The case for precision medicine in the prevention, diagnosis, and treatment of cardiometabolic diseases in low-income and middle-income countries

Publikation: Bidrag til tidsskriftReviewForskningfagfællebedømt

  • Shivani Misra
  • Carlos A. Aguilar-Salinas
  • Tinashe Chikowore
  • Konradsen, Flemming
  • Ronald C.W. Ma
  • Lilian Mbau
  • Viswanathan Mohan
  • Robert W. Morton
  • Moffat J. Nyirenda
  • Neo Tapela
  • Paul W. Franks
Cardiometabolic diseases are the leading preventable causes of death in most geographies. The causes, clinical presentations, and pathogenesis of cardiometabolic diseases vary greatly worldwide, as do the resources and strategies needed to prevent and treat them. Therefore, there is no single solution and health care should be optimised, if not to the individual (ie, personalised health care), then at least to population subgroups (ie, precision medicine). This optimisation should involve tailoring health care to individual disease characteristics according to ethnicity, biology, behaviour, environment, and subjective person-level characteristics. The capacity and availability of local resources and infrastructures should also be considered. Evidence needed for equitable precision medicine cannot be generated without adequate data from all target populations, and the idea that research done in high-income countries will transfer adequately to low-income and middle-income countries (LMICs) is problematic, as many migration studies and transethnic comparisons have shown. However, most data for precision medicine research are derived from people of European ancestry living in high-income countries. In this Series paper, we discuss the case for precision medicine for cardiometabolic diseases in LMICs, the barriers and enablers, and key considerations for implementation. We focus on three propositions: first, failure to explore and implement precision medicine for cardiometabolic disease in LMICs will enhance global health disparities. Second, some LMICs might already be placed to implement cardiometabolic precision medicine under appropriate circumstances, owing to progress made in treating infectious diseases. Third, improvements in population health from precision medicine are most probably asymptotic; the greatest gains are more likely to be obtained in countries where health-care systems are less developed. We outline key recommendations for implementation of precision medicine approaches in LMICs.
TidsskriftThe Lancet Diabetes and Endocrinology
Udgave nummer11
Sider (fra-til)836-847
Antal sider12
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
SM is a Wellcome Trust Career Development Fellow (223024/Z/21/Z) and is supported by the NIHR Imperial Biomedical Research Centre. PWF acknowledges support from the European Research Council (CoG-2015_681742_NASCENT) and the Swedish Research Council (Grants 2014-03529 and 2019-01348). RCWM acknowledges support from the Research Grants Council of the Hong Kong Special Administrative Region (CU R4012–18), and a Croucher Foundation Senior Medical Research Fellowship. VM acknowledges that the Madras Diabetes Research Foundation has been supported by the Indian Council of Medical Research (ICMR) as an ICMR Centre for Advanced Research on Diabetes for its work on precision diabetes and monogenic diabetes. TC is an international training fellow supported by the Wellcome Trust (214205/Z/18/Z).

Publisher Copyright:
© 2023 Elsevier Ltd

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