Genetic risk score for coronary disease identifies predispositions to cardiovascular and noncardiovascular diseases

Journal article

Background:
The taxonomy of cardiovascular (CV) diseases is divided into a broad spectrum of clinical entities. Manysuch diseases coincide in specific patient groups and suggest shared predisposition.

Objectives:
This study focused on coronary artery disease (CAD) and investigated the genetic relationship to CV andnon-CV diseases with reported CAD comorbidity.

Methods:
This study examined 425,196 UK Biobank participants to determine a genetic risk score (GRS) based on 300CAD associated variants (CAD-GRS). This score was associated with 22 traits, including risk factors, diseases secondary toCAD, as well as comorbid and non-CV conditions. Sensitivity analyses were performed in individuals free from CAD orstable angina diagnosis.

Results:
Hypercholesterolemia (odds ratio [OR]: 1.27; 95% CI: 1.26 to 1.29) and hypertension (OR: 1.11; 95% CI: 1.10 to1.12) were strongly associated with the CAD-GRS, which indicated that the score contained variants predisposing to theseconditions. However, the CAD-GRS was also significant in patients with CAD who were free of CAD risk factors (OR: 1.37;95% CI: 1.30 to 1.44). The study observed significant associations between the CAD-GRS and peripheral arterial disease(OR: 1.28; 95% CI: 1.23 to 1.32), abdominal aortic aneurysms (OR: 1.28; 95% CI: 1.20 to 1.37), and stroke (OR: 1.08;95% CI: 1.05 to 1.10), which remained significant in sensitivity analyses that suggested shared genetic predisposition. Thescore was also associated with heart failure (OR: 1.25; 95% CI: 1.22 to 1.29), atrialfibrillation (OR: 1.08; 95% CI: 1.05 to1.10), and premature death (OR: 1.04; 95% CI: 1.02 to 1.06). These associations were abolished in sensitivity analysesthat indicated that they were secondary to prevalent CAD. Finally, an inverse association was observed between the scoreand migraine headaches (OR: 0.94; 95% CI: 0.93 to 0.96).

Conclusions:
A wide spectrum of CV conditions, including premature death, might develop consecutively or inparallel with CAD for the same genetic roots. In conditions like heart failure, the study found evidence that theCAD-GRS could be used to stratify patients with no or limited genetic overlap with CAD risk. Increased geneticpredisposition to CAD was inversely associated with migraine headaches.

Authors: Ntalla, I; Kanoni, S; Zeng, L; Giannakopoulou, O; Danesh, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Journal of the American College of Cardiology
• Volume: 73
• Issue: 23
• Pages: 2932-2942
• Publication date: 2019-06-10
• Acceptance date: 2019-03-19
• DOI: 10.1016/j.jacc.2019.03.512
• EISSN: 1558-3597
• ISSN: 0735-1097
• Pmid: 31196449
• Language: English
• Keywords: coronary artery disease; cardiovascular diseases; migraine; heart failure; UK Biobank; genetic risk score