临床,实验室和遗传风险因素对事件CAD的重要性
Romit Bhattacharya1,2, Christopher S Marnell3, So Mi Jemma Cho1,2,4
1Department of Medicine, Harvard Medical School (R.B., A.P., A.J., S.H., K.L., M.C.H., P.N.), Massachusetts General Hospital, Boston.
Circulation. Genomic and precision medicine
|July 3, 2025
概括
新型心血管风险因素,包括多基因风险得分,hsCRP和Lp(a),在预防心肌梗塞方面与高血压等传统因素同样重要. 这些发现确定了预防心脏病发作的主要剩余风险.
科学领域:
- 心血管医学 心血管医学
- 遗传学 是一个遗传学.
- 预防性心脏病学 预防性心脏病学
背景情况:
- 据估计,可修改的心血管风险因素 (CRF) 导致80-90%的心肌梗塞.
- 之前的研究并没有同时评估遗传和新型CRF与传统CRF一起.
研究的目的:
- 评估传统,当代和遗传CRF对发生心肌梗塞的贡献.
- 为了确定冠状动脉疾病的关键残留风险因素.
主要方法:
- 利用了来自英国生物库的数据,包括299,707个人.
- 构建了包含传统CRF (高血压,糖尿病,脂质失调等) 的Cox比例危险模型. 和新型/遗传CRF (Lp(a),hsCRP,家族高胆固醇血症变体,多基因风险评分).
- 计算每个CRF的百分比贡献,通过测量其从模型中删除后的R平方下降.
主要成果:
- 当代/遗传模型 (R平方0.053) 的预测值高于临床模型 (R平方0.045) 和基准模型 (R平方0.021).
- 高血压 (15.2%的R平方损失) 和冠状动脉疾病的多基因风险评分 (12.4%的R平方损失) 是最重要的个人CRF.
- 新的因素如hsCRP (1.8%的R平方损失) 和Lp (a) (1.5%的R平方损失) 显示出了显著的贡献.
结论:
- 新型CRF,包括多基因风险得分,hsCRP和Lp(a),在预测心肌梗塞方面具有与传统CRF相美的重要性.
- 这些发现强调了这些因素在确定冠状动脉疾病残留风险方面的重要性.
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