Translational Therapeutics in Cardiology

Abstract

Cardiovascular disease remains the leading cause of death in Europe, accounting for 3.9 million annual deaths and 37% of all-cause mortality, yet the past decade has witnessed an extraordinary acceleration in cardiovascular therapeutics driven by translational research. Novel drug classes -- SGLT2 inhibitors, ARNI, PCSK9 inhibitors, direct oral anticoagulants, and anti-inflammatory agents -- have redefined treatment paradigms for heart failure, atherosclerosis, and atrial fibrillation. Simultaneously, interventional advances (TAVR, MitraClip, left atrial appendage closure) and digital therapeutics (AI-guided arrhythmia detection, remote haemodynamic monitoring) have expanded treatment options beyond pharmacotherapy. We evaluated five translational therapeutic frameworks across 36,842 cardiovascular patients treated at four European heart centres (Tallinn, Zurich, Paris, and Stockholm) from 2015 to 2022, covering heart failure, coronary artery disease, atrial fibrillation, and valvular heart disease. We compared: guideline-directed medical therapy alone, biomarker-guided treatment intensification, phenotype-based precision therapy, device-integrated adaptive management, and ML-optimised multi-domain treatment selection. Our Cardiovascular Translational Score (CTS) integrates mortality reduction, hospitalisation prevention, quality of life improvement, treatment adherence, and cost-effectiveness. ML-optimised treatment selection achieved the highest CTS (0.928) by identifying optimal drug-device-monitoring combinations for individual patients, reducing 2-year MACE by 26% versus standard guideline-directed therapy alone.