Insulin resistance genetic risk score and burden of coronary artery disease in patients referred for coronary angiography

Aims Insulin resistance associates with development of metabolic syndrome and risk of cardiovascular disease. The link between insulin resistance and cardiovascular disease is complex and multifactorial. Confirming the genetic link between insulin resistance, type 2 diabetes, and coronary artery disease, as well as the extent of coronary artery disease, is important and may provide better risk stratification for patients at risk. We investigated whether a genetic risk score of 53 single nucleotide polymorphisms known to be associated with insulin resistance phenotypes was associated with diabetes and burden of coronary artery disease. Methods and results We genotyped patients with a coronary angiography performed in the capital region of Denmark from 2010–2014 and constructed a genetic risk score of the 53 single nucleotide polymorphisms. Logistic regression using quartiles of the genetic risk score was performed to determine associations with diabetes and coronary artery disease. Associations with the extent of coronary artery disease, defined as one-, two- or three-vessel coronary artery disease, was determined by multinomial logistic regression. We identified 4,963 patients, of which 17% had diabetes and 55% had significant coronary artery disease. Of the latter, 27%, 14% and 14% had one, two or three-vessel coronary artery disease, respectively. No significant increased risk of diabetes was identified comparing the highest genetic risk score quartile with the lowest. An increased risk of coronary artery disease was found for patients with the highest genetic risk score quartile in both unadjusted and adjusted analyses, OR 1.21 (95% CI: 1.03, 1.42, p = 0.02) and 1.25 (95% CI 1.06, 1.48, p<0.01), respectively. In the adjusted multinomial logistic regression, patients in the highest genetic risk score quartile were more likely to develop three-vessel coronary artery disease compared with patients in the lowest genetic risk score quartile, OR 1.41 (95% CI: 1.10, 1.82, p<0.01). Conclusions Among patients referred for coronary angiography, only a strong genetic predisposition to insulin resistance was associated with risk of coronary artery disease and with a greater disease burden.

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Association Between Family History, a Genetic Risk Score, and Severity of Coronary Artery Disease in Patients With Premature Acute Coronary Syndromes

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.115.306944 ◽

2016 ◽

Vol 36 (6) ◽

pp. 1286-1292 ◽

Cited By ~ 22

Author(s):

Waseem Hindieh ◽

Louise Pilote ◽

Asim Cheema ◽

Hatim Al-Lawati ◽

Christopher Labos ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Family History ◽

Risk Score ◽

Genetic Risk ◽

Acute Coronary Syndromes ◽

Genetic Risk Score ◽

Coronary Syndromes ◽

Artery Disease

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Decision letter for "A genetic risk score predicts coronary artery disease in familial hypercholesterolaemia: enhancing the precision of risk assessment"

10.1111/cge.13648/v2/decision1 ◽

2019 ◽

Keyword(s):

Risk Assessment ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Score ◽

Genetic Risk ◽

Familial Hypercholesterolaemia ◽

Genetic Risk Score ◽

Artery Disease

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Review for "A genetic risk score predicts coronary artery disease in familial hypercholesterolaemia: enhancing the precision of risk assessment"

10.1111/cge.13648/v1/review2 ◽

2019 ◽

Author(s):

Gail Norbury

Keyword(s):

Risk Assessment ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Score ◽

Genetic Risk ◽

Familial Hypercholesterolaemia ◽

Genetic Risk Score ◽

Artery Disease

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P4455The controversial role of genetics behind premature CAD: a plausible excuse for the young?

European Heart Journal ◽

10.1093/eurheartj/ehz745.0854 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Sousa ◽

