Polygenic Risk Scores for Cardiovascular Disease: Clinical Utility Review

Authors systematically reviewed 42 studies evaluating polygenic risk scores (PRS) for coronary artery disease, integrating findings with the Pooled Cohort Equations and ESC SCORE2 risk models.

• PRS improved net reclassification improvement (NRI) by 8–14% in European ancestry populations.
• 12–18% of patients classified as intermediate risk by clinical models were reclassified to high or low risk with PRS integration.
• Clinical utility was highest in patients aged 40–55 without established cardiovascular disease.
• Transferability across ancestries remains a significant limitation.

For patients in the 'gray zone' of cardiovascular risk — where lifestyle and statin decisions are genuinely ambiguous — polygenic scoring may provide the additional clarity needed for confident prevention planning.

We offer PRS interpretation as part of KCM's genetic longevity assessment, always contextualized with family history, imaging, and inflammatory markers. PRS alone never triggers pharmacotherapy — it informs the conversation.