SPC365

Genetic Risk Score and Epicardial Adipose Tissue: New tools with impact on Cardiovascular Risk Assessment

Session: Posters (Sessão 6 - Écran 5) - Risco Cardiovascular
Speaker: Margarida Temtem

Congress: CPC 2023
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.14 Risk Factors and Prevention - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Margarida Temtem; Maria Isabel Mendonça; João Adriano Sousa; Marco Serrão; Marina Santos; Débora Sá; Francisco Sousa; Eva Henriques; Mariana Rodrigues; Sónia Freitas; Sofia Borges; Graça Guerra; Ilídio Ornelas; António Drumond; Ana Célia Sousa; Roberto Palma Dos Reis

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="font-size:12.0pt">Background:</span></strong><span style="font-size:12.0pt"> Cardiovascular disease (CVD) remains the leading cause of death worldwide. One of its main contributors is coronary artery disease (CAD), <span style="background-color:white">a complex multifactorial disease influenced by hereditary and environmental factors</span>. A better cardiovascular risk assessment is&nbsp; a real challenge in our daily clinical practice. Evidence points to high Epicardial Adipose Tissue (EAT) volume as an essential player in the pathophysiology of CAD. <span style="background-color:white"><span style="color:black">On the other hand, genetic predisposition to CAD remains </span></span>crucial to improve cardiovascular risk assessment and treatment. It is unknown whether the association between these two risk markers improved the ability to predict CV events.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="font-size:12.0pt">Objective</span></strong><span style="font-size:12.0pt">: Evaluate whether a high EAT volume added to a Genetic Risk Score (GRS) improves the predictive ability to discriminate CV events in an asymptomatic population without known CVD.&nbsp;&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="font-size:12.0pt">Methods</span></strong><span style="font-size:12.0pt">: A prospective cohort was performed with 1024 participants (mean age 51.6&plusmn;8.2 years, 75.6% male) selected from controls of the GENEMACOR Study. The GRS was created from &nbsp;33 genetic variants associated with CAD by GWAS, choosing those with a hazard ratio (HR) higher than 1. EAT volume was measured with a quantitative semi-automated procedure using a postprocessing workstation-TeraRecon Aquarius Workstation (version 4.4.7, TeraRecon, Inc., San Mateo, CA, USA). We evaluated the discriminative ability of the GRS model without (model 1) and with EAT volume (model 2) using the Harrel C statistics. Categorical free Net Reclassification Improvement (cfNRI) and Integrated Discrimination Index (IDI) reclassified patients.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="font-size:12.0pt">Results:</span></strong><span style="font-size:12.0pt"> Cox regression analysis showed that GRS and EAT remained in the equation with an HR of 1.140 (p=0.002) and HR of 1.221 (p=0.002), respectively. C-statistic demonstrated</span><span style="font-size:12.0pt"><span style="color:#010205"> that the predictive value for MACE was </span></span><span style="font-size:12.0pt">0.588 (95%CI 0.445-0.731) </span><span style="font-size:12.0pt"><span style="color:#010205">for GRS and increased to </span></span><span style="font-size:12.0pt">0.689 (95%CI 0.577-0.801) when EAT volume was added to GRS, <span style="background-color:white"><span style="color:black">showing a better discrimination capacity for MACE</span></span></span><span style="font-size:12.0pt">. </span><span style="font-size:12.0pt">The difference between the two C indexes was significant (p=0.003). </span>CfNRI reclassified 58.9% of the population (p=0.001), and IDI&nbsp; &nbsp;<span style="background-color:white">improved the discrimination when EAT was included in the GRS model (IDI=0.012; p=0.015).</span>&nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="font-size:12.0pt">Conclusion:</span></strong><span style="font-size:12.0pt"> Our results displayed that the GRS associated with a high EAT volume increased the discriminative ability to predict MACE occurrence. Improving the identification of high-risk patients at a subclinical stage could avoid atherosclerosis progression and events occurrence through more rigorous and earlier preventive and even therapeutic measures.&nbsp;</span></span></span></p>