Cardiology at the Threshold of a New Biological Era: The Role of Multiomics and Metabolomics.

Modern cardiology is entering a phase where improving the prevention, diagnosis, and treatment of cardiovascular diseases (CVD) necessitates a deeper understanding of the underlying biological mechanisms. The traditional clinical model, relying primarily on analysis of risk factors and phenotypic presentation, is limited in its ability to account for the biological heterogeneity and individual progression of CVD. Advancements in systems biology, molecular medicine, and multiomics technologies allow for viewing CVD as a long-term dynamic biological process that begins well before clinical manifestation. Genomic, proteomic, and metabolomic research is uncovering the molecular and metabolic phenotypes that dictate individual vulnerability of the cardiovascular system, disease progression rates, and variability in therapeutic response. Among multiomics approaches, metabolomics is uniquely positioned to reflect the real-time functional state of biological systems, capturing the interplay between genetic, metabolic, and environmental factors. By identifying early biological signals of disease progression, metabolomic profiling enables precise risk stratification and personalized preventive and therapeutic interventions. Integrating these multiomics insights with clinical data, imaging, and digital monitoring establishes a new paradigm in clinical cardiology: biologically-oriented medicine. Given the high complexity of biological data, artificial intelligence and machine learning methods are essential for uncovering latent correlations between molecular and clinical variables, ultimately enhancing personalized clinical decision support. The transition toward biologically-oriented cardiology carries profound scientific, clinical, and socioeconomic implications. By identifying adverse biological traits early and utilizing personalized prevention of complications, we can substantially reduce the burden of CVD on healthcare systems and society. Ultimately, multiomics and metabolomics are establishing the scientific foundation for a new clinical paradigm focused on early detection of biological risk signals, precise patient phenotyping, and personalized treatment of CVD.