European and US Guideline-Based Statin Eligibility, Genetically Predicted Coronary Artery Disease, and the Risk of Major Coronary Events.
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Clinical Guidelines
Authored By
Park H, Kim D, You SC, Jang E, Yu HT, Kim TH, Kim DM, Sung JH, Pak HN, Lee MH, Yang PS, Joung B
Authored On
Interests
Cardiology
Internal/Family Medicine
Speciality
Cardiology
Internal/Family Medicine
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volume
13
ISSN
2047-9980
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["Park H, Kim D, You SC, Jang E, Yu HT, Kim TH, Kim DM, Sung JH, Pak HN, Lee MH, Yang PS, Joung B","Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE","Journal Article; Research Support, Non-U.S. Gov't; Research Support, N.I.H., Extramural","2024-05-07","Journal of the American Heart Association [J Am Heart Assoc] 2024 May 07; Vol. 13 (9), pp. e032831. Date of Electronic Publication: 2024 Apr 19.","English","2047-9980","Hydroxymethylglutaryl-CoA Reductase Inhibitors*\/therapeutic use , Coronary Artery Disease*\/genetics , Coronary Artery Disease*\/epidemiology , Coronary Artery Disease*\/prevention & control , Practice Guidelines as Topic*, Humans ; Male ; Female ; Middle Aged ; Risk Assessment ; United States\/epidemiology ; Aged ; Primary Prevention\/methods ; Europe\/epidemiology ; Eligibility Determination ; United Kingdom\/epidemiology ; Risk Factors ; Genetic Predisposition to Disease ; Multifactorial Inheritance ; Patient Selection ; Adult","Humans, Male, Female, Middle Aged, Risk Assessment, United States epidemiology, Aged, Primary Prevention methods, Europe epidemiology, Eligibility Determination, United Kingdom epidemiology, Risk Factors, Genetic Predisposition to Disease, Multifactorial Inheritance, Patient Selection, Adult, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Coronary Artery Disease genetics, Coronary Artery Disease epidemiology, Coronary Artery Disease prevention & control, Practice Guidelines as Topic","Journal of the American Heart Association","13"]
Description
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.<br />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.<br />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.
