Ignite Creation Date:
2024-05-06 @ 2:45 PM
Last Modification Date:
2024-10-26 @ 1:36 PM
Study NCT ID:
NCT04417387
Status:
RECRUITING
Last Update Posted:
2023-11-30
First Post:
2020-06-01
Brief Title:
The Genetics and Vascular Health Check Study GENVASC Aims to Help Determine Whether Gathering Genetic Information Can Improve the Prediction of Risk of Coronary Artery Disease CAD
Sponsor:
University of Leicester
Organization:
University of Leicester
Study Overview
Official Title:
Genetics and Vascular Health Check Study GENVASC
Status:
RECRUITING
Status Verified Date:
2023-11
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
GENVASC
Brief Summary:
The Genetics and Vascular Health Check study GENVASC is a large study run in conjunction with Clinical Commissioning Groups and Primary Care practices across Leicester Leicestershire and Northamptonshire The purpose of GENVASC is to help determine whether gathering genetic information can improve the prediction of risk of Coronary Artery Disease CAD
Currently coronary risk scores are used to put individuals into low 10 medium 10-20 and high 20 risk groups to help target prevention in individuals at the highest risk of developing CAD While this approach has merit since the majority of individuals fall into low or medium risk groups in absolute terms more people develop CAD in these groups than in the high risk group despite their proportional risk being lower Therefore improving the accuracy of risk categorisation for CAD has important public health and clinical benefits
In the last 5 years there has been remarkable progress in identifying genetic variants that affect risk of CAD with much of this work being co-led from Leicester These discoveries provide a framework for testing whether the addition of genetic information in the form of a genetic risk score can improve current risk prediction of CAD
The GENVASC study capitalises on the unique opportunity provided by the NHS Health Check Programme which is being widely promoted and specifically targets all individuals aged 40-74 years who are free of cardiovascular disease Consenting participants taking part in the health check programme are asked to provide an additional sample of blood to subsequently determine whether the addition of genetic information would have improved prediction of risk for coronary disease in individuals at lowmedium risk
To date more than 100 GP surgeries in Leicester and Leicestershire are involved in the study and recruitment has recently commenced in Northamptonshire We aim to recruit and follow-up over 30000 participants over the course of the study
Currently coronary risk scores are used to put individuals into low 10 medium 10-20 and high 20 risk groups to help target prevention in individuals at the highest risk of developing CAD While this approach has merit since the majority of individuals fall into low or medium risk groups in absolute terms more people develop CAD in these groups than in the high risk group despite their proportional risk being lower Therefore improving the accuracy of risk categorisation for CAD has important public health and clinical benefits
In the last 5 years there has been remarkable progress in identifying genetic variants that affect risk of CAD with much of this work being co-led from Leicester These discoveries provide a framework for testing whether the addition of genetic information in the form of a genetic risk score can improve current risk prediction of CAD
The GENVASC study capitalises on the unique opportunity provided by the NHS Health Check Programme which is being widely promoted and specifically targets all individuals aged 40-74 years who are free of cardiovascular disease Consenting participants taking part in the health check programme are asked to provide an additional sample of blood to subsequently determine whether the addition of genetic information would have improved prediction of risk for coronary disease in individuals at lowmedium risk
To date more than 100 GP surgeries in Leicester and Leicestershire are involved in the study and recruitment has recently commenced in Northamptonshire We aim to recruit and follow-up over 30000 participants over the course of the study
Detailed Description:
Coronary Artery Disease CAD is the commonest cause of premature death and disability in the UK Several demographic and lifestyle factors such as age gender smoking hypertension diabetes and dyslipidaemia contribute to risk of CAD A number of CAD prediction risk algorithms based on these factors such as the Framingham and the QRisk2 scores have been developed and allow classification of individuals into low 10 medium 10-20 and high 20 10-year CAD risk These risk scores have been used to identify and target primary prevention measures to those at highest risk While targeting such individuals is clearly beneficial because many more subjects are located in the intermediate or low risk categories although their proportional risk is lower in absolute terms more events actually occur in these groups Improving the accuracy of risk categorisation for CAD is therefore a high public health and clinical priority
