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Multi-Gene Test For Early CVD; Neighborhood HF Risk; Novel Testosterone Drugs

Multi-Gene Test For Early CVD; Neighborhood HF Risk; Novel Testosterone Drugs

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A risk score based on 182 genetic variants independently associated with coronary artery disease boosted prediction of early heart disease (before age 40 for men and 45 for women), researchers reported in Circulation: Genomic and Precision Medicine.

The polygenic test predicted a risk for early onset disease similar to what is observed in heterozygous familial hypercholesterolemia for one in every 53 individuals in the UK Biobank cohort. By comparison, the most common single such genetic variant was seen in only one in 256. A one standard deviation increase in the multi-variant risk score was associated with an 84% elevated risk of early-onset coronary artery disease (CAD).

“As the [genetic risk score] is mostly independent of known risk factors (most variants are not associated with CAD risk factors), such a tool could be used to better stratify a patient’s risk and guide management,” the researchers wrote, suggesting possible inclusion in the diagnostic workup for early heart disease. “This could provide answers to patients affected by such distressing events and would allow genetic screening of relatives.”

Heart Failure in the Neighborhood

Impoverished neighborhoods with few resources may raise risk for heart failure, independent of an individual’s own socioeconomic status and cardiovascular risk, according to an analysis of low-income individuals in the Southern Community Cohort Study in Circulation: Cardiovascular Quality and Outcomes.

Each jump in quartile for neighborhood deprivation index scores carried a 12% increase in risk of heart failure, after adjustment for demographic, lifestyle, and clinical factors. Those scores could account for 4.8% of the variance in heart failure risk.

An accompanying editorial noted that the study challenges society to develop interventions at the neighborhood level, because “such ‘upstream measures’ designed to address the physical, social, and emotional stressors of disadvantaged residential environments have the most potential to reverse the growing burden of heart failure in the U.S.”

See full MedPage Today coverage here.

Repeat MI from Non-Culprit Lesions

An analysis of the SWEDEHEART registry showed that repeat heart attacks from multivessel coronary artery disease were twice as likely to originate from initially non-culprit lesions that weren’t stented, compared with previously stented lesions.

Among the 3,464 who had a second myocardial infarction (MI), initially non-culprit lesion were responsible in 1,243 patients versus the original culprit lesion in 655 patients (cumulative proportion 0.06 versus 0.03 at 8 years), researchers reported in the Journal of the American Heart Association. Other cases were indeterminate.

“A better understanding of long‐term disease progression and whether reinfarctions occur in previously treated lesions or in new or progressive lesions may have an impact on decisions on type and duration of medical treatment after an initial MI,” the researchers concluded. “Secondary prevention after MI is indicated to prevent the patient from stent-related adverse events in the short to medium term and also to prevent atherothrombotic events from non-treated lesions long term and overall coronary disease progression.”

In Other News

An FDA advisory panel recommended against approval of two new oral testosterone drugs, in part citing need for more cardiovascular safety and blood pressure monitoring data. MedPage Today has the rest of the story here.

2018-01-12T12:00:00-0500

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