Association Between a Literature-Based Genetic Risk Score and Cardiovascular Events in Women | Genetics and Genomics | JAMA | JAMA Network
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Original Contribution
February 17, 2010

Association Between a Literature-Based Genetic Risk Score and Cardiovascular Events in Women

Author Affiliations

Author Affiliations: Center for Cardiovascular Disease Prevention and the Divisions of Preventive Medicine and Cardiovascular Diseases, Brigham and Women's Hospital, Boston, Massachusetts (Drs Paynter, Chasman, Paré, Buring, Cook, and Ridker); Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada (Dr Paré); and Amgen Inc, Thousand Oaks, California (Dr Miletich).

JAMA. 2010;303(7):631-637. doi:10.1001/jama.2010.119

Context While multiple genetic markers associated with cardiovascular disease have been identified by genome-wide association studies, their aggregate effect on risk beyond traditional factors is uncertain, particularly among women.

Objective To test the predictive ability of a literature-based genetic risk score for cardiovascular disease.

Design, Setting, and Participants Prospective cohort of 19 313 initially healthy white women in the Women's Genome Health Study followed up over a median of 12.3 years (interquartile range, 11.6-12.8 years). Genetic risk scores were constructed from the National Human Genome Research Institute's catalog of genome-wide association study results published between 2005 and June 2009.

Main Outcome Measure Incident myocardial infarction, stroke, arterial revascularization, and cardiovascular death.

Results A total of 101 single nucleotide polymorphisms reported to be associated with cardiovascular disease or at least 1 intermediate cardiovascular disease phenotype at a published P value of less than 10−7 were identified and risk alleles were added to create a genetic risk score. During follow-up, 777 cardiovascular disease events occurred (199 myocardial infarctions, 203 strokes, 63 cardiovascular deaths, 312 revascularizations). After adjustment for age, the genetic risk score had a hazard ratio (HR) for cardiovascular disease of 1.02 per risk allele (95% confidence interval [CI], 1.00-1.03/risk allele; P = .006). This corresponds to an absolute cardiovascular disease risk of 3% over 10 years in the lowest tertile of genetic risk (73-99 risk alleles) and 3.7% in the highest tertile (106-125 risk alleles). However, after adjustment for traditional factors, the genetic risk score did not improve discrimination or reclassification (change in c index from Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [ATP III] risk score, 0; net reclassification improvement, 0.5%; [P = .24]). The genetic risk score was not associated with cardiovascular disease risk (ATP III–adjusted HR/allele, 1.00; 95% CI, 0.99-1.01). In contrast, self-reported family history remained significantly associated with cardiovascular disease in multivariable models.

Conclusion After adjustment for traditional cardiovascular risk factors, a genetic risk score comprising 101 single nucleotide polymorphisms was not significantly associated with the incidence of total cardiovascular disease.