Validation of an Integrated Risk Tool, Including Polygenic Risk Score, for Atherosclerotic Cardiovascular Disease in Multiple Ethnicities and Ancestries.

The American College of Cardiology / American Heart Association pooled cohort equations tool (ASCVD-PCE) is currently recommended to assess 10-year risk for atherosclerotic cardiovascular disease (ASCVD). ASCVD-PCE does not currently include genetic risk factors. Polygenic risk scores (PRSs) have been shown to offer a powerful new approach to measuring genetic risk for common diseases, including ASCVD, and to enhance risk prediction when combined with ASCVD-PCE. Most work to date, including the assessment of tools, has focused on performance in individuals of European ancestries. Here we present evidence for the clinical validation of a new integrated risk tool (IRT), ASCVD-IRT, which combines ASCVD-PCE with PRS to predict 10-year risk of ASCVD across diverse ethnicity and ancestry groups. We demonstrate improved predictive performance of ASCVD-IRT over ASCVD-PCE, not only in individuals of self-reported White ethnicities (net reclassification improvement [NRI]; with 95% confidence interval = 2.7% [1.1 to 4.2]) but also Black / African American / Black Caribbean / Black African (NRI = 2.5% [0.6-4.3]) and South Asian (Indian, Bangladeshi or Pakistani) ethnicities (NRI = 8.7% [3.1 to 14.4]). NRI confidence intervals were wider and included zero for ethnicities with smaller sample sizes, including Hispanic (NRI = 7.5% [-1.4 to 16.5]), but PRS effect sizes in these ethnicities were significant and of comparable size to those seen in individuals of White ethnicities. Comparable results were obtained when individuals were analyzed by genetically inferred ancestry. Together, these results validate the performance of ASCVD-IRT in multiple ethnicities and ancestries, and favor their generalization to all ethnicities and ancestries.

Integrated Polygenic Tool Substantially Enhances Coronary Artery Disease Prediction.

BACKGROUND: There is considerable interest in whether genetic data can be used to improve standard cardiovascular disease risk calculators, as the latter are routinely used in clinical practice to manage preventative treatment. METHODS: Using the UK Biobank resource, we developed our own polygenic risk score for coronary artery disease (CAD). We used an additional 60 000 UK Biobank individuals to develop an integrated risk tool (IRT) that combined our polygenic risk score with established risk tools (either the American Heart Association/American College of Cardiology pooled cohort equations [PCE] or UK QRISK3), and we tested our IRT in an additional, independent set of 186 451 UK Biobank individuals. RESULTS: The novel CAD polygenic risk score shows superior predictive power for CAD events, compared with other published polygenic risk scores, and is largely uncorrelated with PCE and QRISK3. When combined with PCE into an IRT, it has superior predictive accuracy. Overall, 10.4% of incident CAD cases were misclassified as low risk by PCE and correctly classified as high risk by the IRT, compared with 4.4% misclassified by the IRT and correctly classified by PCE. The overall net reclassification improvement for the IRT was 5.9% (95% CI, 4.7-7.0). When individuals were stratified into age-by-sex subgroups, the improvement was larger for all subgroups (range, 8.3%-15.4%), with the best performance in 40- to 54-year-old men (15.4% [95% CI, 11.6-19.3]). Comparable results were found using a different risk tool (QRISK3) and also a broader definition of cardiovascular disease. Use of the IRT is estimated to avoid up to 12 000 deaths in the United States over a 5-year period. CONCLUSIONS: An IRT that includes polygenic risk outperforms current risk stratification tools and offers greater opportunity for early interventions. Given the plummeting costs of genetic tests, future iterations of CAD risk tools would be enhanced with the addition of a person's polygenic risk.

Platinum(II) complexes of N

A new family of platinum(II) complexes of the form PtL(n)SR have been prepared, where L(n) represents a cyclometalating, N^C^N-bound tridentate ligand and SR is a monodentate thiolate ligand. The complexes fall into two groups, those of PtL(1)SR where HL(1) = 1,3-bis(2-pyridyl)benzene, and those of PtL(2)SR, where HL(2) = methyl 3,5-bis(2-pyridyl)benzoate. Each group consists of five complexes, where R = CH3, C6H5, p-C6H4-CH3, p-C6H4-OMe, p-C6H4-NO2. These compounds, which are bright red, orange, or yellow solids, are formed readily upon treatment of PtL(n)Cl with the corresponding potassium thiolate KSR in solution at room temperature. The replacement of the chloride by the thiolate ligand is accompanied by profound changes in the photophysical properties. A broad, structureless, low-energy band appears in the absorption spectra, not present in the spectra of PtL(n)Cl. In the photoluminescence spectra, the characteristic, highly structured phosphorescence bands of PtL(n)Cl in the green region are replaced by a broad, structureless emission band in the red region. These new bands are assigned to a πS/dPt → π*N^C^N charge-transfer transition from the thiolate/platinum to the N^C^N ligand. This assignment is supported by electrochemical data and TD-DFT calculations and by the observation that the decreasing energies of the bands correlate with the electron-donating ability of the substituent, as do the increasing nonradiative decay rate constants, in line with the energy-gap law. However, the pair of nitro-substituted complexes do not fit the trends. Their properties, including much longer luminescence lifetimes, indicate that the lowest-energy excited state is localized predominantly on the arenethiolate ligand for these two complexes. Red-emitting thiolate adducts may be relevant to the use of PtL(n)Cl complexes in bioimaging, as revealed by the different distributions of emission intensity within live fibroplast cells doped with the parent complex, according to the region of the spectrum examined.