Genetic testing for cardiovascular disease susceptibility: A useful clinical management tool or possible misinformation?

被引:75
作者
Humphries, SE
Ridker, PM
Talmud, PJ
机构
[1] UCL Royal Free & Univ Coll Med Sch, British Heart Fdn Labs, Dept Med, Ctr Cardiovasc Genet, London WC1E 6JF, England
[2] Harvard Univ, Brigham & Womens Hosp, Sch Med,Div Cardiovasc Dis, Ctr Cardiovasc Dis Prevent, Boston, MA 02115 USA
[3] Harvard Univ, Brigham & Womens Hosp, Sch Med,Div Prevent Med, Ctr Cardiovasc Dis Prevent, Boston, MA 02115 USA
关键词
factor V Leiden; ApoE; risk production; ROC curves;
D O I
10.1161/01.ATV.0000116216.56511.39
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Genetic susceptibility tests are already advertised on the Internet to identify individuals at above average risk for cardiovascular disease (CVD), such as deep vein thrombosis, hyperlipidemia, or atherosclerosis, whereas other tests claim to predict response to a particular drug treatment. Some kits are available to the public directly, bypassing a doctor. Their value, however, must be considered carefully, because although a genotype may be strongly and consistently associated with an intermediate trait, and because the intermediate trait is a strong predictor of CVD risk, there may be little or no association of genotype with risk over and above that of the measured trait. This is because multigenic effects and environmental modification (context dependency) of genotype effects determine CVD risk. An individual's personal characteristics and plasma risk-trait levels (which reflect both genotype and exposure) at present are the best predictors of clinical outcome. Only when genetic tests surpass this, possibly by the inclusion of many functional common variants, in conjunction with their context-dependent effects on risk, might their usefulness in clinical management be realized. Here we review some of the particular issues and concerns raised by CVD-risk genetic testing, and suggest areas of further research to address these issues.
引用
收藏
页码:628 / 636
页数:9
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