Personalized Preventive Medicine

Abstract

The long asymptomatic period before the onset of chronic diseases offers an opportunity for disease prevention. Many chronic diseases may be prevented by avoiding those factors that trigger the disease process (primary prevention) or by use of therapy that modulates the disease process before the onset of clinical symptoms (secondary prevention). Prediction is important for disease prevention so that preemptive treatment can be given to those individuals who are most likely to develop the disease. Genomics and genetics are vital for the development of preventive medicine. Current practice of preventive healthcare involves general advice applicable to the population at large, e.g., dietary measures to lower cholesterol. Integration of new genetic information into epidemiologic studies can help clarify causal relations between both life-style and genetic factors and risks of disease. An example is prevention of atherosclerosis where multiple factors interplay in the etiology. Since atherosclerosis involves arterial inflammation, a polymorphism in the 5-lipoxygenase gene promoter could relate to atherosclerosis in humans and that this effect could interact with the dietary intake of competing 5-lipoxygenase substrates. Inflammatory mediators, leukotrienes, are generated from arachidonic acid (polyunsaturated n-6 fatty acid) by the enzyme 5-lipoxygenase. Variant 5-lipoxygenase genotypes identify a subpopulation with increased atherosclerosis (Dwyer et al. 2004). The observed diet-gene interactions further suggest that dietary n-6 polyunsaturated fatty acids promote, whereas marine n-3 fatty acids inhibit, leukotriene-mediated inflammation that leads to atherosclerosis in this subpopulation. These findings could lead to new dietary and targeted molecular approaches to the prevention and treatment of cardiovascular disease according to genotype, particularly in populations of non-European descent.