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Published on: August 9, 2024
Genetics-based risk scores for prediction of premature coronary artery disease
1Department of Preventive Cardiology & Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, India.
Insights
Premature coronary artery disease (CAD) poses a significant health risk in India. Gene risk score (GRS) using genome-wide association studies (GWAS) shows promise in identifying individuals at high risk for early CAD.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Public Health
Background:
- Premature coronary artery disease (CAD) is a major cause of death in India, affecting individuals with and without traditional risk factors.
- Current clinical risk algorithms and imaging techniques offer limited predictive information for premature CAD.
- CAD is a complex, multifactorial condition necessitating advanced risk assessment tools.
Purpose of the Study:
- To evaluate the predictive capability of gene risk scores (GRS) derived from genome-wide association studies (GWAS) for premature CAD.
- To assess the effectiveness of GWAS-based GRS in improving risk stratification for younger individuals.
- To explore the potential of GRS in guiding aggressive interventions for preventing premature CAD.
Main Methods:
- Utilizing genome-wide association studies (GWAS) to incorporate millions of single nucleotide polymorphisms (SNPs) for GRS calculation.
- Comparing the discriminative power of GWAS-based GRS against conventional risk assessment tools.
- Analyzing the impact of GRS on the net reclassification of risk, particularly in South Asian populations.
Main Results:
- GWAS-based GRS demonstrate enhanced discriminative ability compared to traditional methods for assessing CAD risk.
- GRS significantly improves risk reclassification by approximately 15% in younger individuals, especially among South Asians.
- High GRS identifies individuals who may benefit from intensified lifestyle interventions and lipid-lowering therapies.
Conclusions:
- GWAS-based GRS represent a powerful tool for predicting and stratifying risk in premature CAD.
- Integrating GRS into clinical practice can lead to more personalized and effective prevention strategies.
- Targeted interventions in high-GRS individuals hold the potential to significantly reduce the burden of premature CAD.
Abstract:
Premature coronary artery disease (CAD) is endemic in India. Global Burden of Diseases study has reported that it led to 286,000 deaths in 2019 in India. Many of these patients have standard risk factors but a third have none. Clinical risk algorithms and imaging provide limited risk information in premature CAD. CAD is multifactorial and studies have now focused on the predictive capability of clusters of genes and single nucleotide polymorphisms (SNPs) using gene risk score (GRS). Older studies combined data from 10 to 12 genes and 100-500 SNPs to calculate GRS, however, following the advent of genome-wide association studies (GWAS), millions of SNPs have been incorporated. Studies have reported that GWAS-based GRS may be more discriminative than conventional tools. Recent studies, especially among South Asians, have reported that GRS improves net reclassification by 15% (12-19%) for younger individuals. Aggressive lifestyle interventions and lipid-lowering therapies can ameliorate risk in high-GRS individuals and potentially prevent premature CAD.
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