Researchers at the Mass General Brigham Heart and Vascular Institute and collaborators have developed and validated a new integrated polygenic risk score (PRS) that estimates inherited risk across eight cardiovascular conditions using a single genetic test. The tool is a combination of a handful of genetic risk models collected into a comprehensive risk tool and is designed to improve identification of individuals at elevated risk for coronary artery disease (CAD), atrial fibrillation, type 2 diabetes, venous thromboembolism, thoracic aortic aneurysm, extreme hypertension, severe hypercholesterolemia, and elevated lipoprotein(a).
The validation study, published in the Journal of the American College of Cardiology, showed that individuals with high genetic risk scores had significantly higher odds of developing disease compared with those at average risk, including a 3.7-fold higher odds for CAD and a 4.1-fold higher odds for severe hypercholesterolemia.
“Interpreting DNA risk is new for the public as well as clinicians,” said co-senior author Pradeep Natarajan, MD, director of preventive cardiology at Mass General Brigham Heart and Vascular Institute. “It was very important to us to provide a clear genetic risk report that would be accessible and patient-friendly.”
The researchers developed the integrated PRS tool using PRSmix, an elastic-net approach that combines previously published polygenic risk scores from the Polygenic Score Catalog. The model was trained using genotype and clinical data from 245,394 participants in the NIH All of Us Research Program and validated using data from 53,306 people from the Mass General Brigham Biobank. In the validation cohort, the integrated scores demonstrated strong discrimination across all eight conditions, with individuals in the top 10% of genetic risk showing increased odds of disease, including CAD (odds ratio 3.7), type 2 diabetes (3.1), atrial fibrillation (3.0), venous thromboembolism (1.9), hypertension (2.1), and lipoprotein(a) (41.0).
Current cardiovascular risk assessments typically rely on age, sex, blood pressure, cholesterol, and other clinical factors. The Mass General team noted that these methods may miss individuals with substantial inherited risk who do not yet show clinical symptoms. By comparison, the new PRS tool gives a single genetic assessment that can be applied early in life and across multiple disease pathways simultaneously.
“Although PRS have typically been evaluated one condition at a time, a single genotyping assay enables calculation of PRS for any heritable trait without significant additional cost, creating an opportunity to assess inherited risk across multiple cardiovascular conditions simultaneously,” the researchers wrote noting the value of this new method.
In this study, the integrated PRS improved risk classification when incorporated into clinical prediction models, including better stratification of individuals near clinical decision thresholds for cardiovascular disease. The system also generated standardized risk categories—high, average, or low—for each condition and presented results in clinician-facing and patient-facing formats that can be integrated into electronic health records.
Clinically, the new PRS is could be use to identify people whose inherited risk could provide the opportunity for preventive interventions such as increased monitoring, lifestyle modification, or preventive therapies, even when conventional risk factors appear normal. For CAD specifically, the findings suggest that individuals with high polygenic risk may have risk levels comparable to other established high-risk groups, despite modest or normal cholesterol levels.
The researchers also evaluated how the tool could work across diverse populations and clinical settings. They found that while the PRS performed consistently across ancestry groups, predictive strength was reduced in individuals with greater genetic variation from people of European ancestry, exposing the inherent limitations in current genomic reference datasets. Despite this, the integrated framework was designed to allow updating as new data become available.
The PRS is currently available through Mass General Brigham Laboratory for Molecular Medicine and Broad Clinical Labs. The researchers said that next steps to further refine the tool include broader prospective validation across diverse populations, evaluation its cost-effectiveness, and research to determine how genetic risk information should influence clinical decision-making.
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