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Clinical Characteristics and Burden of Risk Factors Among Patients With Early Onset Acute Coronary Syndromes: The ANZACS-QI New Zealand National Cohort (ANZACS-QI 17). Heart Lung Circ 2018; 27:568-575. [DOI: 10.1016/j.hlc.2017.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 03/02/2017] [Accepted: 04/23/2017] [Indexed: 01/09/2023]
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152
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4550] [Impact Index Per Article: 758.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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153
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Guggenheim JA, Ghorbani Mojarrad N, Williams C, Flitcroft DI. Genetic prediction of myopia: prospects and challenges. Ophthalmic Physiol Opt 2018; 37:549-556. [PMID: 28836387 DOI: 10.1111/opo.12403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/07/2017] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Cathy Williams
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - D Ian Flitcroft
- Department of Ophthalmology, Children's University Hospital, Dublin, Ireland
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154
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Novel and Emerging Biomarkers with Risk Predictive Utility for Atherosclerotic Cardiovascular Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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155
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Hindy G, Wiberg F, Almgren P, Melander O, Orho-Melander M. Polygenic Risk Score for Coronary Heart Disease Modifies the Elevated Risk by Cigarette Smoking for Disease Incidence. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2018; 11:e001856. [PMID: 29874179 PMCID: PMC6319562 DOI: 10.1161/circgen.117.001856] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/20/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Coronary heart disease (CHD) is a multifactorial disease with both genetic and environmental components. Smoking is the most important modifiable risk factor for CHD. Our aim was to test whether the increased CHD incidence by smoking is modified by genetic predisposition to CHD. METHODS AND RESULTS Our study included 24 443 individuals from the MDCS (Malmö Diet and Cancer Study). A weighted polygenic risk score (PRS) was created by summing the number of risk alleles for 50 single-nucleotide polymorphisms associated with CHD. Individuals were classified as current, former, or never smokers. Interactions were primarily tested between smoking status and PRS and secondarily with individual single-nucleotide polymorphisms. Then, the predictive use of PRS for CHD incidence was tested among different smoking categories. During a median follow-up time of 19.4 years, 3217 incident CHD cases were recorded. The association between smoking and CHD was modified by the PRS (Pinteraction=0.005). The magnitude of increased incidence of CHD by smoking was highest among individuals in the lowest tertile of PRS (odds ratio, 1.42; 95% confidence interval, 1.29-1.56 per smoking risk category) compared with the highest tertile (odds ratio, 1.20; 95% confidence interval, 1.11-1.30 per smoking risk category). This interaction was stronger among men (Pinteraction=0.001) compared with women (Pinteraction=0.44). The PRS provided a significantly better net reclassification and discrimination on top of traditional risk factors among never smokers compared with current smokers (P<0.001). CONCLUSIONS Genetic predisposition to CHD modifies the associated increased CHD risk by smoking. The PRS has a better predictive use among never smokers compared with smokers.
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Affiliation(s)
- George Hindy
- From the Department of Clinical Sciences in Malmö, Lund University, Sweden (G.H., F.W., P.A., O.M., M.O.-M.); and Program in Medical and Population Genetics, The Broad Institute, Cambridge, MA (G.H.)
| | - Frans Wiberg
- From the Department of Clinical Sciences in Malmö, Lund University, Sweden (G.H., F.W., P.A., O.M., M.O.-M.); and Program in Medical and Population Genetics, The Broad Institute, Cambridge, MA (G.H.)
| | - Peter Almgren
- From the Department of Clinical Sciences in Malmö, Lund University, Sweden (G.H., F.W., P.A., O.M., M.O.-M.); and Program in Medical and Population Genetics, The Broad Institute, Cambridge, MA (G.H.)
| | - Olle Melander
- From the Department of Clinical Sciences in Malmö, Lund University, Sweden (G.H., F.W., P.A., O.M., M.O.-M.); and Program in Medical and Population Genetics, The Broad Institute, Cambridge, MA (G.H.)
| | - Marju Orho-Melander
- From the Department of Clinical Sciences in Malmö, Lund University, Sweden (G.H., F.W., P.A., O.M., M.O.-M.); and Program in Medical and Population Genetics, The Broad Institute, Cambridge, MA (G.H.).
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156
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Abstract
PURPOSE OF REVIEW The current review is to describe the genetic risk variants that have been discovered predisposing to coronary artery disease (CAD) and how they are utilized to stratify for risk of CAD. RECENT FINDINGS Over 90 genetic risk variants have been discovered that predispose to risk for CAD. SUMMARY The total genetic risk burden for CAD is proportional to the number of risk variants inherited and can be combined into a single number referred to as the genetic risk score (GRS). GRS has been utilized in multiple studies and shown to be more effective in risk stratification for CAD than conventional risk factors. There is a major advantage to risk stratification based on the GRS since the risk can be determined at birth or anytime throughout one's lifetime since the individual's DNA does not change. Widespread application of the GRS is likely to enable a paradigm shift in the primary prevention of CAD.
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157
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Genome-Wide Association Studies and Risk Scores for Coronary Artery Disease: Sex Biases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:627-642. [PMID: 30051411 DOI: 10.1007/978-3-319-77932-4_38] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Phenotypic sex differences in coronary artery disease (CAD) and its risk factors have been apparent for many decades in basic and clinical research; however, whether these are also present at the gene level and thus influence genome-wide association and genetic risk prediction studies has often been ignored. From fundamental and medical standpoints, this is critically important to assess in order to fully understand the underlying genetic architecture that predisposes to CAD and better predict disease outcomes based on the interaction between genes, sex effects, and environment. In this chapter we aimed to (1) integrate the history and latest research from genome-wide association studies for CAD and clinical and genetic risk scores for prediction of CAD, (2) highlight sex-specific differences in these areas of research, and (3) discuss reasons why sex differences have often not been considered and, where present, why sex differences exist at genetic and phenotypic levels and how important they are for consideration in future research. While we find interesting examples of sex differences in effects of genetic variants on CAD, genome-wide association and genetic risk studies have typically not tested for sex-specific effects despite mounting evidence from diverse fields that these are likely very important to consider at both the genetic and phenotypic levels. In-depth testing for sex effects in large-scale genome-wide association studies that include autosomal and often excluded sex chromosomes alongside parallel improvements in resolution of sex-specific differences for risk factors and disease outcomes for CAD has the potential to substantially improve clinical and genetic risk prediction studies. Developing sex-tailored genetic risk scores as has been done recently for other disorders might be also warranted for CAD. In the era of precision medicine, this level of accuracy is essential for such a common and costly disease.
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158
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Beaney K, Drenos F, Humphries SE. How close are we to implementing a genetic risk score for coronary heart disease? Expert Rev Mol Diagn 2017; 17:905-915. [DOI: 10.1080/14737159.2017.1368388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katherine Beaney
- Centre for Cardiovascular Genetics, BHF Laboratories, Institute of Cardiovascular Science, University College London, London, UK
| | - Fotios Drenos
- Centre for Cardiovascular Genetics, BHF Laboratories, Institute of Cardiovascular Science, University College London, London, UK
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Steve E. Humphries
- Centre for Cardiovascular Genetics, BHF Laboratories, Institute of Cardiovascular Science, University College London, London, UK
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159
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Genética de la cardiopatía isquémica: del conocimiento actual a las implicaciones clínicas. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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160
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Fujino N, Yoshimuta T, Ichida F, Kinugawa K, Usuda K, Kitayama M, Ino H, Kawashiri MA, Tada H, Mizuno S, Hayashi K, Takemura H, Yamagishi M. Overview of the 81 st Annual Scientific Meeting of the Japanese Circulation Society - Cardiovascular Medicine for the Next Generation. Circ J 2017; 81:1261-1267. [PMID: 28794386 DOI: 10.1253/circj.cj-17-0706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The 81stAnnual Scientific Meeting of the Japanese Circulation Society was held in Kanazawa, Japan, on March 17-19, 2017 under a miraculously clear sky. The frontlines of healthcare and medicine are dramatically changing. Thus, "Cardiovascular Medicine for Next Generation" was chosen as the main theme of this meeting. The program was constructed around major identified issues, including renewal of our understanding of basic cardiovascular medicine, translational research, and preventive molecular medicine, all of which are anticipated to transcend the medical field over the next generation. Despite the provincial location, 15,672 participants, including more than 400 from overseas countries, attended the 3-day meeting, and there were in-depth discussions in the various sessions. In particular, to our great pleasure, Her Imperial Highness Princess Takamado kindly attended the opening ceremony and extended congratulations to us. The meeting successfully completed and we sincerely appreciate the great cooperation and support from all affiliates.
