Polygenic Risk Score Associates with Atherosclerotic Plaque Characteristics at Autopsy

Anne Cornelissen, Neel V. Gadhoke, Kathleen Ryan, Chani J. Hodonsky, Rebecca Mitchell, Nathan A. Bihlmeyer, Thuyvy Duong, Zhifen Chen, Armelle Dikongue, Atsushi Sakamoto, Yu Sato, Rika Kawakami, Masayuki Mori, Kenji Kawai, Raquel Fernandez, Saikat Kumar B. Ghosh, Ryan Braumann, Biniyam Abebe, Robert Kutys, Matthew KutynaMaria E. Romero, Frank D. Kolodgie, Clint L. Miller, Charles C. Hong, Megan L. Grove, Jennifer A. Brody, Nona Sotoodehnia, Dan E. Arking, Heribert Schunkert, Braxton D. Mitchell, Liang Guo, Renu Virmani, Aloke V. Finn

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Polygenic risk scores (PRSs) for coronary artery disease (CAD) potentially improve cardiovascular risk prediction. However, their relationship with histopathologic features of CAD has never been examined systematically. METHODS: From 4327 subjects referred to CVPath by the State of Maryland Office Chief Medical Examiner for sudden death between 1994 and 2015, 2455 cases were randomly selected for genotyping. We generated PRS from 291 known CAD risk loci. Detailed histopathologic examination of the coronary arteries was performed in all subjects. The primary study outcome measurements were histopathologic plaque features determining severity of atherosclerosis, including %stenosis, calcification, thin-cap fibroatheromas, and thrombotic CAD. RESULTS: After exclusion of cases with insufficient DNA sample quality or with missing data, 954 cases (mean age, 48.8±14.7 years; 75.7% men) remained in the final study cohort. Subjects in the highest PRS quintile exhibited more severe atherosclerosis compared with subjects in the lowest quintile, with greater %stenosis (80.3%±27.0% versus 50.4%±38.7%; adjusted P<0.001) and a higher frequency of calcification (69.6% versus 35.8%; adjusted P=0.004) and thin-cap fibroatheroma (26.7% versus 9.5%; adjusted P=0.007). Even after adjustment for traditional CAD risk factors, subjects within the highest PRS quintile had higher odds of severe atherosclerosis (ie, ≥75% stenosis; adjusted odds ratio, 3.77 [95% CI, 2.10-6.78]; P<0.001) and plaque rupture (adjusted odds ratio, 4.05 [95% CI, 2.26-7.24]; P<0.001). Moreover, subjects within the highest quintile had higher odds of CAD-associated cause of death, especially among those aged ≤50 years (adjusted odds ratio, 4.08 [95% CI, 2.01-8.30]; P<0.001). No statistically significant associations were observed with plaque erosion after adjusting for covariates. CONCLUSIONS: This is the first autopsy study investigating associations between PRS and atherosclerosis severity at the histopathologic level in subjects with sudden death. Our pathological analysis suggests PRS correlates with plaque burden and features of advanced atherosclerosis and may be useful as a method for CAD risk stratification, especially in younger subjects.

Original languageEnglish (US)
Pages (from-to)300-313
Number of pages14
JournalArteriosclerosis, thrombosis, and vascular biology
Issue number1
StatePublished - Jan 1 2024


  • atherosclerosis
  • autopsy
  • cause of death
  • coronary artery disease
  • genetic variation
  • heart disease risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Polygenic Risk Score Associates with Atherosclerotic Plaque Characteristics at Autopsy'. Together they form a unique fingerprint.

Cite this