Letter by Braillon Regarding Article, "Polygenic Risk Score Identifies Subgroup With Higher Burden of Atherosclerosis and Greater Relative Benefit From Statin Therapy in the Primary Prevention Setting".

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HomeCirculationVol. 136, No. 22Letter by Braillon Regarding Article, “Polygenic Risk Score Identifies Subgroup With Higher Burden of Atherosclerosis and Greater Relative Benefit From Statin Therapy in the Primary Prevention Setting” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Braillon Regarding Article, “Polygenic Risk Score Identifies Subgroup With Higher Burden of Atherosclerosis and Greater Relative Benefit From Statin Therapy in the Primary Prevention Setting” Alain Braillon, MD, PhD Alain BraillonAlain Braillon Department of Medicine, University Hospital, Amiens, France. Search for more papers by this author Originally published28 Nov 2017https://doi.org/10.1161/CIRCULATIONAHA.117.028763Circulation. 2017;136:2204–2205To the Editor:Natarajan et al1 must be commended for providing the number needed to treat when analyzing the prevention of 1 coronary heart disease event according to genetic risk. However, they did not express it with a time frame.According to Table 3 in their article,1 the number needed to treat during 1 year to avoid 1 coronary heart disease event ranged from 207 to 480 among the 3 studies (WOSCOPS [West of Scotland Coronary Artery Revascularisation in Diabetes and Coronary Prevention Study], CARDIA [Coronary Artery Risk Development in Young Adults], and BioImage). Moreover, in the real-life setting, the number may be twice as high because of poor compliance. This figure must also be balanced with a 9% rate of statin-related adverse events.2In the “Clinical Perspective,”1 box, the response to the question, “What are the clinical implications?” was, “Stratifying by genetic risk may identify a subset of adults…and derive the greatest benefit from statin therapy.” This response was scientifically correct but may seem out of the scope of clinical implications.First, the majority of vascular events can be prevented by avoiding smoking, participating in regular physical activity, maintaining a normal body mass index, and eating a healthy diet, as can the majority of premature deaths, including those from cancers.3 Primary prevention must be a comprehensive framework.Second, considering the plateauing high prevalence of smoking, inactivity, obesity, and poor nutrition after coronary heart disease events in serial surveys from the United States and Europe,4,5 looking for primary prevention with statins for healthy people with a genetic risk may seem a desperate rush ahead.Alain Braillon, MD, PhDDisclosuresNone.FootnotesCirculation is available at http://circ.ahajournals.org.