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Precision Medicine Trends at ACC 2024: PGx, Polygenic Risk Scores, Lp(a) Testing

Red heart and stethoscope on electrocardiogram report

NEW YORK – The American College of Cardiology's annual scientific meeting will take place in Atlanta from April 6 to 8, during which researchers will share data from more than 4,600 abstracts including several that focus on personalized approaches to treating various heart conditions.  

Researchers will share abstracts in oral presentations and poster sessions that cut across 11 pathways focused on different cardiovascular clinical specialties and practices, including vascular medicine, heart failure and cardiomyopathies, and prevention and health promotion.

US Food and Drug Administration Commissioner Robert Califf will join the conference as a keynote speaker Monday to discuss revamping the clinical evidence system for new therapies, and there will be four other keynote presentations on Saturday and Sunday, in which cardiologists will cover topics like diversity in the cardiology workforce and the business of cardiology.

Based on attendance at past meetings, the ACC is expecting between 16,000 to 18,000 attendees this year, an organization spokesperson said in an email.

"This is just an absolute blockbuster of a year," Douglas Drachman, director of education in the heart center at Massachusetts General Hospital and chair of this year's ACC conference, said during a web briefing with reporters ahead of the event.

There were about 7,600 abstracts submitted to the ACC for consideration, which was 1,100 more than the number of abstracts the organization received in 2023. The organization accepted around 60 percent of the submitted abstracts for this year's meeting. Researchers will present on new drugs, medical devices, and behavioral interventions in 43 late-breaking and featured clinical research sessions.

Most presentations related to precision medicine will take place as part of the prevention and health promotion learning pathway. A committee of physicians and researchers aim to feature abstracts and presentations in this pathway that satisfy attendees' myriad interests in precision medicine, including prevention, and attract those in different cardiovascular subspecialties, said Pradeep Natarajan, director of preventive cardiology at Massachusetts General Hospital and associate professor at Harvard Medical School, who's also a co-coordinator of the prevention and health promotion committee at ACC.

The pathway is "intended to be helpful and useful for the breadth of cardiologists, yet also have sufficient nuance for it to be helpful for specialists," Natarajan told Precision Medicine Online.

For example, more than 20 educational sessions and abstracts specifically mention lipoprotein(a), a type of low-density lipoprotein cholesterol and an established risk factor for atherosclerotic cardiovascular disease. That focus is to be expected, since drugs targeting elevated Lp(a) that promise to treat and perhaps even prevent lipid-related cardiovascular diseases are steadily advancing in clinical trials and many cardiologists are interested in learning more about their activity.

On Saturday, there are multiple poster sessions on using Lp(a) levels as a predictor of cardiovascular events and heart diseases, as well as on the prevalence and effect of testing Lp(a) in different populations. On Sunday, researchers will present posters on the clinical management of patients with elevated Lp(a), including research on whether biomarker levels can be reduced with PCSK9 inhibitors. Investigators on Sunday and Monday will share data from studies in which they evaluated Lp(a) in particular demographic groups, including in South Asian and Black patients.

Other precision medicine topics featured at the conference on Sunday include two moderated poster sessions on pharmacogenomics. In one presentation, researchers will discuss how patients who received genotype-guided P2Y12 inhibitor therapy fared within a pharmacogenomics program, and in another, they will report Black and non-Black patients' clinical outcomes after CYP2C19 genotyping.

Polygenic risk scores, which have been talked about for years, remain a key area of interest for cardiologists. "It's one source of genetics that is relevant to patients broadly," as opposed to topics like Mendelian genetic factors, "which are very important, but relevant to a smaller fraction of patients," Natarajan said. 

As evidence evolves, biotech researchers and healthcare professionals are weighing whether and how to incorporate polygenic risk scores into patient care. In an oral presentation on Sunday, for example, researchers will present data on how accurately a score incorporating social determinants of health and lifestyle factors predicted incidence of coronary heart disease compared to a polygenic risk score.

At poster sessions on Saturday, researchers will present data on polygenic risk scores used to predict incidence of cardiomyopathy and cerebrovascular events in certain patients and to predict baseline preclinical coronary artery disease in patients with HIV. There are two more poster sessions on Monday focused on the use of polygenic risk scores for predicting severe aortic stenosis and coronary artery disease subtypes.

"The evidence around [polygenic risk scores] is becoming increasingly compelling and increasingly relevant for a broad cardiovascular audience," Natarajan said. "It's an area of active research investigation, but it's a very exciting area that may have near-term clinical relevance."