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Genome-Wide Polygenic Score, Clinical Risk Factors, and Long-Term Trajectories of Coronary Artery Disease

Hindy, George LU ; Aragam, Krishna G. ; Ng, Kenney ; Chaffin, Mark ; Lotta, Luca A. ; Baras, Aris ; Drake, Isabel LU ; Orho-Melander, Marju LU ; Melander, Olle LU and Kathiresan, Sekar , et al. (2020) In Arteriosclerosis, Thrombosis, and Vascular Biology 40(11). p.2738-2746
Abstract

OBJECTIVE: To determine the relationship of a genome-wide polygenic score for coronary artery disease (GPSCAD) with lifetime trajectories of CAD risk, directly compare its predictive capacity to traditional risk factors, and assess its interplay with the Pooled Cohort Equations (PCE) clinical risk estimator. Approach and Results: We studied GPSCAD in 28 556 middle-aged participants of the Malmö Diet and Cancer Study, of whom 4122 (14.4%) developed CAD over a median follow-up of 21.3 years. A pronounced gradient in lifetime risk of CAD was observed-16% for those in the lowest GPSCAD decile to 48% in the highest. We evaluated the discriminative capacity of the GPSCAD-as assessed by change in the C-statistic from a baseline model including... (More)

OBJECTIVE: To determine the relationship of a genome-wide polygenic score for coronary artery disease (GPSCAD) with lifetime trajectories of CAD risk, directly compare its predictive capacity to traditional risk factors, and assess its interplay with the Pooled Cohort Equations (PCE) clinical risk estimator. Approach and Results: We studied GPSCAD in 28 556 middle-aged participants of the Malmö Diet and Cancer Study, of whom 4122 (14.4%) developed CAD over a median follow-up of 21.3 years. A pronounced gradient in lifetime risk of CAD was observed-16% for those in the lowest GPSCAD decile to 48% in the highest. We evaluated the discriminative capacity of the GPSCAD-as assessed by change in the C-statistic from a baseline model including age and sex-among 5685 individuals with PCE risk estimates available. The increment for the GPSCAD (+0.045, P<0.001) was higher than for any of 11 traditional risk factors (range +0.007 to +0.032). Minimal correlation was observed between GPSCAD and 10-year risk defined by the PCE (r=0.03), and addition of GPSCAD improved the C-statistic of the PCE model by 0.026. A significant gradient in lifetime risk was observed for the GPSCAD, even among individuals within a given PCE clinical risk stratum. We replicated key findings-noting strikingly consistent results-in 325 003 participants of the UK Biobank. CONCLUSIONS: GPSCAD-a risk estimator available from birth-stratifies individuals into varying trajectories of clinical risk for CAD. Implementation of GPSCAD may enable identification of high-risk individuals early in life, decades in advance of manifest risk factors or disease.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
coronary artery disease, disease, genome, risk factors, statistics
in
Arteriosclerosis, Thrombosis, and Vascular Biology
volume
40
issue
11
pages
9 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:32957805
  • scopus:85094220478
ISSN
1524-4636
DOI
10.1161/ATVBAHA.120.314856
language
English
LU publication?
yes
id
f1380a92-6013-46f9-8f86-927342afca3b
date added to LUP
2020-11-05 13:02:02
date last changed
2021-02-23 04:57:35
@article{f1380a92-6013-46f9-8f86-927342afca3b,
  abstract     = {<p>OBJECTIVE: To determine the relationship of a genome-wide polygenic score for coronary artery disease (GPSCAD) with lifetime trajectories of CAD risk, directly compare its predictive capacity to traditional risk factors, and assess its interplay with the Pooled Cohort Equations (PCE) clinical risk estimator. Approach and Results: We studied GPSCAD in 28 556 middle-aged participants of the Malmö Diet and Cancer Study, of whom 4122 (14.4%) developed CAD over a median follow-up of 21.3 years. A pronounced gradient in lifetime risk of CAD was observed-16% for those in the lowest GPSCAD decile to 48% in the highest. We evaluated the discriminative capacity of the GPSCAD-as assessed by change in the C-statistic from a baseline model including age and sex-among 5685 individuals with PCE risk estimates available. The increment for the GPSCAD (+0.045, P&lt;0.001) was higher than for any of 11 traditional risk factors (range +0.007 to +0.032). Minimal correlation was observed between GPSCAD and 10-year risk defined by the PCE (r=0.03), and addition of GPSCAD improved the C-statistic of the PCE model by 0.026. A significant gradient in lifetime risk was observed for the GPSCAD, even among individuals within a given PCE clinical risk stratum. We replicated key findings-noting strikingly consistent results-in 325 003 participants of the UK Biobank. CONCLUSIONS: GPSCAD-a risk estimator available from birth-stratifies individuals into varying trajectories of clinical risk for CAD. Implementation of GPSCAD may enable identification of high-risk individuals early in life, decades in advance of manifest risk factors or disease.</p>},
  author       = {Hindy, George and Aragam, Krishna G. and Ng, Kenney and Chaffin, Mark and Lotta, Luca A. and Baras, Aris and Drake, Isabel and Orho-Melander, Marju and Melander, Olle and Kathiresan, Sekar and Khera, Amit V.},
  issn         = {1524-4636},
  language     = {eng},
  number       = {11},
  pages        = {2738--2746},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Arteriosclerosis, Thrombosis, and Vascular Biology},
  title        = {Genome-Wide Polygenic Score, Clinical Risk Factors, and Long-Term Trajectories of Coronary Artery Disease},
  url          = {http://dx.doi.org/10.1161/ATVBAHA.120.314856},
  doi          = {10.1161/ATVBAHA.120.314856},
  volume       = {40},
  year         = {2020},
}