1
|
Nomura A, Okada H, Nohara A, Kawashiri MA, Takamura M, Tada H. Impact of providing genetics-based future cardiovascular risk on LDL-C in patients with familial hypercholesterolemia. J Clin Lipidol 2023; 17:622-632. [PMID: 37673778 DOI: 10.1016/j.jacl.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is an autosomal dominant monogenic disease characterized by high low-density lipoprotein cholesterol (LDL-C) levels. Although carrying causative FH variants is associated with coronary heart disease (CHD), it remains unclear whether disclosing its associated cardiovascular risk affects outcomes in patients with FH. OBJECTIVE We aimed to evaluate the efficacy of providing future cardiovascular risk based on genetic testing in addition to a standard FH education program. METHODS We conducted a randomized, wait-list controlled, open-label, single-center trial. In the intervention group, we reported a future cardiovascular risk based on the genetic testing adding to standard FH education at week 0. In the wait-list control group, we only disseminated standard FH education according to the guidelines at week 0; they later received a genetic testing-based cardiovascular risk assessment at week 24. The primary endpoint of this study was the plasma LDL-C level at week 24. RESULTS Fifty eligible patients with clinically diagnosed FH, without a history of CHD, were allocated to the intervention group (n = 24) or the wait-list control group (n = 26). At week 24, the intervention group had a significantly greater reduction in LDL-C levels than the wait-list control group (mean changes, -13.1 mg/dL vs. 6.6 mg/dL; difference, -19.7 mg/dL; 95% confidence interval, -34 to -5.6; p = 0.009). This interventional effect was consistent with FH causative variant carriers but not with non-carriers. CONCLUSIONS In addition to standard FH care, providing future cardiovascular risk based on genetic testing can further reduce plasma LDL-C levels, particularly among FH causal variant carriers. REGISTRATION Japan Registry of Clinical Trials (jRCTs04218002). URL: https://jrct.niph.go.jp/latest-detail/jRCTs042180027.
Collapse
Affiliation(s)
- Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University (iCREK), Kanazawa, Japan (Dr. Nomura); Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan (Drs. Nomura, Okada, Takamura and Tada); College of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan (Dr. Nomura); Frontier Institute of Tourism Sciences, Kanazawa University, Kanazawa, Japan (Dr. Nomura)
| | - Hirofumi Okada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan (Drs. Nomura, Okada, Takamura and Tada)
| | - Atsushi Nohara
- Department of Clinical Genetics, Ishikawa Prefectural Central Hospital, Kanazawa, Japan (Dr. Nohara)
| | - Masa-Aki Kawashiri
- Department of Internal Medicine, Kaga Medical Center, Kaga, Japan (Dr. Kawashiri)
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan (Drs. Nomura, Okada, Takamura and Tada)
| | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 9208641, Japan (Drs. Nomura, Okada, Takamura and Tada).
| |
Collapse
|
2
|
Groenendyk JW, Greenland P, Khan SS. Incremental Value of Polygenic Risk Scores in Primary Prevention of Coronary Heart Disease: A Review. JAMA Intern Med 2022; 182:1082-1088. [PMID: 35994254 DOI: 10.1001/jamainternmed.2022.3171] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Risk prediction for coronary heart disease (CHD) is a cornerstone of primary prevention strategies. Polygenic risk scores (PRSs) have emerged as a new approach to predict risk in asymptomatic people. Polygenic risk scores for CHD have been studied in several populations, but there is lack of agreement about the incremental value of PRS beyond traditional risk factor scores in the primary prevention of CHD. OBSERVATIONS This narrative review critically appraised the 5 most highly cited studies published through 2021 that also included a large number (>45 000) of single-nucleotide variations (formerly single-nucleotide polymorphisms) and evaluated the incremental value of PRS in CHD risk prediction according to published PRS reporting standards. The cohorts studied included the Atherosclerosis Risk in Communities Study, FINRISK, the Framingham Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the UK Biobank. All of the studies focused predominantly on populations of European ancestry. The hazard ratio per standard deviation of PRS ranged from 1.24 (95% CI, 1.15-1.34) to 1.74 (95% CI, 1.61-1.86). The C statistic for PRS alone ranged from 0.549 to 0.623. The change in C statistic when PRS was added to a standard risk factor model ranged between -0.001 to +0.021. Net reclassification index was reported in 4 of the 5 studies and varied from 0.001 to 0.097. At a sensitivity (true-positive rate) of 90%, positive predictive values ranged from 1.8% to 16.6%, and false-positive rates ranged from 77.1% to 85.7%. CONCLUSIONS AND RELEVANCE In this review, PRS was significantly associated with CHD risk in all studies. The degree of improvement in C statistic and the net reclassification indexes when PRS was added to traditional risk scores ranged from negligible to modest. Based on established metrics to assess risk prediction scores, the addition of PRS to traditional risk scores does not appear to provide meaningful improvements in clinical decision-making in primary prevention populations.
