The elucidation of genetic mechanisms affecting the risk of atherosclerosis has largely benefited from recent technological breakthroughs in terms of high-throughput sequencing and genotyping. While a decade ago only a positive family history and mutations causing familial hypercholesterolaemia were proven to confer genetic risk of atherosclerosis, by now multiple genes have been implicated in monogenic and complex forms of accelerated atherosclerosis. At the population level, the discovery of hundreds of common variants, each affecting the risk of atherosclerosis by a small margin, may have even broader implications. A substantial finding from these studies is that the risk of atherosclerosis and its clinical manifestations, such as myocardial infarction, stroke, and peripheral arterial disease, is secondary to a much broader spectrum of underlying (genetic) mechanisms than previously thought. Indeed, the genetic variants leading to atherosclerosis go far beyond the effects of classical risk factors, such as hypertension, dyslipidaemia, diabetes mellitus, and smoking. Based on these findings, genetic risk scores are scrutinized to improve the prediction of coronary artery disease in asymptomatic individuals. Remarkably, people with a high genetic risk burden have the greatest benefit from therapeutic lowering of LDL cholesterol. Currently, the systems biology of the multiple interacting factors contributing to the risk of atherosclerosis as well as respective therapeutic implications, in part addressed by Mendelian randomization studies, is subject to intensive research. Likewise, genetic risk scores are scrutinized to improve the prediction of coronary artery disease in asymptomatic individuals. This chapter gives a brief overview on the current understanding of the genetic underpinnings of atherosclerosis.
An update on genetic risk scores for coronary artery disease: are they useful for predicting disease risk and guiding clinical decisions?
