RESUMO
Chronic diseases, including obesity, are major causes of morbidity and mortality in most countries. The adverse impacts of obesity and associated comorbidities on health remain a major concern due to the lack of effective interventions for prevention and management. Precision nutrition is an emerging therapeutic approach that takes into account an individual's genetic and epigenetic information, as well as age, gender, or particular physiopathological status. Advances in genomic sciences are contributing to a better understanding of the role of genetic variants and epigenetic signatures as well as gene expression patterns in the development of diverse chronic conditions, and how they may modify therapeutic responses. This knowledge has led to the search for genetic and epigenetic biomarkers to predict the risk of developing chronic diseases and personalizing their prevention and treatment. Additionally, original nutritional interventions based on nutrients and bioactive dietary compounds that can modify epigenetic marks and gene expression have been implemented. Although caution must be exercised, these scientific insights are paving the way for the design of innovative strategies for the control of chronic diseases accompanying obesity. This document provides a number of examples of the huge potential of understanding nutrigenetic, nutrigenomic, and nutriepigenetic roles in precision nutrition.
Assuntos
Nutrigenômica/métodos , Obesidade/dietoterapia , Obesidade/genética , Doença Crônica , Epigênese Genética , Marcadores Genéticos , Humanos , Obesidade/complicações , Polimorfismo de Nucleotídeo Único , Medicina de Precisão/métodos , Prevenção Primária/métodos , TranscriptomaRESUMO
Apixaban is approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrialfibrillation. However, the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation(ARISTOTLE) trial included a substantial number of patients with valvular heart disease and only excluded patients withclinically significant mitral stenosis or mechanical prosthetic heart valves.Methods and ResultsWe compared the effect of apixaban and warfarin on rates of stroke or systemic embolism, majorbleeding, and death in patients with and without moderate or severe valvular heart disease using Cox proportional hazardsmodeling. Of the 18 201 patients enrolled in ARISTOTLE, 4808 (26.4%) had a history of moderate or severe valvular heartdisease or previous valve surgery. Patients with valvular heart disease had higher rates of stroke or systemic embolismand bleeding than patients without valvular heart disease. There was no evidence of a differential effect of apixaban overwarfarin in patients with and without valvular heart disease in reducing stroke and systemic embolism (hazard ratio [HR],0.70; 95% confidence interval [CI], 0.510.97 and HR, 0.84; 95%, CI 0.671.04; interaction P=0.38), causing less majorbleeding (HR, 0.79; 95% CI, 0.611.04 and HR, 0.65; 95% CI, 0.550.77; interaction P=0.23), and reducing mortality(HR, 1.01; 95% CI, 0.841.22 and HR, 0.84; 95% CI, 0.730.96; interaction P=0.10).ConclusionsMore than a quarter of the patients in ARISTOTLE with nonvalvular atrial fibrillation had moderate or severevalvular heart disease. There was no evidence of a differential effect of apixaban over warfarin in reducing stroke orsystemic embolism, causing less bleeding, and reducing death in patients with and without valvular heart disease.