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Prognostic role of adding a Genetic Risk Score to the new European SCORE2 in cardiovascular events prediction, in a moderate-risk region
Session:
Comunicações Orais (Sessão 5) - Risco CV, Prevenção e Reabilitação Cardíaca 1 - Foco nos Scores de Risco
Speaker:
Margarida Temtem
Congress:
CPC 2022
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.1 Risk Factors and Prevention – Epidemiology
Session Type:
Comunicações Orais
FP Number:
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Authors:
Margarida Temtem; Roberto Palma Dos Reis; Marco Serrão; Débora sá; Marina Santos; Carolina Soares; Ana Célia Sousa; Mariana Rodrigues; Sónia Freitas; Eva Henriques; Sofia Borges; Graça Guerra; Ilídio Ornelas; António Drumond; Maria Isabel Mendonça
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,"sans-serif""><strong>Background:</strong> </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,"sans-serif""><span style="background-color:white"><span style="color:#212121">The new </span></span>SCORE2 provides risk estimates for the combined outcome of fatal and non-fatal cardiovascular disease (CVD) events, in contrast with SCORE’s use for CVD mortality only. <span style="background-color:white"><span style="color:#212121">G</span></span><span style="background-color:white"><span style="color:black">enetic predisposition to CVD is not considered in SCORE2 for prevention and treatment. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,"sans-serif""><strong>Purpose: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,"sans-serif"">Evaluate the impact of adding a Genetic Risk Score (GRS) to the new European SCORE2 in MACE prediction and estimate the additional value in cardiovascular risk stratification in our asymptomatic population.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,"sans-serif""><strong>Methods:</strong> We calculated the new SCORE2 prospectively in a population-based cohort of 1,100 individuals without known cardiovascular disease (CAD) and diabetes (mean age 53.3±6.9). Three risk categories were considered for SCORE2: low, moderate and high-risk. For all included participants, a GRS was created, with 33 genetic variants previously associated with CAD, and two groups were analyzed: lower and higher than the GRS median. Kaplan-Meier survival curves were created and a Cox regression model was performed including the two scores to assess the risk of major cardiovascular events (MACE). Using C-statistic methodology we compared the models SCORE2 and SCORE2 plus GRS.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,"sans-serif""><strong>Results: </strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,"sans-serif"">Kaplan-Meier curves showed that the highest category had a worst survival for each score. Cox regression presented an HR of 7.597 (p=0.001) for SCORE2 for the high-risk category. The GRS as a continuous value displayed an HR of 1.005 (p<0.0001). C-statistic demonstrated<span style="color:#010205"> that the SCORE2 predictive value was 0.678, increasing to 0.792 with the GRS incorporation (p=0.0005). After Kaplan-Meier analysis for MACE occurrence, the group with low SCORE2 category showed better survival when compared to the other categories (p<0.0001). When evaluating GRS, the group higher than median showed worst survival with statistical significance (p<0.0001).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,"sans-serif""><strong>Conclusions:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,"sans-serif"">In this work, <span style="background-color:white"><span style="color:black">combining SCORE2 with multiple genetic loci gathered into a GRS, improved the identification of patients with the worst prognosis. This new tool may be of great utility in risk stratification in primary prevention.</span></span> Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.</span></span></p>
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