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Affiliation(s)
- Noboru Fujino
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Tsuyoshi Yoshimuta
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Fukiko Ichida
- Department of Pediatrics, Faculty of Medicine, University of Toyama
| | - Koichiro Kinugawa
- Internal Medicine II, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Kazuo Usuda
- Division of Cardiology, Toyama Prefectural Central Hospital
| | | | - Hidekazu Ino
- Department of Internal Medicine, Komatsu Municipal Hospital
| | - Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Sumio Mizuno
- Department of Cardiology, Fukui Cardiovascular Center
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
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161
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Roberts R. Genetics-Current and Future Role in the Prevention and Management of Coronary Artery Disease. Curr Atheroscler Rep 2017; 18:78. [PMID: 27815829 DOI: 10.1007/s11883-016-0628-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The purpose of this study is to review genetic risk variants for coronary artery disease (CAD) and how they will change the management and prevention of CAD currently and in the future. RECENT FINDINGS Through the efforts of international consortia, 58 genetic risk variants for CAD of genome-wide significance have been replicated in appropriate independent populations. Only one third of these variants mediate their risk through known conventional risk factors for CAD. Thus, unknown mechanisms contribute to CAD. Secondly, the genetic risk is proportional to the total number of risk variants rather than the intensity of any risk factor. Thirdly, the availability of the genetic risk variants enables one to perform Mendelian randomization (MR) studies since they are randomized at conception, not confounded, fixed for life, and can be used to determine if a risk factor is causative or just a marker. MR can also be used to determine the safety and efficacy of a gene product targeted for drug therapy. Genetic risk variants have been shown to successfully risk stratify for CAD in both primary and secondary preventions. Contrary to dogma, MR documents that plasma HDL-C is not protective of CAD. The use of genetic risk score (GRS) for CAD is shown to be more effective in risk stratifying for CAD than the Framingham risk score and independent of the conventional risk factors including family history. Furthermore, the GRS predicts the response to statin therapy in primary and secondary preventions. The use of GRS could represent a paradigm shift in the prevention of CAD.
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Affiliation(s)
- Robert Roberts
- University of Arizona College of Medicine-Phoenix, 550 East Van Buren, Phoenix, AZ, 85004, USA.
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162
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Knowles JW, Zarafshar S, Pavlovic A, Goldstein BA, Tsai S, Li J, McConnell MV, Absher D, Ashley EA, Kiernan M, Ioannidis JPA, Assimes TL. Impact of a Genetic Risk Score for Coronary Artery Disease on Reducing Cardiovascular Risk: A Pilot Randomized Controlled Study. Front Cardiovasc Med 2017; 4:53. [PMID: 28856136 PMCID: PMC5558259 DOI: 10.3389/fcvm.2017.00053] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/31/2017] [Indexed: 01/29/2023] Open
Abstract
Purpose We tested whether providing a genetic risk score (GRS) for coronary artery disease (CAD) would serve as a motivator to improve adherence to risk-reducing strategies. Methods We randomized 94 participants with at least moderate risk of CAD to receive standard-of-care with (N = 49) or without (N = 45) their GRS at a subsequent 3-month follow-up visit. Our primary outcome was change in low density lipoprotein cholesterol (LDL-C) between the 3- and 6-month follow-up visits (ΔLDL-C). Secondary outcomes included other CAD risk factors, weight loss, diet, physical activity, risk perceptions, and psychological outcomes. In pre-specified analyses, we examined whether there was a greater motivational effect in participants with a higher GRS. Results Sixty-five participants completed the protocol including 30 participants in the GRS arm. We found no change in the primary outcome between participants receiving their GRS and standard-of-care participants (ΔLDL-C: −13 vs. −9 mg/dl). Among participants with a higher GRS, we observed modest effects on weight loss and physical activity. All other secondary outcomes were not significantly different, including anxiety and worry. Conclusion Adding GRS to standard-of-care did not change lipids, adherence, or psychological outcomes. Potential modest benefits in weight loss and physical activity for participants with high GRS need to be validated in larger trials.
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Affiliation(s)
- Joshua W Knowles
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Shirin Zarafshar
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Aleksandra Pavlovic
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Sandra Tsai
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States.,Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States
| | - Jin Li
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael V McConnell
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Devin Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, United States
| | - Euan A Ashley
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States.,Department of Genetics, Stanford University School of Medicine, Stanford, CA, United States
| | - Michaela Kiernan
- Stanford University School of Medicine, Stanford Prevention Research Center, Stanford, CA, United States
| | - John P A Ioannidis
- Stanford University School of Medicine, Stanford Prevention Research Center, Stanford, CA, United States.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, United States
| | - Themistocles L Assimes
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
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163
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Roberts R. A Breakthrough in Genetics and its Relevance to Prevention of Coronary Artery Disease in LMIC. Glob Heart 2017; 12:247-257. [PMID: 28756179 DOI: 10.1016/j.gheart.2017.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/10/2017] [Indexed: 01/27/2023] Open
Abstract
More than 60 genetic risk variants predisposing to coronary artery disease (CAD) have been confirmed. The genetic risk for CAD is related to the number of genetic risk variants present and can be expressed as a genetic risk score (GRS), by summing the product of the number of high-risk variants inherited by each individual times the log of the odds ratio. Studies show risk stratification for CAD, based on the GRS, is more discriminatory than conventional risk factors and predicts the response to statin therapy. A prospective trial showed individuals with high GRS had 91% greater risk of cardiac events, and individuals with a healthy lifestyle had 46% fewer cardiac events than an unfavorable lifestyle. GRS remains the same throughout one's lifetime because your deoxyribonucleic acid does not change. GRS, determined as early as birth from saliva, is inexpensive and could transform the prevention of CAD in low- and middle-income countries.
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Affiliation(s)
- Robert Roberts
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
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164
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Lüscher TF. Risk assessement and its management: from SCORE to statins, ezetimibe to PCSK inhibitors. Eur Heart J 2017; 38:2233-2236. [DOI: 10.1093/eurheartj/ehx435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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165
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Genetics: Implications for Prevention and Management of Coronary Artery Disease. J Am Coll Cardiol 2017; 68:2797-2818. [PMID: 28007143 DOI: 10.1016/j.jacc.2016.10.039] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/12/2016] [Accepted: 10/24/2016] [Indexed: 12/21/2022]
Abstract
An exciting new era has dawned for the prevention and management of coronary artery disease (CAD) utilizing genetic risk variants. The recent identification of over 60 susceptibility loci for CAD confirms not only the importance of established risk factors, but also the existence of many novel causal pathways that are expected to improve our understanding of the genetic basis of CAD and facilitate the development of new therapeutic agents over time. Concurrently, Mendelian randomization studies have provided intriguing insights on the causal relationship between CAD-related traits, and highlight the potential benefits of long-term modifications of risk factors. Last, genetic risk scores of CAD may serve not only as prognostic, but also as predictive markers, and carry the potential to considerably improve the delivery of established prevention strategies. This review will summarize the evolution and discovery of genetic risk variants for CAD and their current and future clinical applications.
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166
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Elosua R, Sayols-Baixeras S. The Genetics of Ischemic Heart Disease: From Current Knowledge to Clinical Implications. ACTA ACUST UNITED AC 2017. [PMID: 28623161 DOI: 10.1016/j.rec.2017.02.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ischemic heart disease continues to cause high morbidity and mortality. Its prevalence is expected to increase due to population aging, and its prevention is a major goal of health policies. The risk of developing ischemic heart disease is related to a complex interplay between genetic, environmental, and lifestyle factors. In the last decade, considerable progress has been made in knowledge of the genetic architecture of this disease. This narrative review provides an overview of current knowledge of the genetics of ischemic heart disease and of its translation to clinical practice: identification of new therapeutic targets, assessment of the causal relationship between biomarkers and disease, improved risk prediction, and identification of responders and nonresponders to specific drugs (pharmacogenomics).
