Genetic risk must be considered in guidelines for managing patients susceptible to CAD

Current guidelines for primary cardiovascular prevention do not fully capture a polygenic susceptibility to coronary artery disease (CAD), suggests a recent study.

“An opportunity may exist to improve CAD prevention efforts by integrating both genetic and clinical risk,” the authors said.

The authors sought to intersect polygenic risk with guideline-based recommendations and management patterns for primary prevention of CAD. They applied a genome-wide CAD polygenic risk score (PRS) to 47,108 individuals (mean age, 60 years) across three US healthcare systems.

The authors then examined whether primary prevention patients at high polygenic risk might be distinguished based on guideline-recommended statin eligibility and higher rates of statin therapy.

Of the patients, 11,020 (23.4 percent) had CAD. A robust association was found between CAD PRS and prevalent CAD (odds ratio, 1.4 per SD increase in PRS; p<0.0001). High polygenic risk (top 20 percent of PRS) correlated with a 1.9-fold increased risk of developing CAD (p<0.0001).

In contrast, high polygenic risk did not lead to greater recommendations for statin therapy among primary prevention patients per the American College of Cardiology/American Heart Association (46.2 percent for those with high PRS vs 46.8 percent for all others; p=0.54) or US Preventive Services Task Force (43.7 percent vs 43.7 percent; p=0.99) or higher rates of statin prescriptions (25.0 percent vs 23.8 percent; p=0.04).

If high CAD PRS were considered a guideline-based risk-enhancing factor, 4.1 percent more primary prevention patients might be recommended for statin therapy, according to the authors.

“PRS for CAD identify high-risk individuals more likely to benefit from primary prevention statin therapy,” the authors explained.