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

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.

Informations de copyright

Copyright © 2023 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests The views expressed in this Series paper do not necessarily reflect those of the institutions to which the authors are affiliated. SM received investigator-initiated research funds from DexCom and is a Trustee of the Diabetes Research and Wellness Foundation. RCWM received research funding from AstraZeneca, Bayer, Novo Nordisk, Pfizer, Roche Diagnostics, and Tricida for carrying out clinical trials, and has received speaker honorarium or consultancy in advisory boards from AstraZeneca, Bayer, Boehringer Ingelheim, Merck, and Kyowa Kirin. All proceeds have been donated to the Chinese University of Hong Kong to support diabetes research. RCWM is a cofounder of GemVCare, a diabetes technology start-up established through support from the Hong Kong Government Technology Start-up Support Scheme for Universities. PWF has received consultancy fees from Zoe. FK, RWM, and PWF are employees of the Novo Nordisk Foundation. TC reports honoraria for the Wellcome Connecting Science Human Genomic Epidemiology, Asia, 2022 conference. VM reports research grants from Novo Nordisk, Johnson and Johnson, Abbott, LifeScan, Lilly, Merck Sharp and Dohme, and Novartis, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novo Nordisk, Johnson and Johnson, Abbott, AstraZeneca, Boehringer Ingelheim, LifeScan, Lilly, MSD, Novartis, Sanofi-Aventis, and Indian pharmaceutical companies including USV, Biocon, Dr Reddy's Laboratories, and Roche Diabetes Care India. All other authors declare no competing interests.