| Title: | European and US Guideline-Based Statin Eligibility, Genetically Predicted Coronary Artery Disease, and the Risk of Major Coronary Events. |
| Journal: | Journal of the American Heart Association |
| Published: | 19 Apr 2024 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/38639378/ |
| DOI: | https://doi.org/10.1161/jaha.123.032831 |
| URL: | https://www.ahajournals.org/doi/pdf/10.1161/JAHA.123.032831 |
Publication 9860
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Abstract
BACKGROUND: A study was designed to investigate whether the coronary artery disease polygenic risk score (CAD-PRS) may guide lipid-lowering treatment initiation as well as deferral in primary prevention beyond established clinical risk scores.</p>
METHODS AND RESULTS: Participants were 311 799 individuals from the UK Biobank free of atherosclerotic cardiovascular disease, diabetes, chronic kidney disease, and lipid-lowering treatment at baseline. Participants were categorized as statin indicated, statin indication unclear, or statin not indicated as defined by the European and US guidelines on statin use. For a median of 11.9 (11.2-12.6) years, 8196 major coronary events developed. CAD-PRS added to European-Systematic Coronary Risk Evaluation 2 (European-SCORE2) and US-Pooled Cohort Equation (US-PCE) identified 18% and 12% of statin-indication-unclear individuals whose risk of major coronary events were the same as or higher than the average risk of statin-indicated individuals and 16% and 12% of statin-indicated individuals whose major coronary event risks were the same as or lower than the average risk of statin-indication-unclear individuals. For major coronary and atherosclerotic cardiovascular disease events, CAD-PRS improved C-statistics greater among statin-indicated or statin-indication-unclear than statin-not-indicated individuals. For atherosclerotic cardiovascular disease events, CAD-PRS added to the European evaluation and US equation resulted in a net reclassification improvement of 13.6% (95% CI, 11.8-15.5) and 14.7% (95% CI, 13.1-16.3) among statin-indicated, 10.8% (95% CI, 9.6-12.0) and 15.3% (95% CI, 13.2-17.5) among statin-indication-unclear, and 0.9% (95% CI, 0.6-1.3) and 3.6% (95% CI, 3.0-4.2) among statin-not-indicated individuals.</p>
CONCLUSIONS: CAD-PRS may guide statin initiation as well as deferral among statin-indication-unclear or statin-indicated individuals as defined by the European and US guidelines. CAD-PRS had little clinical utility among statin-not-indicated individuals.</p>
12 Authors
- Hanjin Park
- Daehoon Kim
- Seng Chan You
- Eunsun Jang
- Hee Tae Yu
- Tae-Hoon Kim
- Dong-Min Kim
- Jung-Hoon Sung
- Hui-Nam Pak
- Moon-Hyoung Lee
- Pil-Sung Yang
- Boyoung Joung
1 Application
| Application ID | Title |
|---|---|
| 77793 | The causal inference study to determine the association of genetically predicted biological, behavioral, ethnic factors with risk of atrial fibrillation and its associated complications. |
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