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Genetic Risk and Statin Benefit | Journal Scan
Study Questions:
Does a genetic risk score for coronary artery disease (CAD) predict clinical benefit of statin treatment?
Methods:
Data from several primary and secondary prevention trials with statins, comprising 48,421 individuals with 3,477 events, were analyzed for associations between a genetic risk score (using 27 gene variants) and CAD events. The response to statin therapy was then analyzed based on risk stratified by genetic score.
Results:
A gradient in risk for CAD was demonstrated based on a genetic score with multivariable-adjusted hazard ratios of 1.34 for the intermediate risk group and 1.72 for the high risk group (compared to the low risk group). The relative risk reduction from statin therapy was 13% for the low genetic risk group, 29% for the intermediate risk group, and 48% for the high risk group. There was also greater absolute risk reduction in the high genetic risk groups, resulting in a threefold decrease in the number of subjects needed to treat to prevent one CAD event.
Conclusions:
The authors concluded that a genetic risk score identified individuals at increased risk for both incident and recurrent coronary heart disease events, and that those with the highest genetic risk derived the largest benefit from statin therapy.
Perspective:
Genome-wide association studies have identified genetic variants associated with elevated risk for cardiovascular events. Although effects of these variants may be small, identification of multiple risk variants in an individual may be useful to identify individuals who may benefit from more intensive therapy. This study supports this hypothesis and demonstrates potential clinical utility of genotyping for CAD risk variants. The added contribution and cost-effectiveness of a genetic risk score to other scores currently used to estimate CAD risk will be of interest.
Keywords: Coronary Artery Disease, Coronary Disease, Primary Prevention, Secondary Prevention, Risk, Risk Factors, Genetics, Population, Genotype, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Numbers Needed To Treat
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