Cited by 704Lipoproteins and Cardiovascular HealthGenetic Associations and EpidemiologyNutrition, Genetics, and Disease

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Genetic risk, coronary heart disease events, and the clinical benefit of statin therapy: an analysis of primary and secondary prevention trials

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Mega, Jessica L, Stitziel, Nathan O, Smith, J Gustav, Chasman, Daniel I, Caulfield, Mark J, Devlin, James J, Nordio, Francesco, Hyde, Craig L, Cannon, Christopher P, Sacks, Frank M, Poulter, Neil R, Sever, Peter S, Ridker, Paul M, Braunwald, Eugene, Melander, Olle, Kathiresan, Sekar, Sabatine, Marc S·2015·The Lancet

DOI 10.1016/s0140-6736(14)61730-xPMC PMC4608367

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Abstract

Background Genetic variants have been associated with the risk of coronary heart disease. In this study, we tested whether or not a composite of these variants could ascertain the risk of both incident and recurrent coronary heart disease events and identify those individuals who derive greater clinical benefit from statin therapy.Methods A community-based cohort study (the Malmo Diet and Cancer Study) and four randomised controlled trials of both primary prevention (JUPITER and ASCOT) and secondary prevention (CARE and PROVE IT-TIMI 22) with statin therapy, comprising a total of 48,421 individuals and 3477 events, were included in these analyses. We studied the association of a genetic risk score based on 27 genetic variants with incident or recurrent coronary heart disease, adjusting for traditional clinical risk factors. We then investigated the relative and absolute risk reductions in coronary heart disease events with statin therapy stratified by genetic risk. We combined data from the different studies using a meta-analysis.Findings When individuals were divided into low (quintile 1), intermediate (quintiles 2-4), and high (quintile 5) genetic risk categories, a significant gradient in risk for incident or recurrent coronary heart disease was shown. Compared with the low genetic risk category, the multivariable-adjusted hazard ratio for coronary heart disease for the intermediate genetic risk category was 1·34 (95% CI 1·22-1·47, p<0·0001) and that for the high genetic risk category was 1·72 (1·55-1·92, p<0·0001). In terms of the benefit of statin therapy in the four randomised trials, we noted a significant gradient (p=0·0277) of increasing relative risk reductions across the low (13%), intermediate (29%), and high (48%) genetic risk categories. Similarly, we noted greater absolute risk reductions in those individuals in higher genetic risk categories (p=0·0101), resulting in a roughly threefold decrease in the number needed to treat to prevent one coronary heart disease event in the primary prevention trials. Specifically, in the primary prevention trials, the number needed to treat to prevent one such event in 10 years was 66 in people at low genetic risk, 42 in those at intermediate genetic risk, and 25 in those at high genetic risk in JUPITER, and 57, 47, and 20, respectively, in ASCOT.Interpretation A genetic risk score identified individuals at increased risk for both incident and recurrent coronary heart disease events. People with the highest burden of genetic risk derived the largest relative and absolute clinical benefit from statin therapy.Funding National Institutes of Health.

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Authors: Mega, J. L., Stitziel, N. O., Smith, J. G., Chasman, D. I., Caulfield, M. J., Devlin, J. J., Nordio, F., Hyde, C. L., Cannon, C. P., Sacks, F. M., Poulter, N. R., Sever, P. S., Ridker, P. M., Braunwald, E., Melander, O., Kathiresan, S., & Sabatine, M. S.
Affiliations: Brigham and Women's Hospital (US)
Washington University in St. Louis (US)
Broad Institute (US)
Queen Mary University of London (GB)
Quest Diagnostics (United States) (US)
Pfizer (United States) (US)
Imperial College London (GB)
Lund University (SE)
Corresponding author: Mega, Jessica L
Stitziel, Nathan O
ORCID: Mega, Jessica L
Stitziel, Nathan O
Chasman, Daniel I
Caulfield, Mark J
Hyde, Craig L
Cannon, Christopher P
Sacks, Frank M
Poulter, Neil R
Ridker, Paul M
Melander, Olle
Kathiresan, Sekar
Sabatine, Marc S
Venue: The Lancet
Publisher: Elsevier BV
Published: 2015-06
Volume: 385
Issue: 9984
Pages: 2264-2271
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(14)61730-x
PMC: PMC4608367
OpenAlex: W2171705978
Cited by: 704
References: 46
Citations by year: 2026: 40 · 2025: 48 · 2024: 51 · 2023: 69 · 2022: 78 · 2021: 83 · 2020: 78 · 2019: 59 · 2018: 62 · 2017: 53 · 2016: 57 · 2015: 25
FWCI: 12.58
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Digital Access to Scholarship at Harvard (DASH) (Harvard University) (acceptedVersion)
Lund University Publications (Lund University) (submittedVersion)
Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
Funders: National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) (RC1 HL099634)
NIH and the NHLBI (grant K08 HL114642)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
Keywords: coronary artery disease, polygenic risk score, genetic variants, statin therapy, primary prevention, secondary prevention, number needed to treat, risk stratification, JUPITER trial, ASCOT trial, CARE trial, PROVE IT-TIMI 22, recurrent cardiovascular events, Malmö Diet and Cancer Study, cardiovascular risk prediction, treatment benefit stratification, LDL cholesterol lowering
MeSH terms: Coronary Disease, Humans, Primary Prevention, Recurrence, Treatment Outcome, Risk Assessment, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Secondary Prevention, Numbers Needed To Treat

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Genetic risk, coronary heart disease events, and the clinical benefit of statin therapy: an analysis of primary and secondary prevention trials

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