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Affiliation(s)
- Roberto Elosua
- Grupo de Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
| | - Sergi Sayols-Baixeras
- Grupo de Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain; Departamento de Ciencias de la Salud y de la Vida, Universidad Pompeu Fabra, Barcelona, Spain
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167
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Girelli D, Piubelli C, Martinelli N, Corrocher R, Olivieri O. A decade of progress on the genetic basis of coronary artery disease. Practical insights for the internist. Eur J Intern Med 2017; 41:10-17. [PMID: 28395986 DOI: 10.1016/j.ejim.2017.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 12/24/2022]
Abstract
Clinicians are well aware of the importance of a positive family history for coronary artery disease (CAD). Nonetheless, elucidation of the genetic basis of CAD has long proven difficult. The scenario changed in the last decade through the application of modern genomic technologies, like genome-wide association studies (GWAS) and next generation sequencing (NGS). GWAS have discovered over 60 common variants highly associated with CAD. For predictive purposes, such variants have been used to build up Genetic Risk Scores (GRSs), but their incorporation into classical prediction models does not appear substantially outperform the simple addition of family history. To date, the only strong case for the utility of incorporating genetic testing into clinical practice is represented by the diagnosis of Familial Hypercholesterolemia (FH). On the other hand, utilization of genomic techniques has driven formidable advances into the knowledge of CAD pathophysiology, particularly by addressing controversies on the causality of some lipid fractions that had long remained unsolved because of limitations of observational epidemiology. For example, NGS-derived rare variants with strong functional effects on key-genes like ANGPTL4, APOA5, APOC3, LPL, and SCARB1, have proven useful as proxies to demonstrate the causality of triglyceride-rich lipoproteins (TRLs) at variance with HDL-cholesterol concentration, thus contributing to tear down a dogma from classical epidemiology. Moreover, such variants have paved the way for the development of new biologic drugs (i.e. monoclonal antibodies or antisense oligonucleotides) targeting key proteins like PCSK9, Lipoprotein(a), and apolipoprotein C3. Such drugs are currently under active investigation, with first results being extremely promising.
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Affiliation(s)
- Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Italy.
| | - Chiara Piubelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Italy
| | - Nicola Martinelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Italy
| | - Roberto Corrocher
- Department of Medicine, Section of Internal Medicine, University of Verona, Italy
| | - Oliviero Olivieri
- Department of Medicine, Section of Internal Medicine, University of Verona, Italy
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168
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Pereira A, Mendonca MI, Sousa AC, Borges S, Freitas S, Henriques E, Rodrigues M, Freitas AI, Guerra G, Ornelas I, Pereira D, Brehm A, Palma Dos Reis R. Genetic risk score and cardiovascular mortality in a southern european population with coronary artery disease. Int J Clin Pract 2017; 71. [PMID: 28503909 DOI: 10.1111/ijcp.12956] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/25/2017] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED Several genetic risk scores (GRS) have been associated with cardiovascular disease; their role, however, in survival from proven coronary artery disease (CAD) have yielded conflicting results. OBJECTIVE The objective of this study was to evaluate long-term cardiovascular mortality according to the genetic risk score in a Southern European population with CAD. METHODS A cohort of 1464 CAD patients with angiographic proven CAD were followed up prospectively for up to 58.3 (interquartile range: 25.8-88.1) months. Genotyping of 32 single-nucleotide polymorphisms previously associated with CAD was performed using oligonucleotides probes marked with fluorescence for each allele. GRS was constructed according to the additive model assuming codominance and categorised using the median (=26). Cox Regression analysis was performed to determine independent multivariate predictors of cardiovascular mortality. Kaplan-Meier survival curves compared high vs low GRS using log-rank test. C-index was done for our population, as a measure of discrimination in survival analysis model. RESULTS During a mean follow-up of 58.3 months, 156 patients (10.7%) died, 107 (7.3%) of CV causes. High GRS (≥26) was associated with reduced cardiovascular survival. Survival analysis with Cox regression model adjusted for 8 variables showed that high GRS, dyslipidemia, diabetes and 3-vessel disease were independent risk factors for cardiovascular mortality (HR=1.53, P=.037; HR=3.64, P=.012; HR=1.75, P=.004; HR=2.97, P<.0001, respectively). At the end of follow-up, the estimated survival probability was 70.8% for high GRS and 80.8% for low GRS (Log-rank test 5.6; P=.018). C-Index of 0.71 was found when GRS was added to a multivariate survival model of diabetes, dyslipidemia, smoking, hypertension and 3 vessel disease, stable angina and dual antiplatelet therapy. CONCLUSIONS Besides the classical risk factors management, this work highlights the relevance of the genetic profile in survival from CAD. It is expected that new therapies will be dirsected to gene targets with proven value in cardiovascular survival.
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Affiliation(s)
- Andreia Pereira
- Research Unit and Cardiology Department, Funchal Hospital Center, Avenida Luís de Camões, Funchal, Portugal
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisboa, Portugal
| | - Maria Isabel Mendonca
- Research Unit and Cardiology Department, Funchal Hospital Center, Avenida Luís de Camões, Funchal, Portugal
| | - Ana Célia Sousa
- Research Unit and Cardiology Department, Funchal Hospital Center, Avenida Luís de Camões, Funchal, Portugal
| | - Sofia Borges
- Research Unit and Cardiology Department, Funchal Hospital Center, Avenida Luís de Camões, Funchal, Portugal
| | - Sónia Freitas
- Research Unit and Cardiology Department, Funchal Hospital Center, Avenida Luís de Camões, Funchal, Portugal
| | - Eva Henriques
- Research Unit and Cardiology Department, Funchal Hospital Center, Avenida Luís de Camões, Funchal, Portugal
| | - Mariana Rodrigues
- Research Unit and Cardiology Department, Funchal Hospital Center, Avenida Luís de Camões, Funchal, Portugal
| | - Ana Isabel Freitas
- Laboratório de Genética Humana, Universidade da Madeira, Campus da Penteada, Funchal, Portugal
| | - Graça Guerra
- Laboratório de Genética Humana, Universidade da Madeira, Campus da Penteada, Funchal, Portugal
| | - Ilídio Ornelas
- Research Unit and Cardiology Department, Funchal Hospital Center, Avenida Luís de Camões, Funchal, Portugal
| | - Décio Pereira
- Research Unit and Cardiology Department, Funchal Hospital Center, Avenida Luís de Camões, Funchal, Portugal
| | - António Brehm
- Laboratório de Genética Humana, Universidade da Madeira, Campus da Penteada, Funchal, Portugal
| | - Roberto Palma Dos Reis
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisboa, Portugal
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169
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Khera AV, Kathiresan S. Genetics of coronary artery disease: discovery, biology and clinical translation. Nat Rev Genet 2017; 18:331-344. [PMID: 28286336 PMCID: PMC5935119 DOI: 10.1038/nrg.2016.160] [Citation(s) in RCA: 382] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Coronary artery disease is the leading global cause of mortality. Long recognized to be heritable, recent advances have started to unravel the genetic architecture of the disease. Common variant association studies have linked approximately 60 genetic loci to coronary risk. Large-scale gene sequencing efforts and functional studies have facilitated a better understanding of causal risk factors, elucidated underlying biology and informed the development of new therapeutics. Moving forwards, genetic testing could enable precision medicine approaches by identifying subgroups of patients at increased risk of coronary artery disease or those with a specific driving pathophysiology in whom a therapeutic or preventive approach would be most useful.
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Affiliation(s)
- Amit V Khera
- Division of Cardiology, Department of Medicine and Center for Genomic Medicine, Massachusetts General Hospital; Cardiovascular Disease Initiative, Broad Institute of Harvard and Massachusetts Institute of Technology, 185 Cambridge Street, CPZN 5.252, Boston, Massachusetts 02114, USA
| | - Sekar Kathiresan
- Division of Cardiology, Department of Medicine and Center for Genomic Medicine, Massachusetts General Hospital; Cardiovascular Disease Initiative, Broad Institute of Harvard and Massachusetts Institute of Technology, 185 Cambridge Street, CPZN 5.252, Boston, Massachusetts 02114, USA
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170
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Thomas MR, Lip GYH. Novel Risk Markers and Risk Assessments for Cardiovascular Disease. Circ Res 2017; 120:133-149. [PMID: 28057790 DOI: 10.1161/circresaha.116.309955] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/01/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022]
Abstract
The use of risk markers has transformed cardiovascular medicine, exemplified by the routine assessment of troponin, for both diagnosis and assessment of prognosis in patients with chest pain. Clinical risk factors form the basis for risk assessment of cardiovascular disease and the addition of biochemical, cellular, and imaging parameters offers further refinement. Identifying novel risk factors may allow greater risk stratification and a steady, but gradual progression toward precision medicine. Indeed, the generation of data in this area of research is explosive and when combined with new technologies and techniques provides the potential for more refined, targeted approaches to cardiovascular medicine. Although discussing the most recent developments in this field, this review article aims to strike a balance between novelty and validity by focusing on recent large sample-size studies that have been validated in a separate cohort in most cases. Risk markers related to atherosclerosis, thrombosis, inflammation, cardiac injury, and fibrosis are introduced in the context of their pathophysiology. Rapidly developing new areas, such as assessment of micro-RNA, are also explored. Subsequently the prognostic ability of these risk markers in coronary artery disease, heart failure, and atrial fibrillation is discussed in detail.