Collapse
Affiliation(s)
| | - Philip Greenland
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sadiya S Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
3
|
Influence of Nursing Intervention Based on Risk Assessment Model on Self-Efficacy and Postoperative Rehabilitation of Surgical Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6750320. [PMID: 35463686 PMCID: PMC9020936 DOI: 10.1155/2022/6750320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
The study aims to explore the effect of nursing intervention based on risk assessment model on self-efficacy and postoperative rehabilitation of surgical patients. The study applied a risk assessment model to the behavioral intervention of rehabilitation exercise in patients after percutaneous coronary intervention (PCI). A total of 157 patients were selected from a certain hospital, with 52 cases in the experimental group and 55 cases in the control group. A comprehensive cardiac rehabilitation intervention strategy based on TTM is given by researchers trained with professional knowledge, including dividing the stages of behavior change, developing a rehabilitation exercise plan through exercise teaching and exercise training, diet and lifestyle guidance, and urging patients to take regular medication and regular follow-up. The stage of rehabilitation movement behavior change improved. The preexperiment health status was (35.39 ± 14.31), and the overall health of the control group was (32.59 ± 15.41). Overall health status and QOL scores were relatively low in both the groups. The intervention group scored higher than the control group. After coronary stent implantation, the heart restores its original pumping function, various organs and tissues receive effective blood perfusion, and the symptoms of myocardial infarction such as profuse sweating, dizziness, fatigue, and precordial discomfort are effectively relieved. The physical discomfort can gradually improve or even recover to the functional state before the onset of the disease. Before the intervention, the self-efficacy score of the intervention group was (23.68 ± 4.49). After the intervention, the self-efficacy score of the intervention group was (26.21 ± 4.09), while the self-efficacy score of the control group before the intervention was (22.21 ± 4.1). After the intervention, the self-efficacy score of the control group was (25.23 ± 4.41). Although the self-efficacy score of the control group was improved, the difference was small, and the intervention effect was not obvious. It indicates that risk assessment intervention can improve patients' self-efficacy level and quality of life of postoperative rehabilitation patients.
Collapse
|
4
|
Clinical Phenotypes of Cardiovascular and Heart Failure Diseases Can Be Reversed? The Holistic Principle of Systems Biology in Multifaceted Heart Diseases. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Recent advances in cardiology and biological sciences have improved quality of life in patients with complex cardiovascular diseases (CVDs) or heart failure (HF). Regardless of medical progress, complex cardiac diseases continue to have a prolonged clinical course with high morbidity and mortality. Interventional coronary techniques together with drug therapy improve quality and future prospects of life, but do not reverse the course of the atherosclerotic process that remains relentlessly progressive. The probability of CVDs and HF phenotypes to reverse can be supported by the advances made on the medical holistic principle of systems biology (SB) and on artificial intelligence (AI). Studies on clinical phenotypes reversal should be based on the research performed in large populations of patients following gathering and analyzing large amounts of relative data that embrace the concept of complexity. To decipher the complexity conundrum, a multiomics approach is needed with network analysis of the biological data. Only by understanding the complexity of chronic heart diseases and explaining the interrelationship between different interconnected biological networks can the probability for clinical phenotypes reversal be increased.
Collapse
|
5
|
Wei N, Hu Y, Liu G, Li S, Yuan G, Shou X, Zhang X, Shi J, Zhai H. A Bibliometric Analysis of Familial Hypercholesterolemia From 2011 to 2021. Curr Probl Cardiol 2022; 48:101151. [PMID: 35202707 DOI: 10.1016/j.cpcardiol.2022.101151] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 01/08/2023]
Abstract
Familial Hypercholesterolemia (FH), an autosomal dominant genetic disease, is increasingly emerging as a global threat. To learn more about the development of FH, 1 617 papers about FH and related research were retrieved in the Web of Science Core Collection from 2011 to 2021. Then, these publications were scientometrically analyzed based on CiteSpace and VOSviewer in terms of spatiotemporal distribution, author distribution, subject categories, topic distribution, and references. The results showed that research on FH is at a stable stage. More FH research has been conducted in developed countries, implying the necessity for strengthening international cooperation and exchanges. We have obtained scholars, institutions, relevant journals, and representative literatures that play an important role in FH. The research direction of FH is on the mechanisms of FH and its complications, diagnosis, statin therapy, and new lipid-lowering drug therapy. Care is the research frontier in FH, and it is in an explosive period.