Inheritance plays an important role in the aetiology of CAD The risk to an individual is 4-8 fold higher if a first degree relative has died prematurely of CAD The heritability of CAD is estimated at around 50 In some especially more recent risk scores a family history of CAD is included in the algorithm However identifying a positive family history due to inheritance has significant limitations Family history based on recall can be notoriously inaccurate Algorithms vary in the age cut-off used to define a positive family history Furthermore an individuals family may not be sufficiently large eg no siblings to assess familial risk family members could have died from competing causes eg cancer or road traffic accidents before manifesting CAD or could have developed CAD but due to a strong lifestyle factor such as heavy smoking In short although a family history of CAD can be useful it is neither a sufficient or accurate surrogate for an individuals genetic risk
Recently significant progress has been made in directly dissecting the genetic basis of CAD In work led by the Principal Investigator in collaboration with national and international collaborators over 30 common genetic variants carried by between 10-80 of the population have been identified that increase risk of CAD by between 5-30 per copy of each variant Further variants are likely to emerge in on-going work and especially lower frequency variants that have more powerful effects Individually the genetic variants do not have sufficient discrimination to individually change risk prediction sufficiently However a Genetic Risk Score GRS based on combining the variants adjusted for their individual effects could be more powerful Indeed in a recent study we showed that there was a 3-fold difference in odds ratio for CAD between those subjects in the highest quintile compared with those in the lowest quintile for a GRS score based on 25 of the initially identified CAD-associated variants This is similar to or greater than the strength of association seen with other established risk factors such as blood pressure and cholesterol Addition of further variants as they are discovered to the GRS is likely to further improve its risk prediction potential Therefore recent discoveries on the basis of CAD now provide a framework for testing whether adding genetic information in the form of a genetic risk score can improve current risk prediction of CAD
To test whether a GRS for CAD can improve risk prediction requires assembling a large cohort of individuals representative of the general population who are i free of overt CAD at recruitment ii who are assessed in a uniform fashion for their CAD risk iii and who can provide blood samples for genetic analysis and iv who can be followed up systematically for Cardiovascular Disease CVD outcomes Such cohorts are rare nationally and internationally Biobank UK at a cost of 30 million has been established to address this deficiency although one of its limitations is that it is not representative of the general population One of the key factors that inhibits the assembly of such cohorts solely for research purposes is the huge initial cost of setting up the infrastructure required to recruit a sufficiently large sample size In this context the recently initiated Department of Health NHS Vascular Health Check Programme provides a unique opportunity to establish such a cohort as all individuals in the appropriate age range 40-74 years free of CVD are being invited to their general practices for a Vascular Health Check The large number of subjects that will be assessed in a systematic manner for cardiovascular risk and who will all have blood samples routinely collected for lipid profiling provides an ideal scenario to add a research project that can help determine whether a GRS will be useful in predicting CAD risk In short the Vascular Health Check programme provides a unique opportunity to test in a major way and at a marginal cost whether in the future adding genetic information will improve CAD risk prediction
Hypothesis Addition of genetic information in the form of a Genetic Risk Score based on recent discoveries of genetic variants that associate with CAD will improve risk prediction of coronary artery disease
Objectives
The objective of the GENVASC Study is to recruit with informed consent subjects who attend their GP practices to have a Vascular Health Check Subjects will be asked to consent to
Providing blood samples for research in most cases taken at the same time as clinical samples for their vascular check
Allow the GENVASC research database to hold semi-anonymised no identifiable names data on their CVD risk score calculated using conventional algorithms
To allow the database to be periodically updated with any CVD outcomes via GP practice databases as well as from appropriate national registries
To allow their stored samples be used for DNA and other analyses again anonymised
The GENVASC Study will not interfere with the primary clinical imperative of the Vascular Health Check Programme It will retrospectively analyse whether addition of a GRS would have improved CAD risk prediction
