A Healthy Lifestyle Can Mitigate High Genetic Risk for Coronary Artery Disease

Summary and Comment |
November 13, 2016

A Healthy Lifestyle Can Mitigate High Genetic Risk for Coronary Artery Disease

  1. Karol E. Watson, MD, PhD, FACC

Researchers quantify the interplay between genetics and lifestyle.

  1. Karol E. Watson, MD, PhD, FACC

How much can a healthy lifestyle offset an elevated genetic risk for coronary artery disease (CAD)? These researchers analyzed genetic and lifestyle data from three prospective cohort studies (N=51,425). The authors quantified individuals' genetic risk via polygenic scores of single nucleotide polymorphisms associated with CAD. They also evaluated four healthy-lifestyle factors: no current smoking, no obesity, regular physical activity, and a healthy diet.

A high genetic risk for CAD (top quintile of polygenic scores) was associated with a 91% higher relative risk for incident coronary events, compared with low genetic risk (bottom quintile). Among individuals at high genetic risk, the relative risk for coronary events was 46% lower with a favorable lifestyle (≥3 healthy-lifestyle factors) than with an unfavorable one (≤1 factor). For individuals at high genetic risk, unhealthy and healthy lifestyles were associated with the following standardized 10-year incidences of coronary events:

  • Women's Genome Health Study, 4.6% and 2.0%

  • Atherosclerosis Risk in Communities, 10.7% and 5.1%

  • Malmö Diet and Cancer Study, 8.2% and 5.3%

Comment

Is genetic risk or lifestyle more important? The “nature versus nurture” argument has been going on for decades. These investigators show that genetic risk is clearly important, but so is a healthy lifestyle. The study is limited by use of observational data but has strengths — the quantification of genetic risk and the demonstration of the interplay between genetics and lifestyle. Within any genetic risk level, individuals who adhered to a healthier lifestyle had lower CAD risk. In fact, the relative risk reduction achieved by adhering to a healthy lifestyle was the same at each stratum of genetic risk. We need to get the message to our patients: A healthy lifestyle can mitigate one's inherited cardiac risk.

Editor Disclosures at Time of Publication

  • Disclosures for Karol E. Watson, MD, PhD, FACC at time of publication Consultant / Advisory board: Amgen; GlaxoSmithKline; Merck; Quest Editorial boards: Reviews in Cardiovascular Medicine; Circulation Quality Outcomes; Circulation

Citation(s):

Reader Comments (2)

YUEN CHEN

Advice should include: Sleep hygeine. Good night sleep without disturbance- nocturia. Avoid eating , drinking 3 hours before bed. Sleep disturbance- induce physical stress and secret more stress hormone-Adrenalin, cortisol, ADH.

Colin Rose Canada

The effect of lifestyle would appear to be much larger than the effect of high dose statins and probably PSCK9 inhibitors, a point never mentioned in the article or by the reveiwer.

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