Collapse
Affiliation(s)
- Namin Wei
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yuanhui Hu
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoxiu Liu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Siyu Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Guozhen Yuan
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xintian Shou
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuesong Zhang
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingjing Shi
- Department of Cardiovascular Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huaqiang Zhai
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China.
| |
Collapse
|
6
|
Zhong S, Li L, Liang N, Zhang L, Xu X, Chen S, Yin H. Acetaldehyde Dehydrogenase 2 regulates HMG-CoA reductase stability and cholesterol synthesis in the liver. Redox Biol 2021; 41:101919. [PMID: 33740503 PMCID: PMC7995661 DOI: 10.1016/j.redox.2021.101919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
HMG-CoA reductase (HMGCR) is the rate-limiting enzyme in cholesterol biosynthesis and the target for cholesterol-lowering therapy. Acetaldehyde dehydrogenase 2 (ALDH2) is primarily responsible for detoxifying ethanol-derived acetaldehyde and endogenous lipid aldehydes derived from lipid peroxidation. Epidemiological and Genome Wide Association Studies (GWAS) have linked an inactive ALDH2 rs671 variant, responsible for alcohol flush in nearly 8% world population and 40% of Asians, with cholesterol levels and higher risk of cardiovascular disease (CVD) but the underlying mechanism remains elusive. Here we find that the cholesterol levels in the serum and liver of ALDH2 knockout (AKO) and ALDH2 rs671 knock-in (AKI) mice are significantly increased, consistent with the increase of intermediates in the cholesterol biosynthetic pathways. Mechanistically, mitochondrial ALDH2 translocates to the endoplasmic reticulum to promote the formation of GP78/Insig1/HMGCR complex to increase HMGCR degradation through ubiquitination. Conversely, ALDH2 mutant or ALDH2 deficiency in AKI or AKO mice stabilizes HMGCR, resulting in enhanced cholesterol synthesis, which can be reversed by Lovastatin. Moreover, ALDH2-regulated cholesterol synthesis is linked to the formation of mitochondria-associated endoplasmic reticulum membranes (MAMs). Together, our study has identified that ALDH2 is a novel regulator of cholesterol synthesis, which may play an important role in CVD.
Collapse
Affiliation(s)
- Shanshan Zhong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences (CAS), Shanghai, 200031, China
| | - Luxiao Li
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences (CAS), Shanghai, 200031, China
| | - Ningning Liang
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences (CAS), Shanghai, 200031, China
| | - Lili Zhang
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences (CAS), Shanghai, 200031, China
| | - Xiaodong Xu
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences (CAS), Shanghai, 200031, China
| | - Shiting Chen
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences (CAS), Shanghai, 200031, China
| | - Huiyong Yin
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences (CAS), Shanghai, 200031, China; School of Life Science and Technology, ShanghaiTech University, Shanghai, 200031, China.
| |
Collapse
|
7
|
Peterlin A, Petrovič D, Peterlin B. Screening for Rare Genetic Variants Associated with Atherosclerosis: Opportunity for Personalized Medicine. Curr Vasc Pharmacol 2020; 17:25-28. [PMID: 29412113 DOI: 10.2174/1570161116666180206111725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/01/2017] [Accepted: 11/07/2017] [Indexed: 01/27/2023]
Abstract
Atherosclerosis and its clinical manifestations is a leading cause of disease burden worldwide. Currently, most of the individuals carrying a strong predisposition to complications of atherosclerosis because of monogenic dyslipidaemias remain undiagnosed and consequently are not given an opportunity for prevention. Therefore, one of the main public health challenges remains the identification of individuals with significantly increased risk for atherosclerosis due to monogenic predisposition. Next-Generation Sequencing (NGS) has revolutionized genetic testing in symptomatic patients. Although new genomic technologies are still developing, and evidence on the use of this methodology for screening purposes is still lacking, genome testing might provide a powerful tool for the identification of individuals at risk. This may pave the way for the implementation of personalized medicine in the field of atherosclerosis prevention. In this review, we discuss the potential of genetic screening for atherosclerosis prevention and present the potential target of 17 genes responsible for monogenic dyslipidaemias associated with atherosclerosis.
Collapse
Affiliation(s)
- Ana Peterlin
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Daniel Petrovič
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Peterlin
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
8
|
Berberich AJ, Hegele RA. The role of genetic testing in dyslipidaemia. Pathology 2019; 51:184-192. [DOI: 10.1016/j.pathol.2018.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 01/28/2023]
|
9
|
Hui SK, Sun L, Ruel M. Genetics, coronary artery disease, and myocardial revascularization: will novel genetic risk scores bring new answers? Indian J Thorac Cardiovasc Surg 2018; 34:213-221. [PMID: 33060941 DOI: 10.1007/s12055-017-0635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 11/25/2022] Open
Abstract
Both percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) are options for revascularization in multi-vessel coronary artery disease (CAD). However, the best form of revascularization remains controversial. Results from clinical trials (FREEDOM, SYNTAX, NOBLE, EXCEL) have identified factors related to CAD severity such as diabetes and SYNTAX score as indicators that patients may have better outcomes with CABG compared to PCI. Nevertheless, the discovery of other predictors of optimal revascularization therapy is necessary to improve decision-making and personalize the treatment of multi-vessel CAD. Genome-wide association studies have identified numerous previously unknown DNA variants that increase predisposition for CAD. Recently, a composite polygenic risk score has been developed to better assess the relative contribution of multiple SNPs and quantify overall genetic risk for CAD. High polygenic risk score is associated with increased coronary events and greater benefit from statin therapy in large observational studies. This effect is independent from traditional cardiovascular risk factors. At the same time, randomized clinical trials have shown that CAD severity is a determinant of optimal revascularization treatment. It remains unknown whether polygenic risk score is robustly associated with increased CAD severity at presentation, and whether this score can be used to identify patients who will show greater benefit from revascularization with CABG or with PCI.
