Author + information
- Panagiotis Antiochos, MD∗ (, )
- Pedro Marques-Vidal, MD, PhD and
- Peter Vollenweider, MD
- ↵∗Department of Internal Medicine, University Hospital of Lausanne, CoLaus study, 19, rue du Bugnon, Lausanne CH-1005, Switzerland
We read with great interest the paper by Yeboah et al. (1) investigating the added predictive value of coronary artery calcium, ankle–brachial index, high-sensitivity C-reactive protein, and family history to the atherosclerotic cardiovascular disease (ASCVD) pooled cohort equation in MESA (Multi-Ethnic Study of Atherosclerosis). Although all of the aforementioned nontraditional cardiovascular risk factors were associated with ASCVD, coronary artery calcium was the only marker to improve predictive accuracy beyond the calibrated pooled cohort equation in a 10-year prediction model.
After recent discoveries from genome-wide association studies, genetic risk scores (GRS) have emerged as an additional nontraditional risk factor for ASCVD. Using data from the CoLaus population-based prospective cohort, we recently showed that literature-based GRS are independently associated with incident coronary heart disease (hazard ratio: 1.50; 95% confidence interval: 1.26 to 1.80) and modestly increase discrimination (C-index improvement 0.016; p = 0.048) and reclassification (net reclassification index improvement 8.6%; p = 0.027) beyond traditional cardiovascular risk factors and parental history of premature coronary heart disease events (2).
Although genetic testing is not recommended in the 2013 American College of Cardiology/American Heart Association guidelines on the assessment of cardiovascular risk or in the 2012 European Society of Cardiology guidelines on cardiovascular disease prevention (Class of recommendation III), there is currently mounting evidence to suggest that multi-locus GRS can significantly improve our predictive capability for ASCVD and guide decision-making for statin treatment (3).
Accordingly, we strongly agree with the editorial by Zamorano et al. (4) underscoring the need to move prevention beyond short-term ASCVD prediction toward lifetime risk estimation. As our understanding about ASCVD heritability grows and availability of genetic screening becomes widespread, we believe that GRS for ASCVD could represent such a powerful, cost-effective lifetime risk-stratification tool. Thus, it would be interesting for the investigators to further test the capacity of a multi-locus GRS to improve ASCVD prediction on top of the calibrated pooled cohort equation in the MESA cohort, even in the 10-year risk model.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Yeboah J.,
- Young R.,
- McClelland R.L.,
- et al.
- Zamorano J.L.,
- Del Val D.