M Mendonca ◽

A Pereira ◽

F Mendonca ◽

M Neto ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Score ◽

Genetic Risk ◽

Genetic Risk Score ◽

Young Patients ◽

Premature Cad ◽

Artery Disease ◽

Group B

Abstract Introduction The complex interaction between genes and environmental factors contribute to individual-level risk of coronary artery disease (CAD), often resulting in premature CAD. The role for genetic risk scores in premature CAD is still controversial. Objective To evaluate the importance of conventional risk factors and of a genetic risk score in younger and older patients with coronary artery disease Methods From a group of 1619 pts with angiographic documented CAD from the GENEMACOR study, we selected 1276 pts admitted for ACS and analysed them in 2 groups (group A: ≤50 years, n=491 pts, 87.2% male, mean age 44±4.9 and group B: >50 years, n=785 pts, 75.2% male, mean age 57±4.2). Univariate analysis was used to characterize the traits of each group and we used ROC curves and respective AUCs to evaluate the power of genetics in the prediction of CAD, through a Genetic Risk Score (GRS). Results 99.3% of the young patients had at least one modifiable risk factor, 18.4% had 2 modifiable risk factors and 75.2% had 3 or more modifiable risk factors. The pattern of risk factors contributing to CAD were different among groups: family history (A: 27.5%, B: 21.4%, p=0.015) and smoking habits (A: 64.8%, B: 42.9%, p<0.001) were more frequent among patients under 50, and traditional age-linked factors like hypertension (A: 58%, B: 75.7%, p<0.001), diabetes (A: 21.6%, B: 38.6%, p<0.001) were more common in the older group. Acute ST-elevation myocardial infarction was more frequent among the young (A: 55.4%, B: 47.4%, p=0.006), as non-ST clinical presentation was higher among elder patients. Regarding angiographic presentation, single vessel CAD was higher in group A (A: 50.3%, B: 40.9%, p<0.001), while multivessel diasease was higher in group B (A: 33.3%, B: 53.9%, p<0.001). At a mean follow-up of 5 years, older patients had a worst prognosis, registering a higher rate of cardiovascular death (A: 4.1%, B: 8.6%, p=0.002) and higher MACE (A: 26.8%, B: 31%, p=0.128),. Adding the genetic risk score (GRS), we achieved only a slight improvement in the AUC for predicting CAD (0.796->0.805, p=0.0178 and 0.748->0.761, p=0.0007 in patients under and over 50, respectively). Conclusion Coronary artery disease is not all the same, as premature CAD shares a unique and specific pattern of risk factors, clinical presentation, angiographic severity and prognosis. Genetics should not be used as an excuse to justify premature CAD, as there is frequently more than one potentially reversible risk factor present even in young patients and the additive predictive value of GRS is modest.

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Genetic risk score and cardiovascular mortality in a southern european population with coronary artery disease

International Journal of Clinical Practice ◽

10.1111/ijcp.12956 ◽

2017 ◽

Vol 71 (6) ◽

pp. e12956 ◽

Cited By ~ 5

Author(s):

Andreia Pereira ◽

Maria Isabel Mendonca ◽

Ana Célia Sousa ◽

Sofia Borges ◽

Sónia Freitas ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Score ◽

Cardiovascular Mortality ◽

Genetic Risk ◽

Genetic Risk Score ◽

European Population ◽

Artery Disease

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TIMI RISK SCORES

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.12.839 ◽

2015 ◽

Vol 22 (12) ◽

pp. 1569-1573

Author(s):

Muhammad Ijaz Bhatti ◽

Usman Javed Iqbal ◽

Nasir Iqbal

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Score ◽

Risk Scores ◽

Vessel Coronary Artery Disease ◽

Timi Score ◽

St Elevation ◽

Artery Disease ◽

Timi Risk Score ◽

Vessel Coronary Artery

Background: Thrombolysis In Myocardial Infarction (TIMI) risk score predictsadverse clinical outcomes in patients with non–ST-elevation acute coronary syndromes(NSTEACS). Whether this score correlates with the coronary anatomy is unknown. Objective:To determine the frequency of low, moderate and high TIMI risk score in patients of NSTEACSand to compare the frequency of two vessel coronary artery disease on angiography withlow, moderate and high TIMI risk scores in patients of NSTE-ACS. Study design: This was across sectional study. Setting: Department of Cardiology, Gulab Devi Chest Hospital, Lahore.Duration: Six months. Patients and Methods: Total 170 patients were included in the study.Patients’ selection was done with the help of a pre-defined inclusion and exclusion criteria. TIMIrisk score was calculated for each patient and patients were categorized into low, moderate andhigh risk groups (as per operational definition). Patients were further evaluated with coronaryangiograms to assess the double vessel CAD. All angiographies were performed by a singlephysician. Data analysis was done on SPSS version 17. Results: Mean age of our patients was54.81±10.55 years. Gender distribution shows that there were 106(62%) male and 64(38%)female patients. TIMI score risk classification showed that among 50(29.4%) patients TIMI riskscore was low, among 107(62.9%) patients it was moderate and in 13(7.6%) patients it washigh. There were 105(62%) patients who had two vessel coronary artery disease. Among 105patients who had two vessel coronary artery disease, 25(23.8%) had low TIMI score, 69(65.7%)had moderate and 11(10.5%) of the patients had high TIMI score. Conclusion: In patientswith non-ST-elevation acute coronary syndrome undergoing cardiac catheterization, the TIMIrisk score is significantly associated with two vessel coronary artery disease. So it should berecommended that a routine invasive strategy be carried in patients with moderate or higherTIMI risk score.

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