Precision Medicine for Cardiovascular Prevention and Population Health: A Bridge Too Far?

Circulation, Volume 150, Issue 21, Page 1720-1731, November 19, 2024. Precision medicine aims to provide personalized clinical care guided by tools that reflect underlying pathophysiology. The need for such an approach has never been greater in cardiovascular medicine, given the large number of guideline-directed medical therapies available. However, progress has been modest to date with few precision tools available for clinicians. Arguably, cardiovascular prevention and population health are poised for innovation to guide evaluation and management, as these areas are already informed by risk-assessment, but limited by the use of crude assessment tools with marginal performance. Risk assessment in prevention and population health may be improved with the use of genetics, circulating biomarkers, and imaging, leading to outcome-specific risk-prediction and enhanced phenotyping. Personalized management matching therapy to risk profile can be then implemented for either individuals or groups, improving cost-effectiveness and risk-benefit. Here, we explore this precision-like approach, including available tools, potential applications, and future perspectives for cardiovascular prevention and population health management.

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Novembre 2024

USPSTF Breast Cancer Screening Guidelines Do Not Go Far Enough

The goal of screening for breast cancer is to find it early, before it has spread to lymph nodes, to reduce breast cancer mortality and also to reduce the morbidity of treatment. The updated recommendations from the US Preventive Services Task Force (USPSTF), informed by a decision analysis and comparative effectiveness review, support biennial screening mammography for women aged 40 to 74 years (B recommendation) but conclude that current evidence is insufficient to assess the balance of benefits and harms in women 75 years and older (I statement). These recommendations expand the potential benefits of screening mammography, but they do not go far enough.

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Giugno 2024