Collapse
Affiliation(s)
- Sonya Kit Hui
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, 3402-40 Ruskin Street, Ottawa, ON K1Y4W7 Canada
| | - Louise Sun
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, ON Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, 3402-40 Ruskin Street, Ottawa, ON K1Y4W7 Canada
| |
Collapse
|
10
|
Tibaut M, Caprnda M, Kubatka P, Sinkovič A, Valentova V, Filipova S, Gazdikova K, Gaspar L, Mozos I, Egom EE, Rodrigo L, Kruzliak P, Petrovic D. Markers of Atherosclerosis: Part 2 - Genetic and Imaging Markers. Heart Lung Circ 2018; 28:678-689. [PMID: 30318392 DOI: 10.1016/j.hlc.2018.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/30/2018] [Accepted: 06/25/2018] [Indexed: 12/18/2022]
Abstract
This is Part 2 of a two-part review summarising current knowledge on biomarkers of atherosclerosis. Part 1 addressed serological biomarkers. Here, in part 2 we address genetic and imaging markers, and other developments in predicting risk. Further improvements in risk stratification are expected with the addition of genetic risk scores. In addition to single nucleotide polymorphisms (SNPs), recent advances in epigenetics offer DNA methylation profiles, histone chemical modifications, and micro-RNAs as other promising indicators of atherosclerosis. Imaging biomarkers are better studied and already have a higher degree of clinical applicability in cardiovascular (CV) event prediction and detection of preclinical atherosclerosis. With new methodologies, such as proteomics and metabolomics, discoveries of new clinically applicable biomarkers are expected.
Collapse
Affiliation(s)
- Miha Tibaut
- General Hospital Murska Sobota, Murska Sobota, Slovenia
| | - Martin Caprnda
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia; Department of Experimental Carcinogenesis, Division of Oncology, Biomedical Center Martin, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia
| | - Andreja Sinkovič
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | | | - Slavomira Filipova
- Department of Cardiology, National Institute of Cardiovascular Diseases and Slovak Medical University, Bratislava, Slovakia
| | - Katarina Gazdikova
- Department of Nutrition, Faculty of Nursing and Professional Health Studies, Slovak Medical University, Bratislava, Slovakia; Department of General Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.
| | - Ludovit Gaspar
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
| | - Ioana Mozos
- Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Emmanuel E Egom
- Jewish General Hospital and Lady Davis Institute for Medical Research, Montreal, Canada; Department of Cardiology, The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital, Dublin, Ireland
| | - Luis Rodrigo
- Faculty of Medicine, University of Oviedo, Central University Hospital of Asturias (HUCA), Oviedo, Spain
| | - Peter Kruzliak
- 2nd Department of Surgery, Center for Vascular Disease, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic; Department of Internal Medicine, Brothers of Mercy Hospital, Brno, Czech Republic.
| | - Daniel Petrovic
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| |
Collapse
|
11
|
Traghella I, Mastorci F, Pepe A, Pingitore A, Vassalle C. Nontraditional Cardiovascular Biomarkers and Risk Factors: Rationale and Future Perspectives. Biomolecules 2018; 8:E40. [PMID: 29914099 PMCID: PMC6023023 DOI: 10.3390/biom8020040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 12/13/2022] Open
Abstract
The primary prevention of cardiovascular (CV) disease depends on the capacity to identify subjects at higher risk long before the occurrence of CV clinical manifestations. Traditional risk factors do not cover fully prediction of individual risk. Moreover, there is an area of gray for patients at intermediate CV risk, which offers wide margins of improvement. These observations highlight the need for new additive tools for a more accurate risk stratification. An increasing number of candidate biomarkers have been identified to predict CV risk and events, although they generally give only a moderate increase when added to currently available predictive scores. The approach utilizing a relative small number of biomarkers in multiple combinations, but only weakly related to each other or unrelated, thus belonging to independent-pathways, and so able to catch the multidimensional characteristic of atherosclerosis, appears promising. We discuss vitamin D and bone turnover biomarkers, hepatitis C virus, and psycho-emotional factors that may reflect alternative pathways over those generally considered for atherosclerosis (e.g., aspects directly related to inflammation and thrombosis). These new biomarkers could facilitate a more accurate assessment of CV risk stratification if incorporated in the current risk assessment algorithms.