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Affiliation(s)
- Mark R Thomas
- From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, United Kingdom (M.R.T., G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Gregory Y H Lip
- From the University of Birmingham Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, United Kingdom (M.R.T., G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).
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171
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Svensson T, Kitlinski M, Engström G, Melander O. A genetic risk score for CAD, psychological stress, and their interaction as predictors of CAD, fatal MI, non-fatal MI and cardiovascular death. PLoS One 2017; 12:e0176029. [PMID: 28426714 PMCID: PMC5398707 DOI: 10.1371/journal.pone.0176029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/04/2017] [Indexed: 11/18/2022] Open
Abstract
Background Psychological stress is an independent risk factor for cardiovascular disease (CVD), but the mechanism by which stress is associated with CVD is not entirely understood. Although genetic factors are implied in both stress responsivity and cardiovascular reactivity, no studies to date have investigated their interactions with stress for cardiovascular end points. The objective was to elucidate the association and interactions between a genetic risk score (GRS), individual genetic variants and stress for three cardiovascular end points: coronary artery disease (CAD), fatal myocardial infarction (MI), non-fatal MI, and cardiovascular death. Methods and findings 18,559 participants from the Malmö Diet Cancer Study, a population-based prospective study, were included in the analyses. Cox proportional hazards regression models were used and adjusted for a large number of known predictors of cardiovascular end points. Mean follow-up time in years was 14.6 (CAD; n = 1938), 14.8 (fatal MI; n = 436), 14.8 (non-fatal MI; n = 1108), and 15.1 (cardiovascular death; n = 1071) respectively. GRS was significantly associated with increased risks of CAD (top quartile hazard ratio [HR], 1.72; 95% confidence interval [CI], 1.51–1.96), fatal MI (top quartile HR, 1.62; 95%CI, 1.23–2.15), non-fatal MI (top quartile HR, 1.55; 95%CI, 1.31–1.84), and cardiovascular death (top quartile HR, 1.29; 95%CI, 1.08–1.53). Stress was not independently associated with any end point and did not interact with GRS. Four individual genetic variants interacted unfavorably with stress for end points with mortality outcomes. Conclusion A GRS composed of 50 SNPs and predictive of CAD was found for the first time to also strongly predict fatal MI, non-fatal MI and cardiovascular death. A stress-sensitive component of the GRS was isolated on the basis of individual genetic variants that interacted unfavorably with stress.
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Affiliation(s)
- Thomas Svensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Mariusz Kitlinski
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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172
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Corella D, Coltell O, Mattingley G, Sorlí JV, Ordovas JM. Utilizing nutritional genomics to tailor diets for the prevention of cardiovascular disease: a guide for upcoming studies and implementations. Expert Rev Mol Diagn 2017; 17:495-513. [PMID: 28337931 DOI: 10.1080/14737159.2017.1311208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Personalized diets based on an individual's genome to optimize the success of dietary intervention and reduce genetic cardiovascular disease (CVD) risk, is one of the challenges most frequently discussed in the scientific community. Areas covered: The authors gathered literature-based evidence on nutritional genomics and CVD phenotypes, our own results and research experience to provide a critical overview of the current situation of using nutritional genomics to tailor diets for CVD prevention and to propose guidelines for future studies and implementations. Expert commentary: Hundreds of studies on gene-diet interactions determining CVD intermediate (plasma lipids, hypertension, etc.) and final phenotypes (stroke, etc.) have furnished top-level scientific evidence for claiming that the genetic effect in cardiovascular risk is not deterministic, but can be modified by diet. However, despite the many results obtained, there are still gaps in practically applying a personalized diet design to specific genotypes. Hence, a better systemization and methodological improvement of new studies is required to obtain top-level evidence that will allow their application in the future precision nutrition/medicine. The authors propose several recommendations for tackling new approaches and applications.
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Affiliation(s)
- Dolores Corella
- a Department of Preventive Medicine and Public Health, School of Medicine , University of Valencia , Valencia , Spain.,b CIBER Fisiopatología de la Obesidad y Nutrición , Instituto de Salud Carlos III , Madrid , Spain
| | - Oscar Coltell
- b CIBER Fisiopatología de la Obesidad y Nutrición , Instituto de Salud Carlos III , Madrid , Spain.,c Department of Computer Languages and Systems, School of Technology and Experimental Sciences , Universitat Jaume I , Castellón , Spain
| | - George Mattingley
- a Department of Preventive Medicine and Public Health, School of Medicine , University of Valencia , Valencia , Spain
| | - José V Sorlí
- a Department of Preventive Medicine and Public Health, School of Medicine , University of Valencia , Valencia , Spain.,b CIBER Fisiopatología de la Obesidad y Nutrición , Instituto de Salud Carlos III , Madrid , Spain
| | - Jose M Ordovas
- d Nutrition and Genomics Laboratory , JM-USDA Human Nutrition Research Center on Aging at Tufts University , Boston , MA , USA
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173
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Abstract
PURPOSE OF REVIEW Genome-wide association studies (GWAS) have identified ∼60 loci for coronary artery disease (CAD). Through genetic risk scores (GRSs), investigators are leveraging this genomic information to gain insights on both the fundamental mechanisms driving these associations as well as their utility in improving risk prediction. RECENT FINDINGS GRSs of CAD track with the earliest atherosclerosis lesions in the coronary including fatty streaks and uncomplicated raised lesions. In multiple cohort studies, they predict incident CAD events independent of all traditional and lifestyle risk factors. The incorporation of SNPs with suggestive but not genome-wide association in GWAS into GRSs often increases the strength of these associations. GRS may also predict recurrent events and identify patients most likely to respond to statins. The effect of the GRS on discrimination metrics remains modest but the minimal degree of improvement needed for clinical utility is unknown. SUMMARY Most novel loci for CAD identified through GWAS facilitate the formation of coronary atherosclerosis and stratify individuals based on their underlying burden of coronary atherosclerosis. GRSs may one day be routinely used in clinical practice to not only assess the risk of incident events but also to predict who will respond best to established prevention strategies.
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Affiliation(s)
- Themistocles L. Assimes
- Department of Medicine, Stanford University, Stanford,
California, USA
- Stanford Cardiovascular Institute, Stanford University,
Stanford, California, USA
| | - Elias L. Salfati
- Department of Medicine, Stanford University, Stanford,
California, USA
- Stanford Cardiovascular Institute, Stanford University,
Stanford, California, USA
| | - Liana Del Gobbo
- Department of Medicine, Stanford University, Stanford,
California, USA
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174
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Fritz J, Shiffman D, Melander O, Tada H, Ulmer H. Metabolic Mediators of the Effects of Family History and Genetic Risk Score on Coronary Heart Disease-Findings From the Malmö Diet and Cancer Study. J Am Heart Assoc 2017; 6:JAHA.116.005254. [PMID: 28320750 PMCID: PMC5524031 DOI: 10.1161/jaha.116.005254] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Family history of coronary heart disease (CHD) as well as genetic predisposition to CHD assessed by a genetic risk score (GRS) are predictors of CHD risk. It is, however, uncertain to what extent these risk predictors are mediated by major metabolic pathways. Methods and Results Total effects of self‐reported family history and a 50‐variant GRS (GRS50), as well as effects mediated by apolipoprotein B and A‐I (apoB, apoA‐I), blood pressure, and diabetes mellitus, on incidence of CHD were estimated in 23 595 participants of the Malmö Diet and Cancer study (a prospective, population‐based study). During a median follow‐up of 14.4 years, 2213 participants experienced a first CHD event. Family history of CHD and GRS50 (highest versus other quintiles) were associated with incident CHD, with hazard ratios of 1.52 (95% CI: 1.39–1.65) and 1.53 (95% CI: 1.39–1.68), respectively, after adjusting for age, sex, and smoking status. Small proportions of the family history effect were mediated by metabolic risk factors: 8.3% (95% CI: 5.8–11.7%) by the apoB pathway, 1.7% (95% CI: 0.2–3.4%) by apoA‐I, 8.5% (95% CI: 5.9–12.0%) by blood pressure, and 1.5% (95% CI: −0.8% to 3.8%) by diabetes mellitus. Similarly, small proportions of GRS50 were mediated: 8.1% (95% CI: 5.5–11.8%) by apoB, 1.2% (95% CI: 0.5–3.0%) by apoA‐I, 4.2% (95% CI: 1.3–7.5%) by blood pressure, and −0.9% (95% CI: −3.7% to 1.6%) by diabetes mellitus. Conclusions A fraction of the CHD risk associated with family history or with GRS50 is mediated through elevated blood lipids and hypertension, but not through diabetes mellitus. However, a major part (≥80%) of the genetic effect operates independently of established metabolic risk factor pathways.
