ArticleAmerican journal of preventive cardiology2027
Utility of a coronary artery disease polygenic risk score in a low-risk primary prevention cohort.
Article in American journal of preventive cardiology, 2027. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: To evaluate whether a coronary artery disease (CAD) polygenic risk score (PRS) identifies clinically low-risk individuals at elevated atherosclerotic cardiovascular disease (ASCVD) risk. Methods: We conducted a longitudinal cohort study within the UK Biobank including adults aged 40-74 years, free of ASCVD and diabetes, not on lipid-lowering therapy, and with baseline LDL <190 mg/dL. Participants were enrolled from 2006 to 2010 and followed through 2021. Ten-year ASCVD risk was estimated using pooled cohort equations. A CAD PRS derived from 2.3 million genome-wide variants was categorized as top 1%, 5%, 20%, 50%, and bottom 50%. Lipoprotein(a) and high-sensitivity C-reactive protein were similarly stratified. The primary endpoint was a composite of myocardial infarction, ischemic stroke, or cardiovascular death. Cox proportional hazards models estimated adjusted hazard ratios (HRs) for 10-year ASCVD events, and net reclassification improvement (NRI) was assessed at 5% and 7.5% risk thresholds. Results: Among 266,917 low-risk individuals (median age 54; 38% male), ASCVD risk increased substantially across higher PRS strata. Compared with the bottom 50%, individuals in the top 50% had more than double the risk (aHR 2.48), the top 20% had over triple the risk (aHR 3.71), and the top 5% and 1% had 6-fold (aHR 6.31) and 9-fold (aHR 9.73) higher risks, respectively (all p < 0.0001). Adding PRS improved model discrimination (AUC 0.76 vs 0.72) and reclassified 12% of low-risk individuals upward-over tenfold more than Lp(a) or hs-CRP. Conclusion: In primary prevention, a CAD PRS identifies individuals with markedly higher ASCVD risk despite low clinical risk estimates and may merit consideration among ASCVD risk enhancers.
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