Collapse
Affiliation(s)
- Irene Traghella
- Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology, CNR San Cataldo Research Area, via Moruzzi, 1, 56124 Pisa, Italy.
| | - Francesca Mastorci
- Institute of Clinical Physiology, CNR San Cataldo Research Area, via Moruzzi, 1, 56124 Pisa, Italy.
| | - Alessia Pepe
- Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology, CNR San Cataldo Research Area, via Moruzzi, 1, 56124 Pisa, Italy.
| | - Alessandro Pingitore
- Institute of Clinical Physiology, CNR San Cataldo Research Area, via Moruzzi, 1, 56124 Pisa, Italy.
| | - Cristina Vassalle
- Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology, CNR San Cataldo Research Area, via Moruzzi, 1, 56124 Pisa, Italy.
| |
Collapse
|
12
|
Ahangari N, Ghayour Mobarhan M, Sahebkar A, Pasdar A. Molecular aspects of hypercholesterolemia treatment: current perspectives and hopes. Ann Med 2018; 50:303-311. [PMID: 29578362 DOI: 10.1080/07853890.2018.1457795] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hypercholesterolemia is a pathological condition which has been reported in 39% of the worlds' adult population. We aimed to review molecular aspects of current and novel therapeutic approaches based on low-density lipoprotein cholesterol lowering strategies. Pathogenic mutations in the LDLR, ApoB, PCSK9 and LDLRAP genes cause deficient clearance of circulating low-density lipoprotein cholesterol particles via hepatic LDL receptor. This leads to increased plasma LDL cholesterol levels from birth, which can cause LDL depositions in the arterial walls. Ultimately, it progresses to atherosclerosis and an increased risk of premature cardiovascular diseases. Currently, statins, Ezetimibe, Bile acid sequestrants and PCSK9 inhibitors are the main therapeutic agents for the treatment of hypercholesterolemia. Moreover, novel RNA-based therapy had a strong impact on therapeutic strategies in recent decades. Additional development in understanding of the molecular basis of hypercholesterolemia will provide opportunities for the development of targeted therapy in the near future. Key Messages The most common genes involved in hypercholesterolemia are LDLR, PCSK9 and ApoB. Pharmacogenetic effects are typically constrained to pathways closely related to the pharmacodynamics and pharmacokinetics. Change in lifestyle and diet along with treatment of the underlying disease and drug therapy are the current therapeutic strategies.
Collapse
Affiliation(s)
- Najmeh Ahangari
- a Departement of Modern Sciences and Technologies, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Majid Ghayour Mobarhan
- b Metabolic Syndrome Research Centre, School of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Amirhossein Sahebkar
- c Biotechnology Research Center , Pharmaceutical Technology Institute, Mashhad University of Medical Sciences , Mashhad , Iran.,d Neurogenic Inflammation Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Alireza Pasdar
- e Medical Genetics Research Centre, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran.,f Division of Applied Medicine, Medical School , University of Aberdeen , Foresterhill , Aberdeen , UK
| |
Collapse
|
13
|
Veljkovic N, Zaric B, Djuric I, Obradovic M, Sudar-Milovanovic E, Radak D, Isenovic ER. Genetic Markers for Coronary Artery Disease. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E36. [PMID: 30344267 PMCID: PMC6122104 DOI: 10.3390/medicina54030036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 12/22/2022]
Abstract
Coronary artery disease (CAD) and myocardial infarction (MI) are recognized as leading causes of mortality in developed countries. Although typically associated with behavioral risk factors, such as smoking, sedentary lifestyle, and poor dietary habits, such vascular phenotypes have also long been recognized as being related to genetic background. We review the currently available data concerning genetic markers for CAD in English and non-English articles with English abstracts published between 2003 and 2018. As genetic testing is increasingly available, it may be possible to identify adequate genetic markers representing the risk profile and to use them in a clinical setting.
Collapse
Affiliation(s)
- Nevena Veljkovic
- Centre for Multidisciplinary Research and Engineering, Institute of Nuclear Science Vinca, University of Belgrade, 11000 Belgrade, Serbia.
| | - Bozidarka Zaric
- Laboratory of Radiobiology and Molecular Genetics, Institute of Nuclear Science Vinca, University of Belgrade, 11000 Belgrade, Serbia.
| | - Ilona Djuric
- Department for Endocrinology and Immunoradiology 11080 Zemun, Institute for the Application of Nuclear Energy-INEP, University of Belgrade, 11000 Belgrade, Serbia.
| | - Milan Obradovic
- Laboratory of Radiobiology and Molecular Genetics, Institute of Nuclear Science Vinca, University of Belgrade, 11000 Belgrade, Serbia.
