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BMJ 2010; 340 doi: (Published 24 February 2010) Cite this as: BMJ 2010;340:c1067

Genetic testing for cardiovascular diseases falls short of clinical utility

As part of an extensive systematic review into 29 genes that might be the bearers of heredity for cardiovascular diseases, a meta-analysis reports an association between single nucleotide polymorphisms on chromosome 9p21 and heart disease. On the basis of data from 35 872 cases and 95 837 controls in the 22 included observational studies, researchers calculated that carriers of two at risk alleles were 1.25-fold more likely to develop heart disease (coronary heart disease, myocardial infarction, or coronary artery disease) than those who carried one risk allele. Similar results were found for carriers of one risk allele compared with those who carried none. The excess risk was age dependent: odds ratios increased with younger age at diagnosis.

The effect size was small, however. A 65 year old man with no traditional risk factors and no at risk alleles would have a 9.2% risk of heart disease over 10 years, whereas the risk increased to 11% and 13.2% for one and two at risk alleles, respectively. Corresponding numbers for a 40 year old woman would be 1.7%, 2%, and 2.4%.

Another study tested a literature based genetic risk score comprising 101 single nucleotide polymorphisms for prediction of myocardial infarction, stroke, arterial revascularisation, and death from cardiovascular disease. In a prospective cohort, 19 313 initially healthy women were followed over 12 years. The genetic risk score did not improve the prediction of cardiovascular events over the use of traditional risk factors. However, although the genetic risk score was not associated with incident events (hazard ratio 1.00, 95% CI 0.99 to 1.01), self reported family history remained a significant predictor in multivariate models.

Statins increase risk of diabetes

People who take statins have a 9% increased risk of type 2 diabetes compared with those on placebo or usual care. For one extra incident case of diabetes to occur, 255 …

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