Those at Greatest Genetic Risk for Heart Disease May Benefit Most from Cardiovascular Health Recommendations

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Adherence to the Life’s Simple 7 (LS7) guidelines created by the American Heart Association (AHA) can significantly reduce the risk of coronary heart disease (CHD) despite a genetic predisposition, according to a new study published in Circulation.

The AHA developed LS7 over a decade ago to define ideal cardiovascular (CV) health according to 7 risk factors that are modifiable through lifestyle changes. In brief, the 7 risk factors include smoking status, body weight, total cholesterol, blood glucose, exercise, and diet.

The primary objective of the study was to quantify differences in the lifetime risk of CHD in White and Black individuals according to polygenic risk and adherence to LS7 guidelines, and to examine these differences in terms of years lived free of CHD.

“One of the main motivations of this study was to provide insight on the question: ‘If I have a high polygenic risk of coronary heart disease, to what extent can I compensate for this through a healthy lifestyle?’” said lead author Natalie Hasbani, MPH, research assistant, doctoral candidate, University of Texas Health Science Center, Houston, in a press release. “We found that regardless of a person’s genetic predisposition, they can lower their chances of developing coronary heart disease by adhering to the AHA’s Life’s Simple 7 guidelines, but those with the highest polygenic risk stood to gain the most.”

Hasbani and colleagues looked at data from 8372 White participants and 2314 Black (or of African ancestry) participants aged ≥45 years and free of CHD at baseline who were enrolled in the Atherosclerosis Risk in Communities study.

A polygenic risk score (PRS) was comprised of over 6 million genetic variants and categorized into low (<20th percentile), intermediate (20th-80th percentile), and high (>80th percentile). An overall LS7 score was calculated at baseline and categorized into 3 groups (poor, intermediate, ideal).

“Previous studies have shown that polygenic risk predicts coronary heart disease, and some studies have suggested that high polygenic risk can be offset by maintaining a healthy lifestyle,” said senior author Paul de Vries, PhD, assistant professor in the Department of Epidemiology, Human Genetics and Environmental sciences at UTHealth School of Public Health, in the press release. “These studies, however, have mainly examined relative risks, without translating this to measures of absolute risk that are easier to interpret.”

Results

Researchers found that the overall risk of CHD ranged from 16.6% in persons with an ideal LS7 score to 43.1% in those with a poor LS7 score.

White participants with a high PRS and poor LS7 score had a remaining lifetime risk of 67.1% and 15.9 fewer CHD-free years than did those with intermediate LS7 scores and PRS. Also, in White adults with high PRS, ideal LS7 score was associated with 20.2 more CHD-free years compared with poor LS7.

In Black participants, remaining lifetime risk of CHD ranged from 19.1% to 28.6% according to increasing PRS category. Similar lifetime risk estimates were observed for individuals of poor LS7 regardless of PRS category. In the high-PRS group, an ideal LS7 score was associated with only 4.5 more CHD-free years compared with a poor LS7 score.

Researchers noted that they could not summarize genetic predisposition among persons of African ancestry as well as they could do so among those of European decent. “This is because sample sizes for genetic associations studies focused on African ancestry individuals are currently lagging far behind sample sizes for studies focused on European ancestry participants. Rectifying this disparity should be a priority of the research community in the years to come,” said de Vries.

“The bottom line is that regardless of anyone’s genetic susceptibility, it is very important to have a healthy diet and live a healthy lifestyle,” added Hasbani. “There is all of this information out there about what we might develop based on our genetics, but it doesn’t determine your fate. You can lower your risk through lifestyle changes that, unlike your genetics, are under your control.”

Reference: Hasbani NR, Ligthart S, Brown MR, et al. American Heart Association’s Life’s Simple 7: Lifestyle recommendations, polygenic risk, and lifetime risk of coronary heart disease. Circulation. Published online January 31, 2022. doi: 10.1161/CIRCULATIONAHA.121.053730.