| | - Emina Sudar-Milovanovic
- Laboratory of Radiobiology and Molecular Genetics, Institute of Nuclear Science Vinca, University of Belgrade, 11000 Belgrade, Serbia.
| | - Djordje Radak
- School of Medicine, Dedinje Cardiovascular Institute, University of Belgrade, 11000 Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia.
| | - Esma R Isenovic
- Laboratory of Radiobiology and Molecular Genetics, Institute of Nuclear Science Vinca, University of Belgrade, 11000 Belgrade, Serbia.
| |
Collapse
|
14
|
Iribarren C, Lu M, Jorgenson E, Martínez M, Lluis-Ganella C, Subirana I, Salas E, Elosua R. Weighted Multi-marker Genetic Risk Scores for Incident Coronary Heart Disease among Individuals of African, Latino and East-Asian Ancestry. Sci Rep 2018; 8:6853. [PMID: 29717161 PMCID: PMC5931622 DOI: 10.1038/s41598-018-25128-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023] Open
Abstract
We examined the clinical utility of two multi-locus genetic risk scores (GRSs) previously validated in Europeans among persons of African (AFR; n = 2,089), Latino (LAT; n = 4,349) and East-Asian (EA; n = 4,804) ancestry. We used data from the GERA cohort (30-79 years old, 68 to 73% female). We utilized two GRSs with 12 and 51 SNPs, respectively, and the Framingham Risk Score (FRS) to estimate 10-year CHD risk. After a median 8.7 years of follow-up, 450 incident CHD events were documented (95 in AFR, 316 in LAT and 39 EA, respectively). In a model adjusting for principal components and risk factors, tertile 3 vs. tertile 1 of GRS_12 was associated with 1.86 (95% CI, 1.15-3.01), 1.52 (95% CI, 1.02-2.25) and 1.19 (95% CI, 0.77-1.83) increased hazard of CHD in AFR, LAT and EA, respectively. Inclusion of the GRSs in models containing the FRS did not increase the C-statistic but resulted in net overall reclassification of 10% of AFR, 7% LAT and EA and in reclassification of 13% of AFR and EA as well as 10% LAT in the intermediate FRS risk subset. Our results support the usefulness of incorporating genetic information into risk assessment for primary prevention among minority subjects in the U.S.
Collapse
Affiliation(s)
- Carlos Iribarren
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
| | - Meng Lu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Eric Jorgenson
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | | | - Isaac Subirana
- CIBER of Epidemiology and Public Health, Barcelona, Spain.,Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain
| | | | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain.,CIBER of Cardiovascular Diseases (CIBERCV), Barcelona, Spain
| |
Collapse
|
15
|
Jarmul J, Pletcher MJ, Hassmiller Lich K, Wheeler SB, Weinberger M, Avery CL, Jonas DE, Earnshaw S, Pignone M. Cardiovascular Genetic Risk Testing for Targeting Statin Therapy in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Cost-Effectiveness Analysis. Circ Cardiovasc Qual Outcomes 2018; 11:e004171. [PMID: 29650716 DOI: 10.1161/circoutcomes.117.004171] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 03/27/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND It is unclear whether testing for novel risk factors, such as a cardiovascular genetic risk score (cGRS), improves clinical decision making or health outcomes when used for targeting statin initiation in the primary prevention of atherosclerotic cardiovascular disease (ASCVD). Our objective was to estimate the cost-effectiveness of cGRS testing to inform clinical decision making about statin initiation in individuals with low-to-intermediate (2.5%-7.5%) 10-year predicted risk of ASCVD. METHODS AND RESULTS We evaluated the cost-effectiveness of testing for a 27-single-nucleotide polymorphism cGRS comparing 4 test/treat strategies: treat all, treat none, test/treat if cGRS is high, and test/treat if cGRS is intermediate or high. We tested a set of clinical scenarios of men and women, aged 45 to 65 years, with 10-year ASCVD risks between 2.5% and 7.5%. Our primary outcome measure was cost per quality-adjusted life-year gained. Under base case assumptions for statin disutility and cost, the preferred strategy is to treat all patients with ASCVD risk >2.5% without cGRS testing. For certain clinical scenarios, such as a 57-year-old man with a 10-year ASCVD risk of 7.5%, cGRS testing can be cost-effective under a limited set of assumptions; for example, when statins cost $15 per month and statin disutility is 0.013 (ie, willing to trade 3 months of life in perfect health to avoid 20 years of statin therapy), the preferred strategy (using a willingness-to-pay threshold of $50 000 per quality-adjusted life-year gained) is to test and treat if cGRS is intermediate or high. Overall, the results were not sensitive to assumptions about statin efficacy and harms. CONCLUSIONS Testing for a 27-single-nucleotide polymorphism cGRS is generally not a cost-effective approach for targeting statin therapy in the primary prevention of ASCVD for low- to intermediate-risk patients.
