A polygenic score (PGS) for coronary artery disease (CAD) could help identify patients most likely to benefit from early interventions to prevent cardiovascular disease, according to a study presented March 28 during a Featured Clinical Research session during ACC.20/WCC.

Brian A Ference MD, MPhil, MSc, FACC, et al., evaluated the lifetime risk of cardiovascular disease at all levels of the PGS for CAD depending on differences in exposure to LDL-C and systolic blood pressure (SBP). The primary outcome was major coronary events, defined as the first occurrence of fatal or nonfatal myocardial infarction (MI) or coronary revascularization. Participants were placed into quintiles based on PGS. The researchers also looked at how PGS for CAD could be combined with information about LDL-C and SBP to modify therapy and inform treatment decisions.

The study population consisted of 445,566 participants, 54% of whom were women. The mean age at enrollment was 57.2 years, while the mean LDL-C and SBP were 138 mg/dL and 137.8 mm Hg, respectively. In the lowest quintile, all participants had a 3.1% risk of a major coronary event, while the risk in the highest quintile was 8%. Without considering lifetime exposure to LDL-C and SBP, participants in the lowest PGS quintile who had elevated LDL-C and SBP had higher lifetime and short-term risks of a major coronary event compared with participants in the highest quintile who had low LDL-C and SBP. Lowering LDL-C by 30% reduced risk of cardiovascular events across all quintiles, but the clinical benefit was greatest for patients with higher LDL-C in the highest quintile.

According to the researchers, lifetime risk of cardiovascular disease varies across all PGS levels depending on differences in lifetime exposure to LDL-C and SBP. Combining information about lifetime exposure to LDL-C and SBP with a PGS for CAD could help more accurately estimate lifetime cardiovascular risk and identify patients who might benefit from early interventions, they conclude.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Lipid Metabolism, Acute Heart Failure

Keywords: ACC Annual Scientific Session, acc20, Blood Pressure, Cardiovascular Diseases, Lipoproteins, LDL, Arteriosclerosis, Geriatrics, Dyslipidemias, Primary Prevention, Heart Failure

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