Key result
Polygenic risk scores modestly improve CAD risk discrimination over clinical models as adjunctive risk modifiers.
Why the study?
Do cardiovascular polygenic risk scores improve risk stratification, clinical decision-making, and cardiovascular outcomes when added to conventional clinical risk models in primary prevention?
Do cardiovascular polygenic risk scores improve risk stratification, clinical decision-making, and cardiovascular outcomes when added to conventional clinical risk models in primary prevention?
Answers are grounded in this paper and cite their sources.
Cardiovascular polygenic risk scores currently serve best as targeted adjunctive risk modifiers to guide shared decision-making in primary CAD prevention—particularly regarding statin therapy in borderline or intermediate-risk patients—rather than as stand-alone population screening tests, and require structured genomic risk stewardship for responsible translation.
Polygenic risk scores (PRS) have emerged as potential genomic tools for refining cardiovascular risk assessment, particularly for coronary artery disease (CAD). Because PRS combine information from multiple common genetic variants, they may offer an early estimate of inherited cardiovascular susceptibility before conventional risk markers become clinically apparent. This makes PRS relevant to preventive cardiology, especially for selected individuals with borderline, intermediate, or clinically underestimated CAD risk. However, improved prediction does not automatically establish clinical utility. Current evidence supports the clinical validity of CAD PRS in selected cohorts, including modest improvements in discrimination and risk reclassification when PRS is added to established clinical risk models. In contrast, evidence that routine PRS-guided care improves clinical outcomes remains limited. The clearest potential actionability pathway is CAD-focused lipid-lowering primary prevention, although PRS should support rather than determine statin decisions. Responsible implementation requires transparent reporting, clinician education, patient-centered communication, workflow integration, ancestry-aware validation, cost-effectiveness assessment, and outcome monitoring. Direct-to-consumer testing, limited transferability across ancestries, false reassurance, anxiety, overmedicalization, and inequitable access are important concerns if PRS is used prematurely or without clinical context. This focused narrative review evaluates cardiovascular PRS as preventive genomic tools and proposes a genomic risk stewardship framework for responsible clinical translation. At present, cardiovascular PRS should be considered, if used, as complementary risk modifiers rather than stand-alone screening tests.
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Hamsa J Banjer (2026) conducted a review in Cardiovascular disease / Coronary artery disease (CAD) primary prevention. Cardiovascular Polygenic Risk Scores (PRS) vs. Established clinical risk models (e.g., Framingham Risk Score, Pooled Cohort Equations, SCORE2, QRISK2, PREVENT equations) was evaluated on Clinical validity (discrimination and risk reclassification) and clinical utility in CAD primary prevention. Cardiovascular polygenic risk scores modestly improve CAD risk discrimination and reclassification over clinical models, supporting their use only as adjunctive risk modifiers rather than stand-alone screening tests.
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