Lifestyle Cardiovascular Risk Score, Genetic Risk Score, and Myocardial Infarction in Hispanic/Latino Adults Living in Costa Rica

Background: A genetic risk score (GRS) and a lifestyle cardiovascular risk score (LCRS) have been independently associated with myocardial infarction (MI) in Hispanics. However, it is unknown if there is an interaction or a joint association between these scores. Objectives: To assess the interactive and joint associations between a GRS and a LCRS, as well as each individual lifestyle risk factor on the likelihood of MI. Methods: Data included 1534 Costa Rican adults with nonfatal acute MI and 1534 without MI participating in a case-control study. The GRS was calculated by summing the number of the top three MI-associated risk alleles. The LCRS was calculated using the estimated coefficients as weights for each lifestyle risk factors (diet, physical activity, smoking, waist:hip ratio, low or high alcohol intake, and low socioeconomic status). Conditional logistic regression was used to calculate odds ratios (OR), adjusting for age, sex, and area of residence (matching condition), and to test for interaction and joint association. Results: The multivariable OR for MI was 1.14 (95% CI 1.07, 1.22) per GRS unit and 2.72 (2.33, 3.91) per LCRS unit. Participants in the highest tertile of the GRS and highest tertile of the LCRS had higher odds of MI (5.43 [3.80, 7.76]) compared to those in the lowest category. A significant joint association was detected (p <0.0001), while the interaction term was non-significant (p=0.44). Similar results were found for the joint association between GRS and each individual lifestyle component: joint odds for highest risk category vs. lowest was 2.16 (1.53, 3.04) for diet, 1.85 (1.33, 2.59) for physical activity, 3.31 (2.45, 4.48) for smoking, 1.32 (0.92, 1.89) for alcohol, 2.84 (1.82, 4.42) for waist:hip ratio, and 1.86 (1.29, 2.69) for socioeconomic status. Conclusion: Although lifestyle risk factors and genetics contribute independently and in combination to the odds of MI, lifestyle risk factors were stronger among Costa Ricans. Efforts to improve lifestyle behaviors in this population, regardless of genetic susceptibility, may help prevent MI and related heart conditions.

Download Full-text

Mendelian Randomization Focused Analysis of Vitamin D on the Secondary Prevention of Ischemic Stroke

Stroke ◽

10.1161/strokeaha.120.032634 ◽

2021 ◽

Author(s):

Yap-Hang Chan ◽

C. Mary Schooling ◽

Jie Zhao ◽

Shiu-Lun Au Yeung ◽

Jo Jo Hai ◽

...

Keyword(s):

Myocardial Infarction ◽

Vitamin D ◽

Ischemic Stroke ◽

Risk Score ◽

Genetic Risk ◽

Odds Ratio ◽

Mendelian Randomization ◽

De Novo ◽

Genetic Risk Score ◽

Ischemic Disease

Background and Purpose: Experimental studies showed vitamin D (Vit-D) could promote vascular regeneration and repair. Prior randomized studies had focused mainly on primary prevention. Whether Vit-D protects against ischemic stroke and myocardial infarction recurrence among subjects with prior ischemic insults was unknown. Here, we dissected through Mendelian randomization any effect of Vit-D on the secondary prevention of recurrent ischemic stroke and myocardial infarction. Methods: Based on a genetic risk score for Vit-D constructed from a derivation cohort sample (n=5331, 45% Vit-D deficient, 89% genotyped) via high-throughput exome-chip screening of 12 prior genome-wide association study–identified genetic variants of Vit-D mechanistic pathways ( rs2060793 , rs4588 , and rs7041 ; F statistic, 73; P <0.001), we performed a focused analysis on prospective recurrence of myocardial infarction (MI) and ischemic stroke in an independent subsample with established ischemic disease (n=441, all with prior first ischemic event; follow-up duration, 41.6±14.3 years) under a 2-sample, individual-data, prospective Mendelian randomization approach. Results: In the ischemic disease subsample, 11.1% (n=49/441) had developed recurrent ischemic stroke or MI and 13.3% (n=58/441) had developed recurrent or de novo ischemic stroke/MI. Kaplan-Meier analyses showed that genetic risk score predicted improved event-free survival from recurrent ischemic stroke or MI (log-rank, 13.0; P =0.001). Cox regression revealed that genetic risk score independently predicted reduced risk of recurrent ischemic stroke or MI combined (hazards ratio, 0.62 [95% CI, 0.48–0.81]; P <0.001), after adjusted for potential confounders. Mendelian randomization supported that Vit-D is causally protective against the primary end points of recurrent ischemic stroke or MI (Wald estimate: odds ratio, 0.55 [95% CI, 0.35–0.81]) and any recurrent or de novo ischemic stroke/MI (odds ratio, 0.64 [95% CI, 0.42–0.91]) and recurrent MI alone (odds ratio, 0.52 [95% CI, 0.30–0.81]). Conclusions: Genetically predicted lowering in Vit-D level is causal for the recurrence of ischemic vascular events in persons with prior ischemic stroke or MI.

Download Full-text

A genetic risk score predicts recurrent events after myocardial infarction in young adults

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2019.08.006 ◽

2020 ◽

Vol 73 (8) ◽

pp. 623-631

Author(s):

Luis M. Rincón ◽

Marcelo Sanmartín ◽

Gonzalo L. Alonso ◽

José Antonio Rodríguez ◽

Alfonso Muriel ◽

...

