Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (N.R.H., M.R.B., A.S.H., A.B., E.B., A.C.M., P.S.d.V).
Department of Epidemiology and Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands (S.L.).
Circulation. 2022 Mar 15;145(11):808-818. doi: 10.1161/CIRCULATIONAHA.121.053730. Epub 2022 Jan 31.
Understanding the effect of lifestyle and genetic risk on the lifetime risk of coronary heart disease (CHD) is important to improving public health initiatives. Our objective was to quantify remaining lifetime risk and years free of CHD according to polygenic risk and the American Heart Association's Life's Simple 7 (LS7) guidelines in a population-based cohort study.
Our analysis included data from participants of the ARIC (Atherosclerosis Risk in Communities) study: 8372 White and 2314 Black participants; 45 years of age and older; and free of CHD at baseline examination. A polygenic risk score (PRS) comprised more than 6 million genetic variants was categorized into low (<20th percentile), intermediate, and high (>80th percentile). An overall LS7 score was calculated at baseline and categorized into "poor," "intermediate," and "ideal" cardiovascular health. Lifetime risk and CHD-free years were computed according to polygenic risk and LS7 categories.
The overall remaining lifetime risk was 27%, ranging from 16.6% in individuals with an ideal LS7 score to 43.1% for individuals with a poor LS7 score. The association of PRS with lifetime risk differed according to ancestry. In White participants, remaining lifetime risk ranged from 19.8% to 39.3% according to increasing PRS categories. Individuals with a high PRS and poor LS7 had a remaining lifetime risk of 67.1% and 15.9 fewer CHD-free years than did those with intermediate polygenic risk and LS7 scores. In the high-PRS group, ideal LS7 was associated with 20.2 more CHD-free years compared with poor LS7. In Black participants, remaining lifetime risk ranged from 19.1% to 28.6% according to increasing PRS category. Similar lifetime risk estimates were observed for individuals of poor LS7 regardless of PRS category. In the high-PRS group, an ideal LS7 score was associated with only 4.5 more CHD-free years compared with a poor LS7 score.
Ideal adherence to LS7 recommendations was associated with lower lifetime risk of CHD for all individuals, especially in those with high genetic susceptibility. In Black participants, adherence to LS7 guidelines contributed to lifetime risk of CHD more so than current PRSs. Improved PRSs are needed to properly evaluate genetic susceptibility for CHD in diverse populations.
了解生活方式和遗传风险对冠心病（CHD）终生风险的影响对于改善公共卫生措施至关重要。我们的目标是在一项基于人群的队列研究中，根据多基因风险和美国心脏协会的“生命简单 7 项”（LS7）准则，量化终生风险和无 CHD 年限。
我们的分析包括 ARIC（社区动脉粥样硬化风险）研究的参与者数据：8372 名白人和 2314 名黑人参试者；年龄在 45 岁及以上；基线检查时无 CHD。多基因风险评分（PRS）由超过 600 万个遗传变异组成，分为低（<20 百分位）、中、高（>80 百分位）。在基线时计算总体 LS7 评分，并分为“差”、“中等”和“理想”心血管健康。根据多基因风险和 LS7 类别计算终生风险和无 CHD 年限。
总体剩余终生风险为 27%，范围为 LS7 评分理想者的 16.6%至 LS7 评分差者的 43.1%。PRS 与终生风险的关联因种族而异。在白种参与者中，根据 PRS 分类递增，剩余终生风险范围为 19.8%至 39.3%。高 PRS 和 LS7 评分差者的剩余终生风险为 67.1%，无 CHD 年限比中等多基因风险和 LS7 评分者少 15.9 年。在高 PRS 组中，LS7 评分理想与 LS7 评分差相比，无 CHD 年限多 20.2 年。在黑种参与者中，根据 PRS 分类递增，剩余终生风险范围为 19.1%至 28.6%。无论 PRS 类别如何，LS7 评分差的个体终生风险估计值相似。在高 PRS 组中，LS7 评分理想仅比 LS7 评分差多 4.5 年无 CHD。
对于所有个体，理想的 LS7 建议的依从性与较低的 CHD 终生风险相关，尤其是在遗传易感性高的个体中。在黑种参与者中，LS7 指南的依从性对 CHD 终生风险的贡献大于当前的 PRS。需要改进 PRS 以正确评估不同人群中 CHD 的遗传易感性。
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