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      Artificial intelligence for cardiovascular disease risk assessment in personalised framework: a scoping review

      review-article
      a , b , b , c , d , e , f , g , h , i , j , k , l , m , n , o , p , a , q , r , s , t , u , v , w , x , y , z , aa , ab , ac , a , l , ad ,
      eClinicalMedicine
      Elsevier
      Artificial intelligence, Cardiovascular diseases, Deep learning, Personalised medicine, Precision medicine

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          Summary

          Background

          The field of precision medicine endeavors to transform the healthcare industry by advancing individualised strategies for diagnosis, treatment modalities, and predictive assessments. This is achieved by utilizing extensive multidimensional biological datasets encompassing diverse components, such as an individual's genetic makeup, functional attributes, and environmental influences. Artificial intelligence (AI) systems, namely machine learning (ML) and deep learning (DL), have exhibited remarkable efficacy in predicting the potential occurrence of specific cancers and cardiovascular diseases (CVD).

          Methods

          We conducted a comprehensive scoping review guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. Our search strategy involved combining key terms related to CVD and AI using the Boolean operator AND. In August 2023, we conducted an extensive search across reputable scholarly databases including Google Scholar, PubMed, IEEE Xplore, ScienceDirect, Web of Science, and arXiv to gather relevant academic literature on personalised medicine for CVD. Subsequently, in January 2024, we extended our search to include internet search engines such as Google and various CVD websites. These searches were further updated in March 2024. Additionally, we reviewed the reference lists of the final selected research articles to identify any additional relevant literature.

          Findings

          A total of 2307 records were identified during the process of conducting the study, consisting of 564 entries from external sites like arXiv and 1743 records found through database searching. After 430 duplicate articles were eliminated, 1877 items that remained were screened for relevancy. In this stage, 1241 articles remained for additional review after 158 irrelevant articles and 478 articles with insufficient data were removed. 355 articles were eliminated for being inaccessible, 726 for being written in a language other than English, and 281 for not having undergone peer review. Consequently, 121 studies were deemed suitable for inclusion in the qualitative synthesis. At the intersection of CVD, AI, and precision medicine, we found important scientific findings in our scoping review. Intricate pattern extraction from large, complicated genetic datasets is a skill that AI algorithms excel at, allowing for accurate disease diagnosis and CVD risk prediction. Furthermore, these investigations have uncovered unique genetic biomarkers linked to CVD, providing insight into the workings of the disease and possible treatment avenues. The construction of more precise predictive models and personalised treatment plans based on the genetic profiles of individual patients has been made possible by the revolutionary advancement of CVD risk assessment through the integration of AI and genomics.

          Interpretation

          The systematic methodology employed ensured the thorough examination of available literature and the inclusion of relevant studies, contributing to the robustness and reliability of the study's findings. Our analysis stresses a crucial point in terms of the adaptability and versatility of AI solutions. AI algorithms designed in non-CVD domains such as in oncology, often include ideas and tactics that might be modified to address cardiovascular problems.

          Funding

          No funding received.

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          Most cited references118

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          Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

          Summary Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5–74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9–19·6), and injuries 8·0% (7·7–8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5–23·9), representing an additional 7·61 million (7·20–8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0–8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0–24·0) and the death rate by 31·8% (30·1–33·3). Total deaths from injuries increased by 2·3% (0·5–4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2–15·1) to 57·9 deaths (55·9–59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000–289 000) globally in 2007 to 352 000 (334 000–363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8–148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2–40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2–36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990—neonatal disorders, lower respiratory infections, and diarrhoeal diseases—were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Funding Bill & Melinda Gates Foundation.
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            Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study

            The Lancet, 349(9064), 1498-1504
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              RNA virus interference via CRISPR/Cas13a system in plants