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Affiliation(s)
- Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria
| | | | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria
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175
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Tada H, Kawashiri MA, Yamagishi M. Clinical Perspectives of Genetic Analyses on Dyslipidemia and Coronary Artery Disease. J Atheroscler Thromb 2017; 24:452-461. [PMID: 28250266 PMCID: PMC5429159 DOI: 10.5551/jat.rv17002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We have learned that low-density lipoprotein (LDL) cholesterol is the cause of atherosclerosis from various aspects, including a single case with familial hypercholesterolemia, other cases with different types of Mendelian dyslipidemias, large-scale randomized controlled trials using LDL cholesterol lowering therapies, and Mendelian randomization studies using common as well as rare variants associated with LDL cholesterol levels. There is no doubt that determinations of genotypes in lipid-associated genes have contributed not only to the genetic diagnosis for Mendelian dyslipidemias but also to the discoveries of novel therapeutic targets. Furthermore, recent studies have shown that such genetic information could provide useful clues for the risk prediction as well as risk stratification in general and in particular population. We provide the current understanding of genetic analyses relating to plasma lipids and coronary artery disease.
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Affiliation(s)
- Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
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176
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Natarajan P, Young R, Stitziel NO, Padmanabhan S, Baber U, Mehran R, Sartori S, Fuster V, Reilly DF, Butterworth A, Rader DJ, Ford I, Sattar N, Kathiresan S. Polygenic Risk Score Identifies Subgroup With Higher Burden of Atherosclerosis and Greater Relative Benefit From Statin Therapy in the Primary Prevention Setting. Circulation 2017; 135:2091-2101. [PMID: 28223407 DOI: 10.1161/circulationaha.116.024436] [Citation(s) in RCA: 348] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 02/17/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Relative risk reduction with statin therapy has been consistent across nearly all subgroups studied to date. However, in analyses of 2 randomized controlled primary prevention trials (ASCOT [Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm] and JUPITER [Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin]), statin therapy led to a greater relative risk reduction among a subgroup at high genetic risk. Here, we aimed to confirm this observation in a third primary prevention randomized controlled trial. In addition, we assessed whether those at high genetic risk had a greater burden of subclinical coronary atherosclerosis. METHODS We studied participants from a randomized controlled trial of primary prevention with statin therapy (WOSCOPS [West of Scotland Coronary Prevention Study]; n=4910) and 2 observational cohort studies (CARDIA [Coronary Artery Risk Development in Young Adults] and BioImage; n=1154 and 4392, respectively). For each participant, we calculated a polygenic risk score derived from up to 57 common DNA sequence variants previously associated with coronary heart disease. We compared the relative efficacy of statin therapy in those at high genetic risk (top quintile of polygenic risk score) versus all others (WOSCOPS), as well as the association between the polygenic risk score and coronary artery calcification (CARDIA) and carotid artery plaque burden (BioImage). RESULTS Among WOSCOPS trial participants at high genetic risk, statin therapy was associated with a relative risk reduction of 44% (95% confidence interval [CI], 22-60; P<0.001), whereas in all others, the relative risk reduction was 24% (95% CI, 8-37; P=0.004) despite similar low-density lipoprotein cholesterol lowering. In a study-level meta-analysis across the WOSCOPS, ASCOT, and JUPITER primary prevention, relative risk reduction in those at high genetic risk was 46% versus 26% in all others (P for heterogeneity=0.05). Across all 3 studies, the absolute risk reduction with statin therapy was 3.6% (95% CI, 2.0-5.1) among those in the high genetic risk group and 1.3% (95% CI, 0.6-1.9) in all others. Each 1-SD increase in the polygenic risk score was associated with 1.32-fold (95% CI, 1.04-1.68) greater likelihood of having coronary artery calcification and 9.7% higher (95% CI, 2.2-17.8) burden of carotid plaque. CONCLUSIONS Those at high genetic risk have a greater burden of subclinical atherosclerosis and derive greater relative and absolute benefit from statin therapy to prevent a first coronary heart disease event. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00738725 (BioImage) and NCT00005130 (CARDIA). WOSCOPS was carried out and completed before the requirement for clinical trial registration.
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Affiliation(s)
- Pradeep Natarajan
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Robin Young
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Nathan O Stitziel
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Sandosh Padmanabhan
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Usman Baber
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Roxana Mehran
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Samantha Sartori
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Valentin Fuster
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Dermot F Reilly
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Adam Butterworth
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Daniel J Rader
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Ian Ford
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Naveed Sattar
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.)
| | - Sekar Kathiresan
- From Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.); Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (P.N., S.K.); Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.); Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, United Kingdom (R.Y., A.B.); Division of Statistical Genetics, Department of Genetics, Cardiovascular Division, Department of Medicine, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO (N.O.S.); British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (S.P., N.S.), and Robertson Centre for Biostatistics (I.F.), University of Glasgow, United Kingdom; Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (S.P.); Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., R.M., S.S., V.F.); Genetics and Pharmacogenomics Department, Merck Sharpe & Dohme Corp, Boston, MA (D.F.R.); and Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.J.R.).
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177
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A 45-SNP genetic risk score is increased in early-onset coronary artery disease but independent of familial disease clustering. Atherosclerosis 2017; 257:172-178. [DOI: 10.1016/j.atherosclerosis.2017.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/16/2016] [Accepted: 01/12/2017] [Indexed: 12/28/2022]
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178
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Consensus statement on the management of dyslipidaemias in adults. ANNALES D'ENDOCRINOLOGIE 2017; 78:43-53. [DOI: 10.1016/j.ando.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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179
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Ho-Le TP, Center JR, Eisman JA, Nguyen HT, Nguyen TV. Prediction of Bone Mineral Density and Fragility Fracture by Genetic Profiling. J Bone Miner Res 2017; 32:285-293. [PMID: 27649491 DOI: 10.1002/jbmr.2998] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/10/2016] [Accepted: 09/18/2016] [Indexed: 12/22/2022]
Abstract
Although the susceptibility to fracture is partly determined by genetic factors, the contribution of newly discovered genetic variants to fracture prediction is still unclear. This study sought to define the predictive value of a genetic profiling for fracture prediction. Sixty-two bone mineral density (BMD)-associated single-nucleotide polymorphisms (SNPs) were genotyped in 557 men and 902 women who had participated in the Dubbo Osteoporosis Epidemiology Study. The incidence of fragility fracture was ascertained from X-ray reports between 1990 and 2015. Femoral neck BMD was measured by dual-energy X-ray absorptiometry. A weighted polygenic risk score (genetic risk score [GRS]) was created as a function of the number of risk alleles and their BMD-associated regression coefficients for each SNP. The association between GRS and fracture risk was assessed by the Cox proportional hazards model. Individuals with greater GRS had lower femoral neck BMD (p < 0.01), but the variation in GRS accounted for less than 2% of total variance in BMD. Each unit increase in GRS was associated with a hazard ratio of 1.20 (95% CI, 1.04 to 1.38) for fracture, and this association was independent of age, prior fracture, fall, and in a subset of 33 SNPs, independent of femoral neck BMD. The significant association between GRS and fracture was observed for the vertebral and wrist fractures, but not for hip fracture. The area under the receiver-operating characteristic (ROC) curve (AUC) for the model with GRS and clinical risk factors was 0.71 (95% CI, 0.68 to 0.74). With GRS, the correct reclassification of fracture versus nonfracture ranged from 12% for hip fracture to 23% for wrist fracture. A genetic profiling of BMD- associated genetic variants could improve the accuracy of fracture prediction over and above that of clinical risk factors alone, and help stratify individuals by fracture status. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Thao P Ho-Le
- Centre for Health Technologies, University of Technology, Sydney, Australia
| | - Jacqueline R Center
- Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent Clinical School, University of New South Wales, Darlinghurst, Australia
| | - John A Eisman
- Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent Clinical School, University of New South Wales, Darlinghurst, Australia.,School of Medicine, Notre Dame University Australia, Sydney, Australia
| | - Hung T Nguyen
- Centre for Health Technologies, University of Technology, Sydney, Australia
| | - Tuan V Nguyen
- Centre for Health Technologies, University of Technology, Sydney, Australia.,Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia.,St Vincent Clinical School, University of New South Wales, Darlinghurst, Australia.,School of Medicine, Notre Dame University Australia, Sydney, Australia.,School of Public Health and Community Medicine, University of New South Wales, Darlinghurst, Australia
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180
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Assessment of the clinical utility of adding common single nucleotide polymorphism genetic scores to classical risk factor algorithms in coronary heart disease risk prediction in UK men. ACTA ACUST UNITED AC 2017; 55:1605-1613. [DOI: 10.1515/cclm-2016-0984] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/28/2017] [Indexed: 01/01/2023]
Abstract
AbstractBackground:Risk prediction algorithms for coronary heart disease (CHD) are recommended for clinical use. However, their predictive ability remains modest and the inclusion of genetic risk may improve their performance.Methods:QRISK2 was used to assess CHD risk using conventional risk factors (CRFs). The performance of a 19 single nucleotide polymorphism (SNP) gene score (GS) for CHD including variants identified by genome-wide association study and candidate gene studies (weighted using the results from the CARDIoGRAMplusC4D meta-analysis) was assessed using the second Northwick Park Heart Study (NPHSII) of 2775 healthy UK men (284 cases). To improve the GS, five SNPs with weak evidence of an association with CHD were removed and replaced with seven robustly associated SNPs – giving a 21-SNP GS.Results:The weighted 19 SNP GS was associated with lipid traits (p<0.05) and CHD after adjustment for CRFs, (OR=1.31 per standard deviation, p=0.03). Addition of the 19 SNP GS to QRISK2 showed improved discrimination (area under the receiver operator characteristic curve 0.68 vs. 0.70 p=0.02), a positive net reclassification index (0.07, p=0.04) compared to QRISK2 alone and maintained good calibration (p=0.17). The 21-SNP GS was also associated with CHD after adjustment for CRFs (OR=1.39 per standard deviation, 1.42×10Conclusions:The 19-SNP GS is robustly associated with CHD and showed potential clinical utility in the UK population.