Keyword(s):

Myocardial Infarction ◽

Young Adults ◽

Risk Score ◽

Genetic Risk ◽

Recurrent Events ◽

Genetic Risk Score

Download Full-text

A MYOCARDIAL INFARCTION GENETIC RISK SCORE ASSOCIATES WITH CAROTID ATHEROSCLEROSIS

Journal of Hypertension ◽

10.1097/00004872-201106001-00052 ◽

2011 ◽

Vol 29 ◽

pp. e19

Author(s):

V. Hamrefors ◽

B. Hedblad ◽

G. Engström ◽

P. Almgren ◽

M. Sjögren ◽

...

Keyword(s):

Myocardial Infarction ◽

Risk Score ◽

Genetic Risk ◽

Carotid Atherosclerosis ◽

Genetic Risk Score

Download Full-text

959Coronary artery disease risk according to genetic risk score deciles, Age and cardiovascular risk factors

European Heart Journal ◽

10.1093/eurheartj/ehx502.959 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

A. Pereira ◽

M. Neto ◽

R. Rodrigues ◽

J. Monteiro ◽

A.C. Sousa ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Risk Score ◽

Genetic Risk ◽

Disease Risk ◽

Genetic Risk Score ◽

Artery Disease

Download Full-text

Association of a Genetic Risk Score With Prevalent and Incident Myocardial Infarction in Subjects Undergoing Coronary Angiography

Circulation Cardiovascular Genetics ◽

10.1161/circgenetics.111.960229 ◽

2012 ◽

Vol 5 (4) ◽

pp. 441-449 ◽

Cited By ~ 29

Author(s):

Riyaz S. Patel ◽

Yan V. Sun ◽

Jaana Hartiala ◽

Emir Veledar ◽

Shaoyong Su ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Angiography ◽

Risk Score ◽

Genetic Risk ◽

Genetic Risk Score

Download Full-text

Impact of a Genetic Risk Score for Coronary Artery Disease on Reducing Cardiovascular Risk: A Pilot Randomized Controlled Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2017.00053 ◽

2017 ◽

Vol 4 ◽

Cited By ~ 17

Author(s):

Joshua W. Knowles ◽

Shirin Zarafshar ◽

Aleksandra Pavlovic ◽

Benjamin A. Goldstein ◽

Sandra Tsai ◽

...

Keyword(s):

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Risk Score ◽

Genetic Risk ◽

Genetic Risk Score ◽

Randomized Controlled Study ◽

Controlled Study ◽

Randomized Controlled ◽

Artery Disease

Download Full-text

P1551A genetic risk score predicts recurrent events after myocardial infarction in young adults

European Heart Journal ◽

10.1093/eurheartj/ehz748.0311 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L M Rincon ◽

M Sanmartin ◽

G L Alonso ◽

J A Rodriguez ◽

A Muriel ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Risk Score ◽

Genetic Risk ◽

Recurrent Events ◽

Cardiac Ct ◽

Ldl Cholesterol ◽

Genetic Risk Score ◽

P Value ◽

Diabetic Patients

Abstract Background To evaluate whether a genetic risk score (GRS) improves the prediction of recurrent events in young non-diabetic patients presenting with an acute myocardial infarction and identifies a more aggressive form of atherosclerosis in this population. Methods and results We performed a prospective study including 81 consecutive non-diabetic patients aged below 55 y.o. presenting with an acute myocardial infarction (48±6 y.o., 89% male). A comprehensive study including serum biomarkers, genetic testing and cardiac CT was performed. We studied the association of a GRS composed of 11 genetic variants with a primary composite end-point (all-cause mortality, recurrent acute coronary syndrome, and cardiac re-hospitalisation). After a median follow-up of 4.1 (3.5 - 4.4) years 24 recurrent events were documented. A significantly higher prevalence of 9 out of 11 risk alleles was noted compared with general population. The GRS was significantly associated with recurrent events, especially when baseline LDL-cholesterol levels were elevated. Compared with the low-risk GRS category, the multivariate-adjusted hazard ratio for recurrent events for the intermediate-risk GRS category was 10.2 (95% CI 1.1–100.3, p=0.04) and for the high-risk GRS was 20.7 (2.4–181.0, p=0.006) when LDL-C ≥2.8 mmol/L. Inclusion of the GRS improved the C statistic (ΔC statistic =0.086), the continuous Net Reclassification Index (30%) and the Integrated Discrimination Improvement (0.05) compared with a multivariate clinical risk model. Cardiac CT detected coronary calcified atherosclerosis and numerous plaques but it had a limited value for prediction of recurrences. No association was observed between extracellular matrix metabolism biomarkers and GRS or recurrent events in this population. Cox regression analysis between GRS terciles and LDL-C Univariate analysis Multivariate analysis* HR (95% CI) p-value HR (95% CI) p-value* Low GRS 1 1 Intermediate GRS 2.0 (0.7–5.8) 0.21 LDL-C≤110 mg/dL (≤2.8 mmol/L) 1.0 (0.3–4.0) >110 mg/dL (>2.8 mmol/L) 10.2 (1.1–100.3) 0.04 High GRS 3.0 (1.0–9.2) 0.05 LDL-C≤110 mg/dL (≤2.8 mmol/L) 0.3 (0.1–1.9) >110 mg/dL (>2.8 mmol/L) 20.7 (2.4–181.0) 0.006 *Multivariate model adjusted for GRACE risk score and LDL-C and interaction. There was a strong interaction between GRS terciles and LDL-C (p<0.01). Recurrent events based on genetic risk Conclusions A multilocus genetic risk score identified non-diabetic young patients at increased risk for recurrent events after a myocardial infarction. The significance of LDL-cholesterol in relation to genetic predisposition for recurrences merits further evaluation. Acknowledgement/Funding Instituto de Salud Carlos III (PI12/0564, PI14/01152 and PI15/00667), the CIBERCV and the Spanish Society of Cardiology (2015/CC)

Download Full-text