Polygenic Risk Score for Optimizing Primary Prevention in Intermediate-Risk Populations

University of Bern204 enrolled

Overview

The goal of this clinical trial is to determine whether incorporating a polygenic risk score (PRS) can optimize primary cardiovascular disease prevention in individuals with intermediate cardiovascular risk. The main questions it aims to answer are: * Can a polygenic risk score improve risk stratification in intermediate-risk individuals? * Does disclosing polygenic risk information to patients and physicians lead to better preventive interventions (e.g., statin use, lifestyle changes)? Researchers will compare outcomes in participants with PRS disclosure versus standard risk assessment to see if PRS-guided prevention leads to improved cardiovascular risk management. Participants will: * Undergo baseline cardiovascular risk assessment * Provide a blood sample for PRS calculation * Complete follow-up visits for lifestyle counseling, medication review, and risk reassessment

Coronary artery disease (CAD) remains the leading cause of mortality worldwide. While current cardiovascular disease (CVD) prevention guidelines rely on clinical risk scores such as SCORE2, these tools may underestimate or overestimate risk in individuals with intermediate clinical risk. Polygenic risk scores (PRS) aggregate the effect of multiple common genetic variants and may provide additional predictive value when combined with traditional risk assessment. This randomized controlled trial evaluates whether incorporating a PRS for CAD (PRS-CAD) into clinical decision-making improves cardiovascular risk stratification and leads to better primary prevention in individuals with intermediate estimated 10-year cardiovascular risk. Participants aged 40-69 years with intermediate CVD risk based on the SCORE2 algorithm will be randomized 1:1 into two groups. In the intervention arm, the PRS-CAD will be calculated using a validated genome-wide algorithm and integrated with the SCORE2 risk to generate a combined PRS-CAD-SCORE2 estimate. Risk will be communicated to participants and their healthcare providers using a standardized, structured communication tool developed by the study team. Participants with elevated combined risk will be referred to lipid clinics for further evaluation. In the control arm, participants will receive standard SCORE2-based risk communication, without inclusion of genetic information. All participants will receive written lifestyle guidance . Physicians will receive the results in a structured format. The primary endpoint is the change in SCORE2 from baseline to 15 months. Secondary endpoints include changes in blood pressure, lipid levels, glucose, HbA1c, hs-CRP, BMI, weight, adherence to the Mediterranean diet (Predimed score), physical activity (IPAQ), tobacco abstinence, medication adherence (MARS), and psychological measures (DASS-21, motivation for change, satisfaction with risk communication). Prescription rates of statins and other preventive therapies, new diagnoses (e.g., diabetes), and new cardiovascular events will also be recorded. Epigenomic analyses will be conducted to explore interactions between genetic risk, lifestyle, and DNA methylation. All outcomes will be assessed at 15 months with blinded outcome assessment. The study aims to inform the clinical utility of integrating PRS into preventive cardiovascular care and support the move toward personalized medicine in primary prevention.

Interventions

Polygenic Risk Score for Coronary Artery Disease (PRS-CAD)DIAGNOSTIC_TEST

A polygenic risk score will be calculated based on genome-wide genotyping and combined with SCORE2 clinical risk factors to estimate personalized cardiovascular risk. The combined risk (PRS-CAD-SCORE2) will be communicated to participants and their healthcare providers using a standardized communication tool. Participants with elevated risk will be referred to a lipid clinic.

Standardized Risk Communication Tool (SCORE2)BEHAVIORAL

Participants will receive risk communication based solely on clinical risk factors using the SCORE2 algorithm. The same structured communication tool will be used (without genetic data), along with general lifestyle guidance.

Eligibility

Sex: ALLMin age: 40 YearsMax age: 69 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 40-69 years old * Intermediate cardiovascular risk based on SCORE2 or SCORE2-Diabetes * Able to give informed consent (understanding German or French or with an interpreter) * Written Informed Consent Exclusion Criteria: * Patient treated under lipid-lowering therapy (defined as statin, ezetimib, bempedoïc acid, PCSK-9 inhibitors) * History of previous cardiovascular disease: coronary artery disease (CAD), peripheral artery disease and ischemic stroke (including transitory ischemic stroke). * Chronic kidney disease (CKD) define as an estimated glomerular filtration rate (eGFR) of less than 30 ml/min or less than 60 ml/min with albuminuria patients with diabetes and end organ damage (classified as very high risk according to ESC guidelines). * Other participation in a clinical study related to CV risk or lifestyle interventions (e.g. diet, smoking cessation...) * Life expectancy of less than one year

Outcomes

Primary Outcomes

Change in SCORE2 between baseline and 15 months

Mean change in SCORE2 cardiovascular risk score from baseline to 15-month follow-up, comparing the intervention (PRS-CAD + SCORE2) and control (SCORE2 only) arms.

Time frame: 15 months