Akinchan Bhardwaj: Key Genomic Insights Transforming Coronary Artery Disease Prevention
Akinchan Bhardwaj, Consultant Interventional Cardiologist at Kauvery Hospital, shared a post on LinkedIn about a recent article by Heribert Schunkert et al, published in NEJM:
“For decades, we treated coronary artery disease as a consequence of lifestyle and conventional risk factors.
Genomics is rewriting that narrative.
A powerful new review in NEJM by Pradeep Natarajan and colleagues highlights a paradigm shift: coronary artery disease is not driven by a single genetic mutation or a single risk factor. Instead, most individuals inherit hundreds of genetic variants that collectively shape lifelong cardiovascular risk.
Some key insights that fundamentally change how we think about prevention:
- Monogenic disorders like familial hypercholesterolemia remain critical but explain only a small fraction of disease burden.
- Polygenic risk scores can identify individuals with a 3-5 fold higher lifetime risk of coronary artery disease; often decades before traditional clinical risk factors appear.
- Genetic risk is not deterministic. Lifestyle modification and lipid-lowering therapies appear to produce the greatest absolute benefit in individuals with the highest genetic risk.
- Many of our most effective cardiovascular therapies, including statins and PCSK9 inhibitors, emerged from understanding human genetic pathways.
Cardiology is gradually transitioning from reactive risk factor management toward biology-driven, lifetime precision prevention.
As our field advances, integrating genomics with clinical cardiology, imaging and interventional decision-making may redefine how we stratify risk and personalize therapy.
Outstanding review by Pradeep Natarajan, Herbert Schunkert and Nilesh Samani.”
Title: The Inherited Basis of Coronary Artery Disease
Authors: Heribert Schunkert, Pradeep Natarajan, Nilesh J. Samani
Read the Full Article on NEJM.
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