Coronary Heart Disease

Polygenic risk

People with high polygenic risk scores are 1.7 to 2.3 times more likely to get coronary heart disease than are people who aren't in the high-risk category.

This estimate is based on data about people of African, Asian, European, and Hispanic or Latino ancestry. Information is lacking or not available for those of other ancestries.

For participants with a high polygenic risk score, recommendations include:

  • Check the participant's lipid profile and Lp(a) level.
  • For those age 40 and over, consider further screening such as a coronary calcium scan, and treatment with a statin to lower coronary heart disease risk.
  • Shared decision-making with the patient.
  • For those under age 40, consider carotid ultrasound to find plaque and measure the intima media — thickness of one of the layers of an artery wall — to assess for early disease.
  • Treat risk factors that are present, such as high blood pressure, diabetes and high cholesterol.
  • Provide guidance for leading a heart-healthy lifestyle, including:
    • Get more physical activity.
    • Eat a heart-healthy diet.
    • Keep body mass index under 25.
    • Limit alcohol intake.
    • Stop smoking if the participant smokes.

Monogenic risk

Monogenic risk of coronary heart disease is due to variants in any of these genes:

  • APOB.
  • LDLR.
  • LDLRAP1.
  • PCSK9.

A person with a variant in one of these genes is 2 to 3 times more likely to get coronary heart disease.

For participants with monogenic risk, recommendations include:

  • Referral to a genetic counselor.
  • Check the participant's lipid profile and Lp(a) level.
  • Consider starting lipid-lowering therapy, such as a statin. Therapy recommendations include:
    • Reduce low-density lipoprotein, also known as LDL or as bad cholesterol, using the highest tolerated statin therapy with or without ezetimibe (Vytorin, Zetia and others).
    • Consider using PCSK9 inhibitors if the participant doesn't reach target LDL cholesterol despite receiving the highest statin dose.
  • Follow the 2018 guideline on the management of blood cholesterol in patients with familial hypercholesterolemia from the American College of Cardiology and American Heart Association.
  • Consider referral to a lipid specialist.
  • Provide guidance for leading a heart-healthy lifestyle, including:
    • Get more physical activity.
    • Eat a heart-healthy diet.
    • Keep body mass index under 25.
    • Limit alcohol intake.
    • Stop smoking if the participant smokes.

Family history

A participant has a family history of coronary heart disease if:

  • Their father, brother or son developed coronary heart disease before age 55.
  • Their mother, sister or daughter developed coronary heart disease before age 65.

People with a family history of coronary heart disease are 1.5 to 2 times more likely to get coronary heart disease than are people without a family history of the disease.

For participants who have a family history of coronary heart disease, recommendations include:

  • Check the participant's lipid profile and Lp(a) level.
  • In those age 40 and older, consider further screening such as a coronary calcium scan, and treatment with a statin to reduce coronary heart disease risk.
  • Shared decision-making with the patient.
  • In those under age 40, consider carotid ultrasound to find plaque and measure the intima media — thickness of one of the layers of an artery wall — to assess for early disease.
  • Treat risk factors that are present, such as:
    • High blood pressure.
    • Diabetes.
    • High cholesterol.
  • Provide guidance for leading a heart-healthy lifestyle, including:
    • Get more physical activity.
    • Eat a heart-healthy diet.
    • Keep body mass index under 25.
    • Limit alcohol intake.
    • Stop smoking if the participant smokes.

10-year coronary heart disease risk

The 10-year coronary heart disease risk is calculated using the pooled cohort equation (PCE) and the integrated score, which combines the PCE and polygenic risk score.

The GIRA report recommends that participants with a 10-year coronary heart disease risk of 7.5% or greater to consider making decisions with a clinician on starting statin therapy to lower the risk of coronary heart disease.