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      American Heart Association’s Life’s Simple 7: Lifestyle Recommendations, Polygenic Risk, and Lifetime Risk of Coronary Heart Disease

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          Background:

          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.

          Methods:

          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.

          Results:

          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.

          Conclusions:

          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.

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          Most cited references43

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          Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

          Circulation, 139(10)
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            Next-generation genotype imputation service and methods.

            Genotype imputation is a key component of genetic association studies, where it increases power, facilitates meta-analysis, and aids interpretation of signals. Genotype imputation is computationally demanding and, with current tools, typically requires access to a high-performance computing cluster and to a reference panel of sequenced genomes. Here we describe improvements to imputation machinery that reduce computational requirements by more than an order of magnitude with no loss of accuracy in comparison to standard imputation tools. We also describe a new web-based service for imputation that facilitates access to new reference panels and greatly improves user experience and productivity.
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              2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

              Circulation
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                Author and article information

                Contributors
                Journal
                Circulation
                Circulation
                CIR
                Circulation
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0009-7322
                1524-4539
                31 January 2022
                15 March 2022
                : 145
                : 11
                : 808-818
                Affiliations
                [1 ]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).
                [2 ]Department of Epidemiology and Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands (S.L.).
                [3 ]Departments of Interventional Cardiovascular Disease and Medicine, University of Mississippi Medical Center, Jackson (K.E.A.).
                [4 ]Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX (E.B.).
                [5 ]Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.).
                [6 ]Division of Cardiovascular Medicine, University of Kentucky, Lexington (D.A.).
                Author notes
                Correspondence to: Paul S. de Vries, PhD, Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin Street #1200, Houston, TX 77030, Email paul.s.devries@ 123456uth.tmc.edu ; or Natalie R. Hasbani, MPH, Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin Street #1200, Houston, TX 77030, Email natalie.hasbani@ 123456uth.tmc.edu
                Article
                00005
                10.1161/CIRCULATIONAHA.121.053730
                8912968
                35094551
                01e468c9-0e05-43c2-b4c0-a47b86b69cba
                © 2021 The Authors.

                Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.

                History
                : 17 January 2021
                : 22 November 2021
                Categories
                10058
                10062
                10064
                10069
                10084
                Original Research Articles
                Custom metadata
                TRUE
                T

                atherosclerosis,cohort studies,coronary disease,genetic predisposition to disease,lifestyle,public health,risk factors

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