Cardiovascular precision medicine: Bad news from the front?

Medical sciences have always been guided by evolving algorithms tailored to identify and stratify disease as well as to account for individual patient circumstances and adjust management accordingly. All interventions and surgical procedures are individualized. Medical practice has always been personalized and will remain so despite guidelines, carefully controlled clinical trials, evidence-based and protocol-based routines that often suggest a seemingly uniform treatment for specific conditions. Another prominent feature of medical science and practice is pragmatism. All theoretical research considerations and drug and technology developments are judged by their ultimate effects on patient and population health. Cardiovascular disease remains the main cause of death impaired quality of life and healthcare resource consumption in the Western world.1,2 In the last 50 years the most important development in medicine in the industrialized world was the decline of cardiovascular disease prevalence and lethality followed by a drop in mortality of some forms of cancer. Underlying this was a holistic prevention, pharmacology and intervention strategy.3,4 During the same period, major developments in biology have brought molecular research and genomics to the limelight of biomedical research. Advances stemming from the human genome project and the molecular biology field enabled affordable high-throughput complete gene analysis5 at many clinical research centres paving the way for integration of genetic data in medical sciences and patient management even for common prevalent conditions such as cardiovascular disease. This has led to the emergence of a new field dubbed precision medicine, first defined by Francis Collins as “using information about a person’s genetic makeup to tailor strategies for the detection, treatment, or prevention of disease”.6 Research in this field has been highly fostered and sponsored worldwide.7 Underlying this new revolutionary