Collapse
Affiliation(s)
- Jamie Jarmul
- Department of Health Policy and Management, Gillings School of Public Health (J.J., K.H.L., S.B.W., M.W.), UNC School of Medicine (J.J., D.E.J.), Department of Epidemiology, Gillings School of Public Health (C.L.A.), Carolina Population Center (C.L.A.), and Cecil G. Sheps Center for Health Services Research (D.E.J.), University of North Carolina-Chapel Hill. Department of Internal Medicine, Dell Medical School, University of Texas-Austin (M.P.). Department of Epidemiology and Biostatistics (M.J.P.) and Department of Medicine (M.J.P.), University of California, San Francisco
| | - Mark J Pletcher
- Department of Health Policy and Management, Gillings School of Public Health (J.J., K.H.L., S.B.W., M.W.), UNC School of Medicine (J.J., D.E.J.), Department of Epidemiology, Gillings School of Public Health (C.L.A.), Carolina Population Center (C.L.A.), and Cecil G. Sheps Center for Health Services Research (D.E.J.), University of North Carolina-Chapel Hill. Department of Internal Medicine, Dell Medical School, University of Texas-Austin (M.P.). Department of Epidemiology and Biostatistics (M.J.P.) and Department of Medicine (M.J.P.), University of California, San Francisco
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Public Health (J.J., K.H.L., S.B.W., M.W.), UNC School of Medicine (J.J., D.E.J.), Department of Epidemiology, Gillings School of Public Health (C.L.A.), Carolina Population Center (C.L.A.), and Cecil G. Sheps Center for Health Services Research (D.E.J.), University of North Carolina-Chapel Hill. Department of Internal Medicine, Dell Medical School, University of Texas-Austin (M.P.). Department of Epidemiology and Biostatistics (M.J.P.) and Department of Medicine (M.J.P.), University of California, San Francisco
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Public Health (J.J., K.H.L., S.B.W., M.W.), UNC School of Medicine (J.J., D.E.J.), Department of Epidemiology, Gillings School of Public Health (C.L.A.), Carolina Population Center (C.L.A.), and Cecil G. Sheps Center for Health Services Research (D.E.J.), University of North Carolina-Chapel Hill. Department of Internal Medicine, Dell Medical School, University of Texas-Austin (M.P.). Department of Epidemiology and Biostatistics (M.J.P.) and Department of Medicine (M.J.P.), University of California, San Francisco
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Public Health (J.J., K.H.L., S.B.W., M.W.), UNC School of Medicine (J.J., D.E.J.), Department of Epidemiology, Gillings School of Public Health (C.L.A.), Carolina Population Center (C.L.A.), and Cecil G. Sheps Center for Health Services Research (D.E.J.), University of North Carolina-Chapel Hill. Department of Internal Medicine, Dell Medical School, University of Texas-Austin (M.P.). Department of Epidemiology and Biostatistics (M.J.P.) and Department of Medicine (M.J.P.), University of California, San Francisco
| | - Christy L Avery
- Department of Health Policy and Management, Gillings School of Public Health (J.J., K.H.L., S.B.W., M.W.), UNC School of Medicine (J.J., D.E.J.), Department of Epidemiology, Gillings School of Public Health (C.L.A.), Carolina Population Center (C.L.A.), and Cecil G. Sheps Center for Health Services Research (D.E.J.), University of North Carolina-Chapel Hill. Department of Internal Medicine, Dell Medical School, University of Texas-Austin (M.P.). Department of Epidemiology and Biostatistics (M.J.P.) and Department of Medicine (M.J.P.), University of California, San Francisco
| | - Daniel E Jonas
- Department of Health Policy and Management, Gillings School of Public Health (J.J., K.H.L., S.B.W., M.W.), UNC School of Medicine (J.J., D.E.J.), Department of Epidemiology, Gillings School of Public Health (C.L.A.), Carolina Population Center (C.L.A.), and Cecil G. Sheps Center for Health Services Research (D.E.J.), University of North Carolina-Chapel Hill. Department of Internal Medicine, Dell Medical School, University of Texas-Austin (M.P.). Department of Epidemiology and Biostatistics (M.J.P.) and Department of Medicine (M.J.P.), University of California, San Francisco
| | - Stephanie Earnshaw
- Department of Health Policy and Management, Gillings School of Public Health (J.J., K.H.L., S.B.W., M.W.), UNC School of Medicine (J.J., D.E.J.), Department of Epidemiology, Gillings School of Public Health (C.L.A.), Carolina Population Center (C.L.A.), and Cecil G. Sheps Center for Health Services Research (D.E.J.), University of North Carolina-Chapel Hill. Department of Internal Medicine, Dell Medical School, University of Texas-Austin (M.P.). Department of Epidemiology and Biostatistics (M.J.P.) and Department of Medicine (M.J.P.), University of California, San Francisco
| | - Michael Pignone
- Department of Health Policy and Management, Gillings School of Public Health (J.J., K.H.L., S.B.W., M.W.), UNC School of Medicine (J.J., D.E.J.), Department of Epidemiology, Gillings School of Public Health (C.L.A.), Carolina Population Center (C.L.A.), and Cecil G. Sheps Center for Health Services Research (D.E.J.), University of North Carolina-Chapel Hill. Department of Internal Medicine, Dell Medical School, University of Texas-Austin (M.P.). Department of Epidemiology and Biostatistics (M.J.P.) and Department of Medicine (M.J.P.), University of California, San Francisco
| |
Collapse
|
16
|
