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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Genetic information is being increasingly used as part of individual clinical care&#44; and genomic medicine is having an impact in several medical fields&#44; especially in rare and undiagnosed diseases but also in oncology&#44; pharmacology&#44; and cardiology&#44; among others&#46; The ability to use genomic information to improve health is a direct result of the Human Genome Project &#40;HGP&#41;&#44; but translation of new discoveries into use in patient care can take years&#46; Since completion of the HGP the focus has been on understanding how variations in an individual&#39;s DNA may affect disease and health&#44; clarifying disease etiologies and prognosis&#44; identifying variants that confer disease susceptibility&#44; and improving the efficacy and safety of pharmacological treatments&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Discoveries in cardiovascular genetics are increasingly moving from bench to bedside and becoming more and more relevant to the clinical management of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This field encompasses a wide variety of inherited cardiac conditions&#44; including monogenic diseases such as various channelopathies and cardiomyopathies&#44; and&#44; although still at a very early stage&#44; some disorders with a more complex inheritance pattern&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Myocardial infarction &#40;MI&#41; is a complex multifactorial disorder caused by the interaction of environmental and genetic factors&#46; It is the most severe type of coronary artery disease &#40;CAD&#41; and one of the leading causes of death worldwide&#46; Several risk factors for MI have been identified&#44; particularly hypertension&#44; dyslipidemia&#44; diabetes and smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Various studies have also addressed the importance of genetic factors&#44; but despite the progress in cardiovascular genetics&#44; data on the genetic background of MI are still limited and somewhat inconsistent&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Clinical and population-based studies have long shown that a positive family history for MI is a major cardiovascular risk factor&#46; However&#44; the heterogeneity of CAD and its clinical complications introduce significant complexity in genetic studies&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and the range of genes underlying the heritable component of MI is not fully known&#46; The Coronary ARtery DIsease Genome wide Replication and Meta-analysis plus The Coronary Artery Disease &#40;CARDIoGRAMplusC4D&#41; consortium is an example of a collaborative effort to combine data from multiple large-scale genetic studies to identify risk loci for CAD and MI&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Current knowledge of genetic variants affecting risk of CAD is largely based on analysis of common single-nucleotide polymorphisms &#40;SNPs&#41; in genome-wide association studies&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Several genetic loci have been associated with CAD and it appears that genetic susceptibility to this common disease is largely determined by common SNPs of small effect size&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> In the context of CAD and MI&#44; as for other disorders with complex inheritance patterns&#44; it is also important to consider epigenetic mechanisms that regulate the expression of these genes&#44; and interactions between multiple genes and between these genes and environmental factors&#44; as well as isolated genetic risk factors&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Knowledge of the genetic factors associated with the risk of MI is of particular importance for clinical management&#46; Coronary atherosclerosis underlies the occurrence of MI in the majority of cases&#44; and factors such as plaque vulnerability and the extent of thrombotic reaction to plaque disruption may predispose to MI in the presence of CAD&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> It is accepted that the rupture of a vulnerable atherosclerotic plaque&#44; local activation of thrombotic mechanisms with or without severe underlying stenosis&#44; local thrombosis formation and arterial lumen closure are the mechanisms most often underlying acute MI&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the current issue of the <span class="elsevierStyleItalic">Journal</span>&#44; Pina-Cabral et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> analyze the potential role of eight polymorphisms in four genes coding for platelet receptors&#44; <span class="elsevierStyleItalic">GP1BA</span>&#44; <span class="elsevierStyleItalic">ITGB3</span>&#44; <span class="elsevierStyleItalic">ITGA2</span> and <span class="elsevierStyleItalic">P2RY12</span>&#44; as risk factors for MI&#46; It is known that platelet G protein-coupled receptors are critical regulators of platelet function&#44; and it has been hypothesized that increased platelet activity at the site of atherosclerotic plaque rupture may result in MI&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Pina-Cabral et al&#46;&#8217;s study has several limitations that are clearly stated by the authors&#44; including the low numbers of patients and polymorphisms studied and heterogeneity between the control and MI groups&#44; which limit the conclusions of the study&#46; Despite its limitations&#44; the paper assesses these polymorphisms in a Portuguese population and underlines the importance of fully understanding the genetic factors and molecular mechanisms behind the pathogenesis of MI&#44; highlighting the need for further studies addressing genetic risk factors for MI&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Previously&#44; genetic testing was based on conventional techniques like Sanger sequencing&#44; analyzing genes one by one&#44; but recent advances in DNA sequencing technologies have made it possible to investigate large numbers of disease genes simultaneously&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> These new sequencing methods&#44; known as next-generation sequencing &#40;NGS&#41;&#44; are able to maximize the number of bases sequenced in the least amount of time&#44; generating a wealth of data that can be used to understand complex phenotypes&#46; These techniques are providing researchers and clinicians with a variety of tools to probe genomes in greater depth&#44; leading to an enhanced understanding of how genome sequence variants underlie phenotype and disease&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Not surprisingly&#44; clinical screening tools for whole-exome or genome sequencing are now entering the clinical domain&#44; and the results they generate are beginning to be used by different medical specialties&#44; including cardiology&#46; With this in mind&#44; as a final remark&#44; it is important to emphasize that as genetic testing advances and NGS technologies become more accessible and affordable&#44; training in cardiovascular genetics will be critical to ensure that the cardiological community is able to provide effective high-quality care for patients and families&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Editorial comment
Genetics and myocardial infarction
Genética e enfarte do miocárdio
Joana Barbosa Melo
