G C A T T A C G G C A T genes Review Precision and Personalized Medicine: How Genomic Approach Improves the Management of Cardiovascular and Neurodegenerative Disease Oriana Strianese 1,2, Francesca Rizzo 2 , Michele Ciccarelli 3 , Gennaro Galasso 3, Ylenia D’Agostino 2, Annamaria Salvati 2 , Carmine Del Giudice 1, Paola Tesorio 4 and Maria Rosaria Rusciano 1,3,* 1 Clinical Research and Innovation, Clinica Montevergine S.p.A., 83013 Mercogliano, Italy; [email protected] (O.S.); [email protected] (C.D.G.) 2 Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, 84084 Baronissi, Italy; [email protected] (F.R.); [email protected] (Y.D.); [email protected] (A.S.) 3 Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, 84084 Baronissi, Italy; [email protected] (M.C.); [email protected] (G.G.) 4 Unit of Cardiology, Clinica Montevergine S.p.A., 83013 Mercogliano, Italy; [email protected] * Correspondence: [email protected] Received: 18 June 2020; Accepted: 2 July 2020; Published: 6 July 2020 Abstract: Life expectancy has gradually grown over the last century. This has deeply affected healthcare costs, since the growth of an aging population is correlated to the increasing burden of chronic diseases. This represents the interesting challenge of how to manage patients with chronic diseases in order to improve health care budgets. Effective primary prevention could represent a promising route. To this end, precision, together with personalized medicine, are useful instruments in order to investigate pathological processes before the appearance of clinical symptoms and to guide physicians to choose a targeted therapy to manage the patient. Cardiovascular and neurodegenerative diseases represent suitable models for taking full advantage of precision medicine technologies applied to all stages of disease development. The availability of high technology incorporating artificial intelligence and advancement progress made in the field of biomedical research have been substantial to understand how genes, epigenetic modifications, aging, nutrition, drugs, microbiome and other environmental factors can impact health and chronic disorders. The aim of the present review is to address how precision and personalized medicine can bring greater clarity to the clinical and biological complexity of these types of disorders associated with high mortality, involving tremendous health care costs, by describing in detail the methods that can be applied. This might offer precious tools for preventive strategies and possible clues on the evolution of the disease and could help in predicting morbidity, mortality and detecting chronic disease indicators much earlier in the disease course. This, of course, will have a major effect on both improving the quality of care and quality of life of the patients and reducing time efforts and healthcare costs. Keywords: precision medicine; personalized medicine; clinical application; genomics 1. Introduction Over the last century, there has been a gradual increase in average life expectancy [1]. Today, for the first time in history, most people can expect to live into their sixties and beyond. Population aging represents one of the most important demographic features worldwide [2] and it is poised to become one of the most significant social transformations of the twenty-first century, Genes 2020, 11, 747; doi:10.3390/genes11070747 www.mdpi.com/journal/genes Genes 2020, 11, x; doi: FOR PEER REVIEW 2 of 24 poised to become one of the most significant social transformations of the twenty-first century, with implications in all aspects of society [3,4]. One of the major consequences of a rapidly aging Genespopulation2020, 11, 747[5] is the increasing burden of chronic diseases associated with age and related healthcare 2 of 24 costs [6]. The most common chronic diseases linked to an aging society are the following: cardiovascular disease; diabetes; neurodegenerative diseases; most cancers [7]. The management of withcomplex implications chronic diseases in all aspects is becoming of society a serious [3, 4social]. One and of economic the major trouble consequences for the world's of a elderly rapidly aging populationpopulation [ 5and] is represents the increasing a huge burden challenge of chronicfor national diseases and international associated health with age care and budgets related [8]. healthcare costs [6The]. 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