Objective To examine whether adherence to ideal cardiovascular health (CVH) can mitigate the genetic risk of coronary artery disease (CAD) in non-European populations.
Methods Fine and Grey’s models were used to calculate HRs and their corresponding 95% CIs, as well as the lifetime risk of CVH metrics across Polygenic Risk Score (PRS) categories.
Results We included 39 755 individuals aged 30–75 years in Chinese prospective cohorts. 1275 CAD cases were recorded over a mean follow-up of 12.9 years. Compared with unfavourable CVH profile (zero to three ideal CVH metrics), favourable CVH profile (six to seven ideal CVH metrics) demonstrated similar relative effects across PRS categories, with the HRs of 0.40 (95% CI 0.24 to 0.67), 0.41 (95% CI 0.32 to 0.52) and 0.36 (95% CI 0.26 to 0.52) in low (bottom quintile of PRS), intermediate (two to four quintiles of PRS) and high (top quintile of PRS) PRS categories, respectively. For the absolute risk reduction (ARR), individuals with high PRS achieved the greatest benefit from favourable CVH, mitigating the risk to the average level of population (from 21.1% to 8.7%), and the gradient was strengthened in individuals at the top 5% of PRS. Moreover, compared with individuals at low PRS, those at high PRS obtained longer CAD-free years (2.6 vs 1.1) from favourable CVH at the index age of 35 years.
Conclusion Favourable CVH profile reduced the CAD relative risk by similar magnitude across PRS categories, while the ARR from favourable CVH was most pronounced in high PRS category. Attaining favourable CVH should be encouraged for all individuals, especially in individuals with high genetic susceptibility.
- coronary artery disease
- risk factors
Data availability statement
Data are available upon reasonable request.
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QC and ZL contributed equally.
Contributors DG and XL conceptualised and designed the study and were the guarantors of this work; as such, they had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. QC and ZL analysed the data and drafted the manuscript. All study authors contributed to interpretation, revision, writing and finalisation of the final submission version of the manuscript.
Funding This work was supported by Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2021-I2M-1-010, 2019-I2M-2-003 and 2017-I2M-1-004), Research Unit of Prospective Cohort of Cardiovascular Diseases and Cancers, CAMS (2019RU038), the National Key Research and Development Program of China (2018YFE0115300 and 2017YFC0211700), the National Natural Science Foundation of China (82030102, 12126602 and 91857118) and the Taikang Yicai Public Health and Epidemic Control Fund (TKYC-GW-2020).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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