciences at the Scripps Research Institute in San Diego, Calif. (see story on page 11).
Topol said progress in genetics “may help to revolutionize the prevention and treatment of coronary diseases in the future and may represent significant advancements for cardiovascular medicine.” Topol also said he expects that in the future, doctors will have the ability to determine which patients possess genetic traits that could put them at an increased risk for an MI later in life. “This will affect our practices in years ahead,” Topol said. “We are moving forward with other genetic studies for myocardial infarction and are looking at thousands of patients to gain a better understanding.”
Unraveling of MI
Topol said researchers have already begun to determine some of the genetic underpinnings related to an increased risk for MI or other coronary disease, “whether it’s the integrity of the artery wall, the diapedesis of LDL and cells across the artery wall or the inflammation within the wall and the plaque rupture erosion and development of thrombosis,” Topol said. “Many genes will come into play, but in the years ahead, the unraveling of MI will be possible.”
Researchers have already determined that some genetic risks for coronary disease may be associated with certain ethnicities. “We know that at least one third to half of patients of Asian ancestry have a marked unresponsiveness to nitrates, which we commonly use in cardiovascular medicine,” he said.
Topol cited an ancestry-specific finding indicating an increased risk for MI in patients with the LTA4 gene mutation (Table). “In European Americans, the risk of heart attack was 19% increased in people with this mutation; in African Americans, the risk was 350% increased and accounted for a much higher proportion of the population’s attributable risk (PAR),” he said.
MEF2A
Topol said that the MEF2A gene deletion represents an increased risk for MI, information gleaned through extensive studies of families in which coronary disease was common. The mutation can be identified in patients of all ages, allowing physicians to give these patients early warning and encourage them to adjust their behavior in ways that could lower their risk of coronary disease.