多基因风险与长期冠状动脉斑块进展及高危斑块相关。
Polygenic Risk Is Associated With Long-Term Coronary Plaque Progression and High-Risk Plaque.
作者信息
Nurmohamed Nick S, Shim Injeong, Gaillard Emilie L, Ibrahim Shirin, Bom Michiel J, Earls James P, Min James K, Planken R Nils, Choi Andrew D, Natarajan Pradeep, Stroes Erik S G, Knaapen Paul, Reeskamp Laurens F, Fahed Akl C
机构信息
Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.
Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of South Korea.
出版信息
JACC Cardiovasc Imaging. 2024 Dec;17(12):1445-1459. doi: 10.1016/j.jcmg.2024.06.015. Epub 2024 Aug 14.
BACKGROUND
The longitudinal relation between coronary artery disease (CAD) polygenic risk score (PRS) and long-term plaque progression and high-risk plaque (HRP) features is unknown.
OBJECTIVES
The goal of this study was to investigate the impact of CAD PRS on long-term coronary plaque progression and HRP.
METHODS
Patients underwent CAD PRS measurement and prospective serial coronary computed tomography angiography (CTA) imaging. Coronary CTA scans were analyzed with a previously validated artificial intelligence-based algorithm (atherosclerosis imaging-quantitative computed tomography imaging). The relationship between CAD PRS and change in percent atheroma volume (PAV), percent noncalcified plaque progression, and HRP prevalence was investigated in linear mixed-effect models adjusted for baseline plaque volume and conventional risk factors.
RESULTS
A total of 288 subjects (mean age 58 ± 7 years; 60% male) were included in this study with a median scan interval of 10.2 years. At baseline, patients with a high CAD PRS had a more than 5-fold higher PAV than those with a low CAD PRS (10.4% vs 1.9%; P < 0.001). Per 10 years of follow-up, a 1 SD increase in CAD PRS was associated with a 0.69% increase in PAV progression in the multivariable adjusted model. CAD PRS provided additional discriminatory benefit for above-median noncalcified plaque progression during follow-up when added to a model with conventional risk factors (AUC: 0.73 vs 0.69; P = 0.039). Patients with high CAD PRS had an OR of 2.85 (95% CI: 1.14-7.14; P = 0.026) and 6.16 (95% CI: 2.55-14.91; P < 0.001) for having HRP at baseline and follow-up compared with those with low CAD PRS.
CONCLUSIONS
Polygenic risk is strongly associated with future long-term plaque progression and HRP in patients suspected of having CAD.
背景
冠状动脉疾病（CAD）多基因风险评分（PRS）与长期斑块进展及高危斑块（HRP）特征之间的纵向关系尚不清楚。
目的
本研究旨在探讨CAD PRS对长期冠状动脉斑块进展和HRP的影响。
方法
患者接受CAD PRS测量及前瞻性系列冠状动脉计算机断层扫描血管造影（CTA）成像。采用先前验证的基于人工智能的算法（动脉粥样硬化成像-定量计算机断层扫描成像）分析冠状动脉CTA扫描结果。在针对基线斑块体积和传统危险因素进行调整的线性混合效应模型中，研究CAD PRS与粥样斑块体积百分比（PAV）变化、非钙化斑块进展百分比及HRP患病率之间的关系。
结果
本研究共纳入288名受试者（平均年龄58±7岁；60%为男性），中位扫描间隔为10.2年。基线时，CAD PRS高的患者PAV比CAD PRS低的患者高5倍多（10.4%对1.9%；P<0.001）。在多变量调整模型中，每随访10年，CAD PRS增加1个标准差与PAV进展增加0.69%相关。当将CAD PRS添加到包含传统危险因素的模型中时，其为随访期间非钙化斑块进展高于中位数提供了额外的鉴别益处（曲线下面积：0.73对0.69；P=0.039）。与CAD PRS低的患者相比，CAD PRS高的患者在基线和随访时出现HRP的比值比分别为2.85（95%置信区间：1.14-7.14；P=0.026）和6.16（95%置信区间：2.55-14.91；P<0.001）。
结论
多基因风险与疑似CAD患者未来的长期斑块进展和HRP密切相关。
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