Early Detection of Coronary Artery Disease by Polygenic and Metabolic Risk Scoring
Early Detection of Coronary Artery Disease by Polygenic and Metabolic Risk Scoring
The overall goal of this study is to develop a combined polygenic risk score (PRS) and
 metabolic risk score (MRS) and determine its impact on selecting community members for CCS.
 The trial component of this study will compare the use of these scores to motivate people to
 adhere to therapy, an ongoing challenge for clinicians, by providing feedback in a meaningful
 form to both the clinicians and the patients.
Patients undergoing a polygenic risk score (PRS), metabolic risk score (MRS) and coronary
 calcium score (CCS) will be randomized to receive PRS and CCS information and followed for
 the reduction of risk over 12 months. This information will provide information about how to
 motivate people to adhere to therapy, by providing feedback in a meaningful form to both the
 clinicians and the patients.
Inclusion Criteria:

 1. Asymptomatic subjects age 40-70y

 2. Statin naïve

 3. TC ≤ 6.5 mmol/L and LDLC <5 mmol/L, and

 4. 5 year Australian risk ≥2%.

 Exclusion Criteria:

 1. Symptomatic coronary, cerebrovascular, or peripheral vascular disease

 2. Intolerance of statins or currently on statins for any length of time

 3. Pre-existing muscle disease (eg polymyositis, fibromyalgia) - this may be confused
 with myalgia from statins

 4. Patients on drugs that increase the risk of myopathy/rhabdomyolysis such as
 cyclosporine and strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole, and
 HIV/hepatitis C protease inhibitors)

 5. Atrial fibrillation (interferes with CTCA)

 6. Chronic kidney disease on haemodialysis (because of vascular calcification) or GFR
 <50ml/min per 1.73m2 using the Modification of Diet in Renal Disease (MDRD) formula

 7. Inability to provide informed consent

 8. Major systemic illness eg. malignancy; rheumatoid arthritis

 9. Women of child bearing potential (due to performance of CT)

 10. Poorly controlled hypertension: SBP> 200 and or DBP > 100

 11. Severe psychiatric disorder (eg bipolar depression; psychosis)

 12. Patients eligible for treatment based on current Australian guidelines (5 year risk
 >15%)

 13. Patients eligible for treatment based on current PBS thresholds TC >7.5 mmol/l and
 other criteria (see below).