Genetic Risk and Coronary Artery Calcium in Personalizing Antihypertensive Treatment: A Pooled Cohort Analysis

IF 6.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Mayo Clinic proceedings Pub Date : 2024-09-01 DOI:10.1016/j.mayocp.2023.12.020

Naman S. Shetty MD , Mokshad Gaonkar MS , Akhil Pampana MS , Nirav Patel MD , Marguerite R. Irvin PhD , Henry J. Lin MD , Xiuqing Guo PhD , Stephen S. Rich PhD , Jerome I. Rotter MD , Matthew J. Budoff MD , Peng Li PhD , Garima Arora MD , Pankaj Arora MD

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Abstract

Objective

To assess the role of the systolic blood pressure polygenic risk score (SBP-PRS) in antihypertensive treatment initiation and its comparative efficacy with coronary artery calcium (CAC) scores.

Patients and Methods

This retrospective cohort study included participants with whole genome sequencing data who underwent CAC scanning between 1971 and 2008, were free of prevalent cardiovascular disease (CVD), and were not taking antihypertensive medications. The cohort was stratified by blood pressure (BP) treatment group and SBP-PRS (low/intermediate, first and second tertiles; high, third tertile) and CAC score (0 vs >0) subgroups. The primary outcome was the first occurence of adjudicated coronary heart disease, heart failure, or stroke during 10-year follow-up. The 10-year number needed to treat (NNT) to prevent 1 event of the primary outcome was estimated. A relative risk reduction of 25% for the primary outcome based on the treatment effect of intensive control (SBP <120 mm Hg) of hypertension in SPRINT (Systolic Blood Pressure Intervention Trial) was used for estimating the NNT.

Results

Among the 5267 study participants, the median age was 59 years (interquartile range, 51-68 years); 2817 (53.5%) were women and 2880 (54.7%) were non-White individuals. Among 1317 individuals with elevated BP/low-risk stage 1 hypertension not recommended treatment, the 10-year incidence rate of the primary outcome was 5.6% for low/intermediate SBP-PRS and 6.3% for high SBP-PRS with NNTs of 63 and 59, respectively. Similarly, the 10-year incidence rate of the primary outcome was 2.9% for CAC score 0 and 9.7% for CAC score greater than 0, with NNTs of 117 and 37, respectively.

Conclusion

Including genetic information in risk estimation of individuals with elevated BP/low-risk stage 1 hypertension has modest value in the initiation of antihypertensive therapy. Genetic risk and CAC both have efficacy in personalizing antihypertensive therapy.

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个性化降压治疗中的遗传风险和冠状动脉钙化：汇总队列分析

目的评估收缩压多基因风险评分（SBP-PRS）在启动降压治疗中的作用及其与冠状动脉钙化（CAC）评分的疗效比较：这项回顾性队列研究纳入了具有全基因组测序数据的参与者，他们在 1971 年至 2008 年间接受了 CAC 扫描，没有流行性心血管疾病（CVD），也没有服用降压药。队列按血压（BP）治疗组和SBP-PRS（低/中，第一和第二三等分；高，第三三等分）和CAC评分（0 vs >0）亚组进行分层。主要结果是在 10 年随访期间首次出现经判定的冠心病、心力衰竭或中风。估算了预防 1 次主要结局事件的 10 年治疗需要量（NNT）。根据强化控制的治疗效果，主要结果的相对风险降低了 25%（SBP 结果）：在 5267 名研究参与者中，年龄中位数为 59 岁（四分位间范围为 51-68 岁）；2817 人（53.5%）为女性，2880 人（54.7%）为非白人。在 1317 名未建议治疗的血压升高/低风险 1 期高血压患者中，低/中度 SBP-PRS 的 10 年主要结局发生率为 5.6%，高 SBP-PRS 的 10 年主要结局发生率为 6.3%，NNT 分别为 63 和 59。同样，CAC 评分为 0 的 10 年主要结果发生率为 2.9%，CAC 评分大于 0 的 10 年主要结果发生率为 9.7%，NNT 分别为 117 和 37：结论：将遗传信息纳入血压升高/低危一期高血压患者的风险评估，对启动降压治疗的价值不大。遗传风险和 CAC 在个性化降压治疗中均有疗效。

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来源期刊

Mayo Clinic proceedings 医学-医学：内科

CiteScore

16.80

自引率

1.10%

发文量

383

审稿时长

37 days

期刊介绍： Mayo Clinic Proceedings is a premier peer-reviewed clinical journal in general medicine. Sponsored by Mayo Clinic, it is one of the most widely read and highly cited scientific publications for physicians. Since 1926, Mayo Clinic Proceedings has continuously published articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal welcomes submissions from authors worldwide and includes Nobel-prize-winning research in its content. With an Impact Factor of 8.9, Mayo Clinic Proceedings is ranked #20 out of 167 journals in the Medicine, General and Internal category, placing it in the top 12% of these journals. It invites manuscripts on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics.