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Sex-specific genetic risks for adverse outcomes after coronary revascularization procedures

Jouko Marko Nurkkala1,2, Jenni Aittokallio1,2,

  • 1Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.

Interdisciplinary Cardiovascular and Thoracic Surgery
|January 12, 2024
PubMed

Insights

Genetic risk for atrial fibrillation (AF) after revascularization is higher in men, while risk for intracranial hemorrhage (ICH) is higher in women. Polygenic risk scores (PRS) can identify individuals at high genetic risk for these sex-specific complications.

Area of Science:

  • Cardiovascular Genetics
  • Genomics
  • Precision Medicine

Background:

  • Sex differences in adverse events after revascularization are observed, potentially influenced by genetic factors.
  • Understanding these sex-specific genetic predispositions is crucial for personalized risk assessment and management in cardiovascular patients.

Purpose of the Study:

  • To investigate sex-specific associations between polygenic risk scores (PRSs) and major adverse cardiovascular and cerebrovascular events following coronary revascularization.
  • To determine if genetic predisposition to conditions like atrial fibrillation (AF) and intracranial hemorrhage (ICH) differs between men and women post-revascularization.

Main Methods:

  • A large cohort of 5,561 women and 17,578 men undergoing revascularization procedures were included.
  • Genotyping was performed, and polygenic risk scores (PRSs) for various outcomes were calculated.
  • Cox proportional hazards models with interaction terms were used to analyze sex-specific associations between PRSs and adverse events, including AF, ischaemic stroke (STR), ICH, myocardial infarction (MI), and gastrointestinal hemorrhage (GIH).

Main Results:

  • The atrial fibrillation PRS (AF-PRS) showed a stronger association with AF in men compared to women (P for interaction = 0.006).
  • Conversely, the intracranial hemorrhage PRS (ICH-PRS) was more strongly associated with ICH in women than in men (P for interaction = 0.008).
  • No significant sex-specific differences were found for the PRS associations with ischaemic stroke, myocardial infarction, or gastrointestinal hemorrhage.

Conclusions:

  • Genetic predisposition to AF after revascularization is greater in men, whereas the genetic risk for ICH is higher in women.
  • Sex-specific PRS can potentially be utilized to identify individuals at elevated genetic risk for these sex-specific post-revascularization complications.
  • These findings support the development of tailored genetic risk stratification strategies in cardiovascular care.

Keywords:
ComplicationCoronary artery bypass graftingGeneticPercutaneous coronary interventionRevascularizationRisk score

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