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181
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Börnigen D, Karakas M, Zeller T. The challenges of genetic risk scores for the prediction of coronary heart disease. ACTA ACUST UNITED AC 2017; 55:1450-1452. [DOI: 10.1515/cclm-2017-0330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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182
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Khera AV, Emdin CA, Drake I, Natarajan P, Bick AG, Cook NR, Chasman DI, Baber U, Mehran R, Rader DJ, Fuster V, Boerwinkle E, Melander O, Orho-Melander M, Ridker PM, Kathiresan S. Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease. N Engl J Med 2016; 375:2349-2358. [PMID: 27959714 PMCID: PMC5338864 DOI: 10.1056/nejmoa1605086] [Citation(s) in RCA: 840] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Both genetic and lifestyle factors contribute to individual-level risk of coronary artery disease. The extent to which increased genetic risk can be offset by a healthy lifestyle is unknown. METHODS Using a polygenic score of DNA sequence polymorphisms, we quantified genetic risk for coronary artery disease in three prospective cohorts - 7814 participants in the Atherosclerosis Risk in Communities (ARIC) study, 21,222 in the Women's Genome Health Study (WGHS), and 22,389 in the Malmö Diet and Cancer Study (MDCS) - and in 4260 participants in the cross-sectional BioImage Study for whom genotype and covariate data were available. We also determined adherence to a healthy lifestyle among the participants using a scoring system consisting of four factors: no current smoking, no obesity, regular physical activity, and a healthy diet. RESULTS The relative risk of incident coronary events was 91% higher among participants at high genetic risk (top quintile of polygenic scores) than among those at low genetic risk (bottom quintile of polygenic scores) (hazard ratio, 1.91; 95% confidence interval [CI], 1.75 to 2.09). A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor), regardless of the genetic risk category. Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle (hazard ratio, 0.54; 95% CI, 0.47 to 0.63). This finding corresponded to a reduction in the standardized 10-year incidence of coronary events from 10.7% for an unfavorable lifestyle to 5.1% for a favorable lifestyle in ARIC, from 4.6% to 2.0% in WGHS, and from 8.2% to 5.3% in MDCS. In the BioImage Study, a favorable lifestyle was associated with significantly less coronary-artery calcification within each genetic risk category. CONCLUSIONS Across four studies involving 55,685 participants, genetic and lifestyle factors were independently associated with susceptibility to coronary artery disease. Among participants at high genetic risk, a favorable lifestyle was associated with a nearly 50% lower relative risk of coronary artery disease than was an unfavorable lifestyle. (Funded by the National Institutes of Health and others.).
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Affiliation(s)
- Amit V Khera
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Connor A Emdin
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Isabel Drake
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Pradeep Natarajan
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Alexander G Bick
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Nancy R Cook
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Daniel I Chasman
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Usman Baber
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Roxana Mehran
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Daniel J Rader
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Valentin Fuster
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Eric Boerwinkle
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Olle Melander
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Marju Orho-Melander
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Paul M Ridker
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
| | - Sekar Kathiresan
- From the Center for Human Genetic Research and Cardiology Division, Massachusetts General Hospital (A.V.K., P.N., S.K.), and the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (N.R.C., D.I.C., P.M.R.), Boston, and the Program in Medical and Population Genetics, Broad Institute, Cambridge (A.V.K., C.A.E., A.G.B., S.K.) - all in Massachusetts; the Department of Clinical Sciences, Lund University, Malmö, Sweden (I.D., O.M., M.O.-M.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., V.F.); Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (D.J.R.); and the University of Texas Health Science Center School of Public Health, Houston (E.B.)
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183
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Tzoulaki I, Elliott P, Kontis V, Ezzati M. Worldwide Exposures to Cardiovascular Risk Factors and Associated Health Effects: Current Knowledge and Data Gaps. Circulation 2016; 133:2314-33. [PMID: 27267538 DOI: 10.1161/circulationaha.115.008718] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Information on exposure to, and health effects of, cardiovascular disease (CVD) risk factors is needed to develop effective strategies to prevent CVD events and deaths. Here, we provide an overview of the data and evidence on worldwide exposures to CVD risk factors and the associated health effects. Global comparative risk assessment studies have estimated that hundreds of thousands or millions of CVD deaths are attributable to established CVD risk factors (high blood pressure and serum cholesterol, smoking, and high blood glucose), high body mass index, harmful alcohol use, some dietary and environmental exposures, and physical inactivity. The established risk factors plus body mass index are collectively responsible for ≈9.7 million annual CVD deaths, with high blood pressure accounting for more CVD deaths than any other risk factor. Age-standardized CVD death rates attributable to established risk factors plus high body mass index are lowest in high-income countries, followed by Latin America and the Caribbean; they are highest in the region of central and eastern Europe and central Asia. However, estimates of the health effects of CVD risk factors are highly uncertain because there are insufficient population-based data on exposure to most CVD risk factors and because the magnitudes of their effects on CVDs in observational studies are likely to be biased. We identify directions for research and surveillance to better estimate the effects of CVD risk factors and policy options for reducing CVD burden by modifying preventable risk factors.
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Affiliation(s)
- Ioanna Tzoulaki
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.)
| | - Paul Elliott
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.)
| | - Vasilis Kontis
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.)
| | - Majid Ezzati
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.).