Laboratório de Citogenética e Genómica, CNC.IBILI, CIMAGO, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Genetic information is being increasingly used as part of individual clinical care&#44; and genomic medicine is having an impact in several medical fields&#44; especially in rare and undiagnosed diseases but also in oncology&#44; pharmacology&#44; and cardiology&#44; among others&#46; The ability to use genomic information to improve health is a direct result of the Human Genome Project &#40;HGP&#41;&#44; but translation of new discoveries into use in patient care can take years&#46; Since completion of the HGP the focus has been on understanding how variations in an individual&#39;s DNA may affect disease and health&#44; clarifying disease etiologies and prognosis&#44; identifying variants that confer disease susceptibility&#44; and improving the efficacy and safety of pharmacological treatments&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Discoveries in cardiovascular genetics are increasingly moving from bench to bedside and becoming more and more relevant to the clinical management of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This field encompasses a wide variety of inherited cardiac conditions&#44; including monogenic diseases such as various channelopathies and cardiomyopathies&#44; and&#44; although still at a very early stage&#44; some disorders with a more complex inheritance pattern&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Myocardial infarction &#40;MI&#41; is a complex multifactorial disorder caused by the interaction of environmental and genetic factors&#46; It is the most severe type of coronary artery disease &#40;CAD&#41; and one of the leading causes of death worldwide&#46; Several risk factors for MI have been identified&#44; particularly hypertension&#44; dyslipidemia&#44; diabetes and smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Various studies have also addressed the importance of genetic factors&#44; but despite the progress in cardiovascular genetics&#44; data on the genetic background of MI are still limited and somewhat inconsistent&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Clinical and population-based studies have long shown that a positive family history for MI is a major cardiovascular risk factor&#46; However&#44; the heterogeneity of CAD and its clinical complications introduce significant complexity in genetic studies&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and the range of genes underlying the heritable component of MI is not fully known&#46; The Coronary ARtery DIsease Genome wide Replication and Meta-analysis plus The Coronary Artery Disease &#40;CARDIoGRAMplusC4D&#41; consortium is an example of a collaborative effort to combine data from multiple large-scale genetic studies to identify risk loci for CAD and MI&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Current knowledge of genetic variants affecting risk of CAD is largely based on analysis of common single-nucleotide polymorphisms &#40;SNPs&#41; in genome-wide association studies&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Several genetic loci have been associated with CAD and it appears that genetic susceptibility to this common disease is largely determined by common SNPs of small effect size&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> In the context of CAD and MI&#44; as for other disorders with complex inheritance patterns&#44; it is also important to consider epigenetic mechanisms that regulate the expression of these genes&#44; and interactions between multiple genes and between these genes and environmental factors&#44; as well as isolated genetic risk factors&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Knowledge of the genetic factors associated with the risk of MI is of particular importance for clinical management&#46; Coronary atherosclerosis underlies the occurrence of MI in the majority of cases&#44; and factors such as plaque vulnerability and the extent of thrombotic reaction to plaque disruption may predispose to MI in the presence of CAD&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> It is accepted that the rupture of a vulnerable atherosclerotic plaque&#44; local activation of thrombotic mechanisms with or without severe underlying stenosis&#44; local thrombosis formation and arterial lumen closure are the mechanisms most often underlying acute MI&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the current issue of the <span class="elsevierStyleItalic">Journal</span>&#44; Pina-Cabral et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> analyze the potential role of eight polymorphisms in four genes coding for platelet receptors&#44; <span class="elsevierStyleItalic">GP1BA</span>&#44; <span class="elsevierStyleItalic">ITGB3</span>&#44; <span class="elsevierStyleItalic">ITGA2</span> and <span class="elsevierStyleItalic">P2RY12</span>&#44; as risk factors for MI&#46; It is known that platelet G protein-coupled receptors are critical regulators of platelet function&#44; and it has been hypothesized that increased platelet activity at the site of atherosclerotic plaque rupture may result in MI&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Pina-Cabral et al&#46;&#8217;s study has several limitations that are clearly stated by the authors&#44; including the low numbers of patients and polymorphisms studied and heterogeneity between the control and MI groups&#44; which limit the conclusions of the study&#46; Despite its limitations&#44; the paper assesses these polymorphisms in a Portuguese population and underlines the importance of fully understanding the genetic factors and molecular mechanisms behind the pathogenesis of MI&#44; highlighting the need for further studies addressing genetic risk factors for MI&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Previously&#44; genetic testing was based on conventional techniques like Sanger sequencing&#44; analyzing genes one by one&#44; but recent advances in DNA sequencing technologies have made it possible to investigate large numbers of disease genes simultaneously&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> These new sequencing methods&#44; known as next-generation sequencing &#40;NGS&#41;&#44; are able to maximize the number of bases sequenced in the least amount of time&#44; generating a wealth of data that can be used to understand complex phenotypes&#46; These techniques are providing researchers and clinicians with a variety of tools to probe genomes in greater depth&#44; leading to an enhanced understanding of how genome sequence variants underlie phenotype and disease&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Not surprisingly&#44; clinical screening tools for whole-exome or genome sequencing are now entering the clinical domain&#44; and the results they generate are beginning to be used by different medical specialties&#44; including cardiology&#46; With this in mind&#44; as a final remark&#44; it is important to emphasize that as genetic testing advances and NGS technologies become more accessible and affordable&#44; training in cardiovascular genetics will be critical to ensure that the cardiological community is able to provide effective high-quality care for patients and families&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Article information
ISSN: 21742049
Original language: English
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Revista Portuguesa de Cardiologia (English edition)
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