Fiatal S, Ádány R. Application of Single-Nucleotide Polymorphism-Related Risk Estimates in Identification of Increased Genetic Susceptibility to Cardiovascular Diseases: A Literature Review. Front Public Health 2018; 5:358. [PMID: 29445720 PMCID: PMC5797796 DOI: 10.3389/fpubh.2017.00358] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/15/2017] [Indexed: 12/17/2022] Open
Abstract
Background Although largely preventable, cardiovascular diseases (CVDs) are the biggest cause of death worldwide. Common complex cardiovascular disorders (e.g., coronary heart disease, hypertonia, or thrombophilia) result from a combination of genetic alterations and environmental factors. Recent advances in the genomics of CVDs have fostered huge expectations about future use of susceptibility variants for prevention, diagnosis, and treatment. Our aim was to summarize the latest developments in the field from a public health perspective focusing on the applicability of data on single-nucleotide polymorphisms (SNPs), through a systematic review of studies from the last decade on genetic risk estimating for common CVDs. Methods Several keywords were used for searching the PubMed, Embase, CINAHL, and Web of Science databases. Recent advances were summarized and structured according to the main public health domains (prevention, early detection, and treatment) using a framework suggested recently for translational research. This framework includes four recommended phases: “T1. From gene discovery to candidate health applications; T2. From health application to evidence-based practice guidelines; T3. From evidence-based practice guidelines to health practice; and T4. From practice to population health impacts.” Results The majority of translation research belongs to the T1 phase “translation of basic genetic/genomic research into health application”; there are only a few population-based impacts estimated. The studies suggest that an SNP is a poor estimator of individual risk, whereas an individual’s genetic profile combined with non-genetic risk factors may better predict CVD risk among certain patient subgroups. Further research is needed to validate whether these genomic profiles can prospectively identify individuals at risk to develop CVDs. Several research gaps were identified: little information is available on studies suggesting “Health application to evidence-based practice guidelines”; no study is available on “Guidelines to health practice.” It was not possible to identify studies that incorporate environmental or lifestyle factors in the risk estimation. Conclusion Currently, identifying populations having a larger risk of developing common CVDs may result in personalized prevention programs by reducing people’s risk of onset or disease progression. However, limited evidence is available on the application of genomic results in health and public health practice.
Collapse
Affiliation(s)
- Szilvia Fiatal
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
17
|
|
18
|
Yang KQ, Lu CX, Fan P, Zhang Y, Meng X, Dong XQ, Luo F, Liu YX, Zhang HM, Wu HY, Cai J, Zhang X, Zhou XL. Genetic screening of SCNN1B and SCNN1G genes in early-onset hypertensive patients helps to identify Liddle syndrome. Clin Exp Hypertens 2017; 40:107-111. [PMID: 28718682 DOI: 10.1080/10641963.2017.1334799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Kun-Qi Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao-Xia Lu
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peng Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Meng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Qi Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Luo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya-Xin Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Min Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Ying Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Cai
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Zhang
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
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: 366] [Impact Index Per Article: 52.3] [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.
Collapse
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
| |
Collapse
|
21
|
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: 94] [Impact Index Per Article: 13.4] [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.
Collapse
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.).
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Affiliation(s)
- Peter Libby
- From the Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (P.L.); Department of Medicine, Division of Metabolism, Endocrinology and Nutrition (K.E.B.), and Department of Pathology (K.E.B.), UW Diabetes Institute, University of Washington, Seattle; and Division of Molecular Medicine, Department of Medicine, Columbia University, New York (A.R.T.).
| | - Karin E Bornfeldt
- From the Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (P.L.); Department of Medicine, Division of Metabolism, Endocrinology and Nutrition (K.E.B.), and Department of Pathology (K.E.B.), UW Diabetes Institute, University of Washington, Seattle; and Division of Molecular Medicine, Department of Medicine, Columbia University, New York (A.R.T.)
| | - Alan R Tall
- From the Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (P.L.); Department of Medicine, Division of Metabolism, Endocrinology and Nutrition (K.E.B.), and Department of Pathology (K.E.B.), UW Diabetes Institute, University of Washington, Seattle; and Division of Molecular Medicine, Department of Medicine, Columbia University, New York (A.R.T.)
| |
Collapse
|