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184
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Bush WS, Crawford DC. Predicting Incident Coronary Heart Disease Many Markers at a Time. ACTA ACUST UNITED AC 2016; 9:472-473. [DOI: 10.1161/circgenetics.116.001645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William S. Bush
- From the Department of Epidemiology and Biostatistics, Institute for Computational Biology, Case Western Reserve University, Cleveland, OH
| | - Dana C. Crawford
- From the Department of Epidemiology and Biostatistics, Institute for Computational Biology, Case Western Reserve University, Cleveland, OH
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185
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Béliard S, Bonnet F, Bouhanick B, Bruckert E, Cariou B, Charrière S, Durlach V, Moulin P, Valéro R, Vergès B. Consensus statement on the management of dyslipidaemias in adults. DIABETES & METABOLISM 2016; 42:398-408. [DOI: 10.1016/j.diabet.2016.07.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 11/30/2022]
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186
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Affiliation(s)
- Themistocles L Assimes
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin A Goldstein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
- Center for Predictive Medicine, Duke Clinical Research Institute, Durham, NC, USA
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187
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Iribarren C, Lu M, Jorgenson E, Martínez M, Lluis-Ganella C, Subirana I, Salas E, Elosua R. Clinical Utility of Multimarker Genetic Risk Scores for Prediction of Incident Coronary Heart Disease: A Cohort Study Among Over 51 000 Individuals of European Ancestry. ACTA ACUST UNITED AC 2016; 9:531-540. [PMID: 27780846 DOI: 10.1161/circgenetics.116.001522] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/28/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND We evaluated whether including multilocus genetic risk scores (GRSs) into the Framingham Risk Equation improves the predictive capacity, discrimination, and reclassification of asymptomatic individuals with respect to coronary heart disease (CHD) risk. METHODS AND RESULTS We performed a cohort study among 51 954 European-ancestry members of a Northern California integrated healthcare system (67% female; mean age 59) free of CHD at baseline (2007-2008). Four GRSs were constructed using between 8 and 51 previously identified genetic variants. After a mean (±SD) follow-up of 5.9 (±1.5) years, 1864 incident CHD events were documented. All GRSs were linearly associated with CHD in a model adjusted by individual risk factors: hazard ratio (95% confidence interval) per SD unit: 1.21 (1.15-1.26) for GRS_8, 1.20 (1.15-1.26) for GRS_12, 1.23 (1.17-1.28) for GRS_36, and 1.23 (1.17-1.28) for GRS_51. Inclusion of the GRSs improved the C statistic (ΔC statistic =0.008 for GRS_8 and GRS_36; 0.007 for GRS_12; and 0.009 for GRS_51; all P<0.001). The net reclassification improvement was 5% for GRS_8, GRS_12, and GRS_36 and 4% for GRS_51 in the entire cohort and was (after correcting for bias) 9% for GRS_8 and GRS_12 and 7% for GRS_36 and GRS_51 when analyzing those classified as intermediate Framingham risk (10%-20%). The number required to treat to prevent 1 CHD after selectively treating with statins up-reclassified subjects on the basis of genetic information was 36 for GRS_8 and GRS_12, 41 for GRS_36, and 43 for GRS_51. CONCLUSIONS Our results demonstrate significant and clinically relevant incremental discriminative/predictive capability of 4 multilocus GRSs for incident CHD among subjects of European ancestry.
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Affiliation(s)
- Carlos Iribarren
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.).
| | - Meng Lu
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Eric Jorgenson
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Manuel Martínez
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Carla Lluis-Ganella
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Isaac Subirana
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Eduardo Salas
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
| | - Roberto Elosua
- From the Kaiser Permanente Northern California Division of Research, Oakland, CA (C.I., M.L., E.J.); Gendiag, Inc/Ferrer inCode, Inc, Barcelona, Spain (M.M., C.L.-G., E.S.); CIBER of Epidemiology and Public Health, Barcelona, Spain (I.S.); and Cardiovascular Epidemiology & Genetics, IMIM, Barcelona, Spain (I.S., R.E.)
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188
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Beaney KE, Ward CE, Bappa DAS, McGale N, Davies AK, Hirani SP, Li K, Howard P, Vance DR, Crockard MA, Lamont JV, Newman S, Humphries SE. A 19-SNP coronary heart disease gene score profile in subjects with type 2 diabetes: the coronary heart disease risk in type 2 diabetes (CoRDia study) study baseline characteristics. Cardiovasc Diabetol 2016; 15:141. [PMID: 27716211 PMCID: PMC5048451 DOI: 10.1186/s12933-016-0457-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/23/2016] [Indexed: 12/22/2022] Open
Abstract
Background The coronary risk in diabetes (CoRDia) trial (n = 211) compares the effectiveness of usual diabetes care with a self-management intervention (SMI), with and without personalised risk information (including genetics), on clinical and behavioural outcomes. Here we present an assessment of randomisation, the cardiac risk genotyping assay, and the genetic characteristics of the recruits. Methods Ten-year coronary heart disease (CHD) risk was calculated using the UKPDS score. Genetic CHD risk was determined by genotyping 19 single nucleotide polymorphisms (SNPs) using Randox’s Cardiac Risk Prediction Array and calculating a gene score (GS). Accuracy of the array was assessed by genotyping a subset of pre-genotyped samples (n = 185). Results Overall, 10-year CHD risk ranged from 2–72 % but did not differ between the randomisation groups (p = 0.13). The array results were 99.8 % concordant with the pre-determined genotypes. The GS did not differ between the Caucasian participants in the CoRDia SMI plus risk group (n = 66) (p = 0.80) and a sample of UK healthy men (n = 1360). The GS was also associated with LDL-cholesterol (p = 0.05) and family history (p = 0.03) in a sample of UK healthy men (n = 1360). Conclusions CHD risk is high in this group of T2D subjects. The risk array is an accurate genotyping assay, and is suitable for estimating an individual’s genetic CHD risk. Trial registration This study has been registered at ClinicalTrials.gov; registration identifier NCT01891786
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Affiliation(s)
- Katherine E Beaney
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK
| | - Claire E Ward
- Molecular Diagnostics Group, Randox Laboratories Ltd, Crumlin, UK
| | - Dauda A S Bappa
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK
| | - Nadine McGale
- School of Health Sciences, City University London, Northampton Square, London, UK
| | - Anna K Davies
- School of Health Sciences, City University London, Northampton Square, London, UK
| | - Shashivadan P Hirani
- School of Health Sciences, City University London, Northampton Square, London, UK
| | - KaWah Li
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK
| | - Philip Howard
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK
| | - Dwaine R Vance
- Molecular Diagnostics Group, Randox Laboratories Ltd, Crumlin, UK
| | | | - John V Lamont
- Molecular Diagnostics Group, Randox Laboratories Ltd, Crumlin, UK
| | - Stanton Newman
- School of Health Sciences, City University London, Northampton Square, London, UK
| | - Steve E Humphries
- British Heart Foundation Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, University Street, London, UK.
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189
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Abraham G, Havulinna AS, Bhalala OG, Byars SG, De Livera AM, Yetukuri L, Tikkanen E, Perola M, Schunkert H, Sijbrands EJ, Palotie A, Samani NJ, Salomaa V, Ripatti S, Inouye M. Genomic prediction of coronary heart disease. Eur Heart J 2016; 37:3267-3278. [PMID: 27655226 PMCID: PMC5146693 DOI: 10.1093/eurheartj/ehw450] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/06/2016] [Accepted: 08/26/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Genetics plays an important role in coronary heart disease (CHD) but the clinical utility of genomic risk scores (GRSs) relative to clinical risk scores, such as the Framingham Risk Score (FRS), is unclear. Our aim was to construct and externally validate a CHD GRS, in terms of lifetime CHD risk and relative to traditional clinical risk scores. METHODS AND RESULTS We generated a GRS of 49 310 SNPs based on a CARDIoGRAMplusC4D Consortium meta-analysis of CHD, then independently tested it using five prospective population cohorts (three FINRISK cohorts, combined n = 12 676, 757 incident CHD events; two Framingham Heart Study cohorts (FHS), combined n = 3406, 587 incident CHD events). The GRS was associated with incident CHD (FINRISK HR = 1.74, 95% confidence interval (CI) 1.61-1.86 per S.D. of GRS; Framingham HR = 1.28, 95% CI 1.18-1.38), and was largely unchanged by adjustment for known risk factors, including family history. Integration of the GRS with the FRS or ACC/AHA13 scores improved the 10 years risk prediction (meta-analysis C-index: +1.5-1.6%, P < 0.001), particularly for individuals ≥60 years old (meta-analysis C-index: +4.6-5.1%, P < 0.001). Importantly, the GRS captured substantially different trajectories of absolute risk, with men in the top 20% of attaining 10% cumulative CHD risk 12-18 y earlier than those in the bottom 20%. High genomic risk was partially compensated for by low systolic blood pressure, low cholesterol level, and non-smoking. CONCLUSIONS A GRS based on a large number of SNPs improves CHD risk prediction and encodes different trajectories of lifetime risk not captured by traditional clinical risk scores.
