P91 The development and validation of a polygenic risk score for myocardial infarction in SLE

Background: Several risk factors for coronary artery disease (CAD) have been described, some of which are genetically determined. The use of a polygenic risk score (PRS) could improve CAD risk assessment, but predictive accuracy according to age and sex is not well established. Methods: A PRS CAD including the weighted effects of >1.14 million SNPs associated with CAD was calculated in UK Biobank (n=408 422), using LDpred. Cox regressions were performed, stratified by age quartiles and sex, for incident myocardial infarction (MI) and mortality, with a median follow-up of 11.0 years. Improvement in risk prediction of MI was assessed by comparing PRS CAD to the pooled cohort equation with categorical net reclassification index using a 2% threshold (NRI 0.02 ) and continuous NRI (NRI >0 ). Results: From 7746 incident MI cases and 393 725 controls, hazard ratio for MI reached 1.53 (95% CI, 1.49–1.56; P =2.69×10 −296 ) per SD increase of PRS CAD . PRS CAD was significantly associated with MI in both sexes, with a stronger association in men (interaction P =0.002), particularly in those aged between 40 and 51 years (hazard ratio, 2.00 [95% CI, 1.86–2.16], P =1.93×10 −72 ). This group showed the highest reclassification improvement, mainly driven by the up-classification of cases (NRI 0.02 , 0.199 [95% CI, 0.157–0.248] and NRI >0 , 0.602 [95% CI, 0.525–0.683]). From 23 982 deaths, hazard ratio for mortality was 1.08 (95% CI, 1.06–1.09; P =5.46×10 −30 ) per SD increase of PRS CAD , with a stronger association in men (interaction P =1.60×10 −6 ). Conclusions: Our PRS CAD predicts MI incidence and all-cause mortality, especially in men aged between 40 and 51 years. PRS could optimize the identification and management of individuals at risk for CAD.

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Polygenic risk score and statin relative risk reduction for primary prevention in a real-world population

10.1101/2021.07.28.21254571 ◽

2021 ◽

Author(s):

Akinyemi Oni-Orisan ◽

Tanushree Haldar ◽

Mari Angelica Cayabyab ◽

Dilrini K Ranatunga ◽

Thomas J Hoffmann ◽

...

Keyword(s):

Myocardial Infarction ◽

Relative Risk ◽

Primary Prevention ◽

Risk Reduction ◽

Risk Score ◽

Relative Risk Reduction ◽

Routine Care ◽

Polygenic Risk Score ◽

Polygenic Risk ◽

Ascvd Risk

Background Randomized-controlled trials demonstrate that high coronary heart disease (CHD) polygenic risk score modifies statin CHD relative risk reduction, but it is unknown if the association extends to statin users undergoing routine care. Objectives The primary objective was to determine how statin effectiveness is modified by CHD polygenic risk score in a real-world cohort of primary prevention participants. Methods We determined polygenic risk scores in participants of the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. Cox regression models were used to compare the risk of the cardiovascular outcomes between statin users and matched nonusers. Results The hazard ratio (HR) for statin effectiveness on incident myocardial infarction was similar within 10-year atherosclerotic cardiovascular disease (ASCVD) risk score groups at 0.65 (95% confidence interval [CI] 0.39-1.08; P=0.10), 0.65 (95% CI 0.56-0.77; P=2.1E-7), and 0.67 (95% CI 0.57-0.80; P=4.3E-6) for borderline, intermediate, and high ASCVD groups, respectively. In contrast, statin effectiveness by polygenic risk was largest in the high polygenic risk score group (HR 0.62, 95% CI 0.50-0.77; P=1.4E-5), intermediate in the intermediate polygenic risk score group (HR 0.70, 95% CI 0.61-0.80; P=5.7E-7), and smallest in the low polygenic risk score group (HR 0.86, 95% CI 0.65-1.16; P=0.33). ASCVD risk and statin LDL-C lowering did not differ across polygenic risk score groups. Conclusions In primary prevention patients undergoing routine care, CHD polygenic risk modified statin relative risk reduction of incident myocardial infarction independent of statin LDL-C lowering. Our findings extend prior work by identifying a subset of patients with attenuated clinical benefit from statins.

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