■冠心病(CHD)的预测模型中不包括遗传因素。
■作者评估了冠心病(定义为心肌梗死,冠状动脉血运重建,或心血管死亡)以及单基因家族性高胆固醇血症(FH)和家族史(FamHx)引起的风险是否独立于PRS并与之相加。
■在英国生物银行的参与者中,PRSCHD使用metaGRS计算,使用合并队列方程(PCE)估计发生CHD的10年风险.评估受试者操作者曲线的曲线下面积(AUC)和净再分类改善(NRI)。FH被定义为LDLR中存在致病性或可能致病性变异,APOB,或PCSK9。FamHx被定义为一级亲属的冠心病诊断。PRSCHD的独立和累加效应,FH,和FamHx在分层分析中进行了评估。
■在323,373名具有基因型数据的参与者中,在PCE中加入PRSCHD可使AUC从0.759(95%CI:0.755-0.763)增加至0.773(95%CI:0.769-0.777).在55岁之前,PRSCHD的AUC和NRIEvent较高。在199,997名具有外显子组序列数据的参与者中,10,000人的PRSCHD≥95百分位数(PRSP95),673有FH,46,163人拥有FamHx。与PRSP95相关的CHD风险独立于FH和FamHx。与PRSCHD组合相关的风险,FH,和FamHx是相加的,可以通过将每个遗传因素的风险相乘来获得综合估计。
■将PRSCHD纳入PCE可以改善冠心病的风险预测,尤其是在年轻的时候。PRSCHD协会,FH,FamHx与CHD是独立和相加的。
UNASSIGNED: Genetic factors are not included in prediction models for coronary heart disease (CHD).
UNASSIGNED: The authors assessed the predictive utility of a polygenic risk score (PRS) for CHD (defined as myocardial infarction, coronary revascularization, or cardiovascular death) and whether the risks due to monogenic familial hypercholesterolemia (FH) and family history (FamHx) are independent of and additive to the PRS.
UNASSIGNED: In UK-biobank participants, PRSCHD was calculated using metaGRS, and 10-year risk for incident CHD was estimated using the pooled cohort equations (PCE). The area under the curve (AUC) of the receiver operator curve and net reclassification improvement (NRI) were assessed. FH was defined as the presence of a pathogenic or likely pathogenic variant in LDLR, APOB, or PCSK9. FamHx was defined as a diagnosis of CHD in first-degree relatives. Independent and additive effects of PRSCHD, FH, and FamHx were evaluated in stratified analyses.
UNASSIGNED: In 323,373 participants with genotype data, the addition of PRSCHD to PCE increased the AUC from 0.759 (95% CI: 0.755-0.763) to 0.773 (95% CI: 0.769-0.777). The AUC and NRIEvent for PRSCHD were higher before the age of 55 years. Of 199,997 participants with exome sequence data, 10,000 had a PRSCHD ≥95th percentile (PRSP95), 673 had FH, and 46,163 had FamHx. The CHD risk associated with PRSP95 was independent of FH and FamHx. The risks associated with combinations of PRSCHD, FH, and FamHx were additive and comprehensive estimates could be obtained by multiplying the risk from each genetic factor.
UNASSIGNED: Incorporating PRSCHD into the PCE improves risk prediction for CHD, especially at younger ages. The associations of PRSCHD, FH, and FamHx with CHD were independent and additive.