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Editorials

A Dream, a Journey, and a Promise

The Inauguration of Circulation: Cardiovascular Genetics

Ramachandran S. Vasan, MD and Calum A. MacRae, MD, PhD

From the Framingham Heart Study, Framingham, Mass. and the Cardiovascular Research Center, Massachusetts General Hospital, Boston.

Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mt Wayte Ave, Framingham, MA 01701. E-mail vasan@bu.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The journey of a thousand miles must begin with a single step.

— —Lao-Tzu, Vietnamese philosopher

These are the "best of times." Cardiologists worldwide are fortunate that they can offer much more to their patients today than was possible even a decade ago. Never before has cardiology been on such an exciting trajectory, with such exponential growth of knowledge and the exhilarating promise of harnessing the secrets of the genome to prevent, diagnose, and treat cardiovascular disease and enhance vascular health over the human life course. The future offers the possibility of realizing the dream of practicing personalized preventive cardiovascular medicine.

These are also the most challenging of times. Increased life expectancy has generated an unprecedented growth in the older segment of the population, with the accompanying rising burden of aging-associated cardiovascular disorders. Burgeoning medical knowledge and escalating patient expectations push cardiologists to keep abreast of the latest advances in cardiovascular research as never before. We understand now that common genetic variation may predispose to common forms of cardiovascular disease in the community, and rare genetic conditions provide unique pathogenetic insights into these diseases. The sequential steps in the origins of cardiovascular syndromes are beginning to unfold, revealing the stunning complexities involved in the molecular basis of disease. We are beginning to understand how genetic factors interact with environmental influences over an entire lifetime to pattern and remodel function at the molecular, cellular, tissue, and organ levels and to ultimately manifest as subclinical or clinical cardiovascular disease. Molecular phenotyping of . . . [Full Text of this Article]