Genetic tests could save patients at ‘invisible’ danger of heart attacks and strokes

Genetic tests can identify thousands of middle-aged people at risk of heart attacks and strokes who would otherwise be “invisible” to the NHS, a pilot study has found.

GPs currently offer statins to around eight million people in England, based on checks including blood pressure and cholesterol levels.

But NHS research involving people aged 45 to 64 found around one-quarter of people were given a different risk profile if genetic tests were also included.

If tests were routinely offered to everyone in this age group, about 700,000 extra people would be offered statins.

As a result, up to 11,000 heart attacks and strokes could be prevented within a decade, said scientists.

The NHS study, called Heart, offered genetic tests to nearly 1,000 people aged 45 to 64, in the hope of better predicting their risk of developing cardiovascular disease over the next 10 years.

Doctors at 12 GP surgeries in the north-east and north Cumbria found that the calculated risk of heart disease based on routine measures such as family history, blood pressure, body mass index and smoking status changed for about a quarter of participants when their DNA was taken into account.

In 13 per cent of cases, GPs said the increase in risk was significant enough to change their treatment of the patient - for example, by offering statins.

Tests could mean earlier treatment The results, from the world’s first pilot investigating the use of genomic “polygenic risk score testing“ to support the prevention of cardiovascular disease in NHS clinical practice, were unveiled at the American Heart Association Annual World Congress.

Researchers said the findings meant patients who would otherwise have been “invisible” to the NHS could be offered better advice and medication to lower their risk of heart attacks and strokes.

Prof Sir Peter Donnelly, the founder and chief executive of Genomics, the company that developed the genetic tests, said: “We hope that this is an important first step towards a more widespread uptake and adoption of genomic approaches like this.

“Heart studied the impact in cardiovascular disease, but in future a single blood sample could be used to calculate an individual’s risk of many different common diseases simultaneously, and earlier than current methods allow, allowing prevention and treatment more time to work.”

‘Gamechanger’ Modelling by Genomics suggested that offering the test to everyone in England aged between 45 to 64 would identify 700,000 extra people who should be offered statins - and could cut the number of heart attacks and strokes by 11,000 over 10 years.

Doctors on the Heart study offered genetic tests to 836 people who visited their GPs for NHS health MOTs.

The checks, provided every five years from the age of 40, use an algorithm called Qrisk to estimate a person’s chance of cardiovascular disease in the next decade.

Those deemed to have less than a 10 per cent chance of heart problems within the next decade are deemed as low risk, while a chance of 20 per cent or more is deemed very high risk.

The study found 5.2 per cent of study participants moved from low risk to high risk after their DNA was added to their risk assessment. Around three per cent moved from being high risk, with a Qrisk score between 10 per cent and 20 per cent, to very high risk.

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Professor Ahmet Fuat, a GP with a specialist interest in cardiology and the chief investigator of the study, said: “The Heart study has shown us that this kind of genomic testing has the potential to transform the way we manage cardiovascular disease in primary care.”

The honorary professor of primary care cardiology at Durham University said the study was “groundbreaking”. He added that the integration of genetic information into best practice could be a “gamechanger” for patients and GPs, saving lives.

Many of his own patients who had been reluctant to start statins became keen to take them when they saw the new risk scores come through, he said.