              Background CRISPR/Cas systems confer immunity against invading nucleic acids and phages in bacteria and archaea. CRISPR/Cas13a (known previously as C2c2) is a class 2 type VI-A ribonuclease capable of targeting and cleaving single-stranded RNA (ssRNA) molecules of the phage genome. Here, we employ CRISPR/Cas13a to engineer interference with an RNA virus, Turnip Mosaic Virus (TuMV), in plants. Results CRISPR/Cas13a produces interference against green fluorescent protein (GFP)-expressing TuMV in transient assays and stable overexpression lines of Nicotiana benthamiana. CRISPR RNA (crRNAs) targeting the HC-Pro and GFP sequences exhibit better interference than those targeting other regions such as coat protein (CP) sequence. Cas13a can also process pre-crRNAs into functional crRNAs. Conclusions Our data indicate that CRISPR/Cas13a can be used for engineering interference against RNA viruses, providing a potential novel mechanism for RNA-guided immunity against RNA viruses and for other RNA manipulations in plants. Electronic supplementary material The online version of this article (doi:10.1186/s13059-017-1381-1) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Journal
                eClinicalMedicine
                EClinicalMedicine
                eClinicalMedicine
                Elsevier
                2589-5370
                27 May 2024
                July 2024
                27 May 2024
                : 73
                : 102660
                Affiliations
                [a ]Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, 95661, USA
                [b ]Bennett University, 201310, Greater Noida, India
                [c ]Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, 110001, India
                [d ]Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, 94574, USA
                [e ]Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Cyprus
                [f ]Department of Pathology, University of Cagliari, Cagliari, Italy
                [g ]Department of Medicine, Division of Cardiology, Queen's University, Kingston, Canada
                [h ]Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Canada
                [i ]Department of Vascular Surgery, University of Lisbon, Lisbon, Portugal
                [j ]Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
                [k ]Department of Food Science and Technology, Graphic Era Deemed to Be University, Dehradun, Uttarakhand, 248002, India
                [l ]Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID, 83209, USA
                [m ]Department of Research and Innovation, Uttaranchal Institute of Technology, Uttaranchal University, Dehradun, 248007, India
                [n ]Division of Cardiovascular Medicine, University of Virginia, Charlottesville, 22901, VA, USA
                [o ]Academic Affairs, Dudley Group NHS Foundation Trust, DY1, Dudley, UK
                [p ]Nephrology Department, Kaiser Permanente, Sacramento, CA, 95823, USA
                [q ]Jio Artificial Intelligence, Centre of Excellence, India
                [r ]Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON, L4Z 4C4, Canada
                [s ]Department of Radiobiology and Molecular Genetics, National Institute of The Republic of Serbia, University of Belgrade, 110010, Serbia
                [t ]Department of Neurology & Stroke Program, University of Maryland, Baltimore, MD, USA
                [u ]SR University, Warangal, Telangana, India
                [v ]Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece
                [w ]Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
                [x ]MV Diabetes Centre, Royapuram, Chennai, Tamil Nadu, 600013, India
                [y ]Department of Radiology, Harvard Medical School, Boston, MA, USA
                [z ]Invasive Cardiology Division, University of Szeged, Szeged, Hungary
                [aa ]Department of Radiology, Azienda Ospedaliero Universitaria, 40138, Cagliari, Italy
                [ab ]Departments of Biomedical and Radiology, Columbia University, New York, NY, USA
                [ac ]Icahn School of Medicine, Mount Sinai, NY, USA
                [ad ]Department of Computer Science, Graphic Era Deemed to Be University, Dehradun, Uttarakhand, 248002, India
                Author notes
                []Corresponding author. Stroke Monitoring and Diagnosis Division, AtheroPoint™, Roseville, CA, 95661, USA. jasjit.suri@ 123456atheropoint.com
                Article
                S2589-5370(24)00239-6 102660
                10.1016/j.eclinm.2024.102660
                11154124
                38846068
                2606fd0b-565e-4b15-a701-c716252c150b
                © 2024 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 10 January 2024
                : 25 April 2024
                : 8 May 2024
                Categories
                Review

                artificial intelligence,cardiovascular diseases,deep learning,personalised medicine,precision medicine

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