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Affiliation(s)
- Gad Abraham
- Centre for Systems Genomics, School of BioSciences, The University of Melbourne, Parkville, Victoria 3010, Australia.,Department of Pathology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Aki S Havulinna
- National Institute for Health and Welfare, Helsinki FI-00271, Finland
| | - Oneil G Bhalala
- Centre for Systems Genomics, School of BioSciences, The University of Melbourne, Parkville, Victoria 3010, Australia.,Department of Pathology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Sean G Byars
- Centre for Systems Genomics, School of BioSciences, The University of Melbourne, Parkville, Victoria 3010, Australia.,Department of Pathology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Alysha M De Livera
- Centre for Systems Genomics, School of BioSciences, The University of Melbourne, Parkville, Victoria 3010, Australia.,Department of Pathology, The University of Melbourne, Parkville, Victoria 3010, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Laxman Yetukuri
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki FI-00014, Finland
| | - Emmi Tikkanen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki FI-00014, Finland
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki FI-00271, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki FI-00014, Finland
| | - Heribert Schunkert
- Deutsches Herzzentrum München, and Technische Universität München, Munich 80636, Germany.,Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich 81377, Germany
| | - Eric J Sijbrands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, CA 3000, The Netherlands
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki FI-00014, Finland.,Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA.,Department of Psychiatry, Psychiatric & Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Groby Rd, Leicester, LE3 9QP, United Kingdom .,National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki FI-00271, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki FI-00014, Finland .,Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, United Kingdom.,Department of Public Health, University of Helsinki, Helsinki FI-00014, Finland
| | - Michael Inouye
- Centre for Systems Genomics, School of BioSciences, The University of Melbourne, Parkville, Victoria 3010, Australia .,Department of Pathology, The University of Melbourne, Parkville, Victoria 3010, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
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190
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Muñoz M, Pong-Wong R, Canela-Xandri O, Rawlik K, Haley CS, Tenesa A. Evaluating the contribution of genetics and familial shared environment to common disease using the UK Biobank. Nat Genet 2016; 48:980-3. [PMID: 27428752 PMCID: PMC5989924 DOI: 10.1038/ng.3618] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 06/14/2016] [Indexed: 12/15/2022]
Abstract
Genome-wide association studies have detected many loci underlying susceptibility to disease, but most of the genetic factors that contribute to disease susceptibility remain unknown. Here we provide evidence that part of the 'missing heritability' can be explained by an overestimation of heritability. We estimated the heritability of 12 complex human diseases using family history of disease in 1,555,906 individuals of white ancestry from the UK Biobank. Estimates using simple family-based statistical models were inflated on average by ∼47% when compared with those from structural equation modeling (SEM), which specifically accounted for shared familial environmental factors. In addition, heritabilities estimated using SNP data explained an average of 44.2% of the simple family-based estimates across diseases and an average of 57.3% of the SEM-estimated heritabilities, accounting for almost all of the SEM heritability for hypertension. Our results show that both genetics and familial environment make substantial contributions to familial clustering of disease.
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Affiliation(s)
- María Muñoz
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The
University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Ricardo Pong-Wong
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The
University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Oriol Canela-Xandri
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The
University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Konrad Rawlik
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The
University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Chris S. Haley
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The
University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
- MRC Human Genetics Unit at the MRC Institute of Genetics and
Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road
South, Edinburgh, EH4 2XU, UK
| | - Albert Tenesa
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The
University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
- MRC Human Genetics Unit at the MRC Institute of Genetics and
Molecular Medicine, University of Edinburgh, Western General Hospital, Crewe Road
South, Edinburgh, EH4 2XU, UK
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191
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Morris RW, Cooper JA, Shah T, Wong A, Drenos F, Engmann J, McLachlan S, Jefferis B, Dale C, Hardy R, Kuh D, Ben-Shlomo Y, Wannamethee SG, Whincup PH, Casas JP, Kivimaki M, Kumari M, Talmud PJ, Price JF, Dudbridge F, Hingorani AD, Humphries SE. Marginal role for 53 common genetic variants in cardiovascular disease prediction. Heart 2016; 102:1640-7. [PMID: 27365493 PMCID: PMC5099215 DOI: 10.1136/heartjnl-2016-309298] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/30/2016] [Indexed: 12/20/2022] Open
Abstract
Objective We investigated discrimination and calibration of cardiovascular disease (CVD) risk scores when genotypic was added to phenotypic information. The potential of genetic information for those at intermediate risk by a phenotype-based risk score was assessed. Methods Data were from seven prospective studies including 11 851 individuals initially free of CVD or diabetes, with 1444 incident CVD events over 10 years' follow-up. We calculated a score from 53 CVD-related single nucleotide polymorphisms and an established CVD risk equation ‘QRISK-2’ comprising phenotypic measures. The area under the receiver operating characteristic curve (AUROC), detection rate for given false-positive rate (FPR) and net reclassification improvement (NRI) index were estimated for gene scores alone and in addition to the QRISK-2 CVD risk score. We also evaluated use of genetic information only for those at intermediate risk according to QRISK-2. Results The AUROC was 0.635 for QRISK-2 alone and 0.623 with addition of the gene score. The detection rate for 5% FPR improved from 11.9% to 12.0% when the gene score was added. For a 10-year CVD risk cut-off point of 10%, the NRI was 0.25% when the gene score was added to QRISK-2. Applying the genetic risk score only to those with QRISK-2 risk of 10%–<20% and prescribing statins where risk exceeded 20% suggested that genetic information could prevent one additional event for every 462 people screened. Conclusion The gene score produced minimal incremental population-wide utility over phenotypic risk prediction of CVD. Tailored prediction using genetic information for those at intermediate risk may have clinical utility.
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Affiliation(s)
- Richard W Morris
- School of Social & Community Medicine, University of Bristol, Bristol, UK Department of Primary Care & Population Health, University College London, London, UK
| | - Jackie A Cooper
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK
| | - Tina Shah
- Institute of Cardiovascular Science and Farr Institute, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Fotios Drenos
- Institute of Cardiovascular Science and Farr Institute, University College London, London, UK MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jorgen Engmann
- Institute of Cardiovascular Science and Farr Institute, University College London, London, UK
| | - Stela McLachlan
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Barbara Jefferis
- Department of Primary Care & Population Health, University College London, London, UK
| | - Caroline Dale
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Yoav Ben-Shlomo
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - S Goya Wannamethee
- Department of Primary Care & Population Health, University College London, London, UK
| | - Peter H Whincup
- Division of Population Health Sciences and Education, St George's, University of London, London, UK
| | - Juan-Pablo Casas
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK
| | - Mika Kivimaki
- Department of Epidemiology & Public Health, UCL Institute of Epidemiology & Health Care, University College London, London, UK
| | - Meena Kumari
- Department of Epidemiology & Public Health, UCL Institute of Epidemiology & Health Care, University College London, London, UK Institute for Social and Economic Research, University of Essex, Colchester, UK
| | - Philippa J Talmud
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK
| | - Jacqueline F Price
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Frank Dudbridge
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science and Farr Institute, University College London, London, UK
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK
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Hindieh W, Pilote L, Cheema A, Al-Lawati H, Labos C, Dufresne L, Engert JC, Thanassoulis G. Association Between Family History, a Genetic Risk Score, and Severity of Coronary Artery Disease in Patients With Premature Acute Coronary Syndromes. Arterioscler Thromb Vasc Biol 2016; 36:1286-92. [DOI: 10.1161/atvbaha.115.306944] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/31/2016] [Indexed: 12/16/2022]
Abstract
Objective—
A genetic risk score (GRS) for coronary artery disease has recently been shown to be independent of family history (FHx) in predicting future cardiovascular events. We sought to determine whether the presence of these risk factors, either individually or together, was associated with a higher burden of angiographic coronary artery disease.
Approach and Results—
We included 763 patients with premature acute coronary syndrome (median age, 50 [46–53] years; 30.8% women) with at least 1 major epicardial vessel stenosis enrolled in the Gender and Sex Determinants of Cardiovascular Disease From Bench to Beyond in Premature Acute Coronary Syndrome (GENESIS-PRAXY) study, a multicentre prospective cohort study of premature patients with acute coronary syndrome (aged ≤55 years). The prevalence of multivessel disease (ie, ≥2 vessels with >50% stenosis) in individuals with FHx was 49.7% as compared with 37.9% in those without FHx (
P
<0.01 for comparison). In adjusted models for age, sex, traditional risk factors, and GRS, FHx was associated with a higher prevalence of 3-vessel disease (odds ratio [OR], 1.42; 95% confidence interval, 0.91–2.21;
P
=0.12 for 2-vessel disease and OR, 2.26; 95% confidence interval, 1.29–3.95;
P
=0.005 for 3-vessel disease). Individuals with a high GRS were also more likely to have multivessel disease (OR, 1.41; 95% confidence interval, 1.01–1.99;
P
=0.047) after adjustment for traditional risk factors, including FHx. Individuals with both a FHx and a high GRS as compared with those with neither had the highest ORs for multivessel disease (adjusted OR, 2.14; 95% confidence interval, 1.24–3.69;
P
=0.0064).
Conclusions—
In patients with premature acute coronary syndrome, the presence of either a high GRS or FHx is associated with greater severity of coronary artery disease at angiography. Whether preventive strategies targeted to genetically predisposed individuals will reduce the burden of early acute coronary syndrome warrants further study.
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Affiliation(s)
- Waseem Hindieh
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Louise Pilote
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Asim Cheema
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Hatim Al-Lawati
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Christopher Labos
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Line Dufresne
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - James C. Engert
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - George Thanassoulis
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
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