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冠心病遗传风险评分对降低心血管风险的影响:一项试点随机对照研究。

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

作者信息

Knowles Joshua W, Zarafshar Shirin, Pavlovic Aleksandra, Goldstein Benjamin A, Tsai Sandra, Li Jin, McConnell Michael V, Absher Devin, Ashley Euan A, Kiernan Michaela, Ioannidis John P A, Assimes Themistocles L

机构信息

Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States.

Duke Clinical Research Institute, Duke University, Durham, NC, United States.

出版信息

Front Cardiovasc Med. 2017 Aug 14;4:53. doi: 10.3389/fcvm.2017.00053. eCollection 2017.

Abstract

PURPOSE

We tested whether providing a genetic risk score (GRS) for coronary artery disease (CAD) would serve as a motivator to improve adherence to risk-reducing strategies.

METHODS

We randomized 94 participants with at least moderate risk of CAD to receive standard-of-care with ( = 49) or without ( = 45) their GRS at a subsequent 3-month follow-up visit. Our primary outcome was change in low density lipoprotein cholesterol (LDL-C) between the 3- and 6-month follow-up visits (ΔLDL-C). Secondary outcomes included other CAD risk factors, weight loss, diet, physical activity, risk perceptions, and psychological outcomes. In pre-specified analyses, we examined whether there was a greater motivational effect in participants with a higher GRS.

RESULTS

Sixty-five participants completed the protocol including 30 participants in the GRS arm. We found no change in the primary outcome between participants receiving their GRS and standard-of-care participants (ΔLDL-C: -13 vs. -9 mg/dl). Among participants with a higher GRS, we observed modest effects on weight loss and physical activity. All other secondary outcomes were not significantly different, including anxiety and worry.

CONCLUSION

Adding GRS to standard-of-care did not change lipids, adherence, or psychological outcomes. Potential modest benefits in weight loss and physical activity for participants with high GRS need to be validated in larger trials.

摘要

目的

我们测试了提供冠状动脉疾病(CAD)的遗传风险评分(GRS)是否会成为提高对降低风险策略依从性的一个激励因素。

方法

我们将94名至少有中度CAD风险的参与者随机分组,在随后3个月的随访中,一组(n = 49)接受包含其GRS的标准治疗,另一组(n = 45)接受不包含GRS的标准治疗。我们的主要结局是3个月和6个月随访之间低密度脂蛋白胆固醇(LDL-C)的变化(ΔLDL-C)。次要结局包括其他CAD风险因素、体重减轻、饮食、身体活动、风险认知和心理结局。在预先设定的分析中,我们研究了GRS较高的参与者是否有更大的激励效果。

结果

65名参与者完成了研究方案,包括GRS组的30名参与者。我们发现接受GRS的参与者和标准治疗参与者之间的主要结局没有变化(ΔLDL-C:-13 vs. -9mg/dl)。在GRS较高的参与者中,我们观察到对体重减轻和身体活动有适度影响。所有其他次要结局没有显著差异,包括焦虑和担忧。

结论

在标准治疗中添加GRS并没有改变血脂、依从性或心理结局。GRS较高的参与者在体重减轻和身体活动方面潜在的适度益处需要在更大规模的试验中得到验证。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b128/5558259/535ff785af3f/fcvm-04-00053-g001.jpg

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