Dr iftikar kullo
This study was not powered to detect a difference in low-density lipoprotein cholesterol levels between participants with and those without a family history of CHD. Among participants with a family history of CHD, disclosure of a GRS was associated with a greater initiation of statins than was disclosure of an FRS alone, suggesting that quantitative genetic risk information additionally influences shared decision making regarding statin therapy. To our knowledge, this study is the first to demonstrate that discussion of risk associated with a family history of CHD influences shared decision making regarding statin treatment in intermediate-risk individuals. In a 2-variable model (odds ratio ), both family history (2.46 P < .01) and allocation to GRS (2.13 P = .01) were associated with greater frequency of statin initiation.
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Disclosure of a GRS resulted in a higher rate of statin prescriptions (16 vs 10 P = .02) among individuals with a family history of CHD than in those who received only an FRS ( Table 2). Among participants who received a GRS, statin therapy was also more frequent in those with than in those without a family history of CHD (16 vs 26, P = .007). Of individuals with a family history of CHD, 26 (47.3%) began statin therapy compared with 42 (28.4%) of those without a family history (χ 2 = 6.43 P = .01). No difference in self-reported fat intake and physical activity was noted between participants with and those without a family history of CHD.
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Both the GRS and FRS tended to be higher in participants with a family history of CHD but the 2 measures were not correlated ( r = 0.01 P = .85). Participant characteristics did not differ significantly between groups ( Table 1). Data analysis was conducted from September 26, 2015, to January 10, 2016. All analyses were performed in JMP Pro, version 10.0.0 (SAS Institute Inc). A comparison between the groups was performed using an unpaired t test. A paired difference test was used to assess changes over time within each group. We tested the association of GRS with family history, using t tests with significance set at P < .05.
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We compared the rate of statin initiation between participants with and those without a family history of CHD using logistic regression, also adjusting for allocation to GRS. 8 Continuous or dichotomous variables were compared between groups using a 2-sample t test or a χ 2 test, respectively. Participants returned at 3 and 6 months after risk disclosure for measurement of low-density lipoprotein cholesterol levels and assessment of statin use, dietary fat consumption (scores ranged between 0 to 110 indicative of very high dietary fat intake as measured by the fat screener 7), and physical activity levels (scores ranged between 7 and 1 based on the adapted version of telephonic assessment of a physical activity questionnaire). All participants gave written informed consent financial compensation was provided. The study protocol was approved by the Mayo Clinic institutional review board. 6 The 10-year risk of CHD was disclosed by a genetic counselor informing participants of a 1.5- to 2.0-fold higher risk in the presence of family history, followed by shared decision making regarding statin therapy with a physician. A GRS was calculated based on genotypes at 28 CHD susceptibility loci. Family history was defined as the presence of CHD (ie, angina, myocardial infarction, or myocardial revascularization) in a first-degree male or female relative (ie, parents, siblings, and children) before age 55 or 65 years, respectively. Shared Decision Making and Communicationīetween October 9, 2013, and April 28, 2014, residents of Olmsted County, Minnesota, at intermediate risk for CHD and not receiving statin therapy were randomized 1:1 to either a conventional (Framingham) risk score (FRS) 5 alone or FRS supplemented with a GRS.Scientific Discovery and the Future of Medicine.
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