Inheritance plays an important role in the aetiology of CAD The risk to an individual is 4-8 fold higher if a first degree relative has died prematurely of CAD The heritability of CAD is estimated at around 50 In some especially more recent risk scores a family history of CAD is included in the algorithm However identifying a positive family history due to inheritance has significant limitations Family history based on recall can be notoriously inaccurate Algorithms vary in the age cut-off used to define a positive family history Furthermore an individuals family may not be sufficiently large eg no siblings to assess familial risk family members could have died from competing causes eg cancer or road traffic accidents before manifesting CAD or could have developed CAD but due to a strong lifestyle factor such as heavy smoking In short although a family history of CAD can be useful it is neither a sufficient or accurate surrogate for an individuals genetic risk
Recently significant progress has been made in directly dissecting the genetic basis of CAD In work led by the Principal Investigator in collaboration with national and international collaborators over 30 common genetic variants carried by between 10-80 of the population have been identified that increase risk of CAD by between 5-30 per copy of each variant Further variants are likely to emerge in on-going work and especially lower frequency variants that have more powerful effects Individually the genetic variants do not have sufficient discrimination to individually change risk prediction sufficiently However a Genetic Risk Score GRS based on combining the variants adjusted for their individual effects could be more powerful Indeed in a recent study we showed that there was a 3-fold difference in odds ratio for CAD between those subjects in the highest quintile compared with those in the lowest quintile for a GRS score based on 25 of the initially identified CAD-associated variants This is similar to or greater than the strength of association seen with other established risk factors such as blood pressure and cholesterol Addition of further variants as they are discovered to the GRS is likely to further improve its risk prediction potential Therefore recent discoveries on the basis of CAD now provide a framework for testing whether adding genetic information in the form of a genetic risk score can improve current risk prediction of CAD
To test whether a GRS for CAD can improve risk prediction requires assembling a large cohort of individuals representative of the general population who are i free of overt CAD at recruitment ii who are assessed in a uniform fashion for their CAD risk iii and who can provide blood samples for genetic analysis and iv who can be followed up systematically for Cardiovascular Disease CVD outcomes Such cohorts are rare nationally and internationally Biobank UK at a cost of 30 million has been established to address this deficiency although one of its limitations is that it is not representative of the general population One of the key factors that inhibits the assembly of such cohorts solely for research purposes is the huge initial cost of setting up the infrastructure required to recruit a sufficiently large sample size In this context the recently initiated Department of Health NHS Vascular Health Check Programme provides a unique opportunity to establish such a cohort as all individuals in the appropriate age range 40-74 years free of CVD are being invited to their general practices for a Vascular Health Check The large number of subjects that will be assessed in a systematic manner for cardiovascular risk and who will all have blood samples routinely collected for lipid profiling provides an ideal scenario to add a research project that can help determine whether a GRS will be useful in predicting CAD risk In short the Vascular Health Check programme provides a unique opportunity to test in a major way and at a marginal cost whether in the future adding genetic information will improve CAD risk prediction
Hypothesis Addition of genetic information in the form of a Genetic Risk Score based on recent discoveries of genetic variants that associate with CAD will improve risk prediction of coronary artery disease
Objectives
The objective of the GENVASC Study is to recruit with informed consent subjects who attend their GP practices to have a Vascular Health Check Subjects will be asked to consent to
Providing blood samples for research in most cases taken at the same time as clinical samples for their vascular check
Allow the GENVASC research database to hold semi-anonymised no identifiable names data on their CVD risk score calculated using conventional algorithms
To allow the database to be periodically updated with any CVD outcomes via GP practice databases as well as from appropriate national registries
To allow their stored samples be used for DNA and other analyses again anonymised
The GENVASC Study will not interfere with the primary clinical imperative of the Vascular Health Check Programme It will retrospectively analyse whether addition of a GRS would have improved CAD risk prediction
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None