Migration-driven exposome reconfiguration: a predictive, preventive and personalized medicine perspective on cardiometabolic risk

Figures

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  Fig. 1. Immigration factors that may influence increased cardiovascular process. In the pre-migration phase, genetic and environmental factors in the country of origin have important relevance for the risk of developing CVD, including individual behavioral risk factors, access to health care, and community determinants of CVD. During the journey, risks related to injury and violence, psychological distress, mental health disorders, and lack of access to care and, especially, life-sustaining medications, are dominant. The migration process, whether voluntary, forced, or illegal, influences the phenotypic characteristics of those who move, in particular, the likelihood that those with pre-existing CVD will move and survive the journey. In the post-migration phase, risk factors for CVD include the conditions in which migrants live in the host countries, barriers to accessing care, and problems adapting to the prevailing culture

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  Fig. 2. Types of Exposome. (1) General external exposome, encompassing the physical space in which one lives; social environment, being the relationships and social contexts in which groups of people live; physical-chemical environment, chemical or physical agents in our local area; (2) Specific external exposome, being those exposures at the individual level, such as health behaviors, income/financial situation, exposure to pollutants, and lifestyle (smoking, alcohol intake, physical activity), and food environment, encompassing accessibility, availability, and affordability of food in the neighborhood, and (3) Internal exposome, characterized by internal biological processes, including metabolism and microbiome, that can be impacted by external exposures

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  Fig. 3. Migration-related exposome and its implications for cardiometabolic vulnerability within the framework of predictive, preventive and personalized medicine (PPPM/3PM). Migration dynamically reshapes environmental, psychosocial, behavioral, occupational, and sociocultural exposures across the life course. Protective and adverse exposome factors interact with biological mechanisms including oxidative stress, chronic inflammation, neuroendocrine dysregulation, gut microbiota alterations, endothelial dysfunction, metabolic dysfunction, and suboptimal health conditions, thereby influencing cardiometabolic risk in migrant populations. Integration of biomarkers, multi-omics approaches, wearable sensors, geospatial monitoring, artificial intelligence, and digital health technologies may support predictive diagnostics, targeted prevention, and personalized healthcare strategies aimed at reducing long-term cardiovascular vulnerability