A new genetic test targets young hearts

Despite the high expectations of the new tests, there are many questions.

Some critics say a focus on treating younger people is misplaced because they may not live up to taking a statin or another drug for the rest of their lives. It can be difficult for young people to focus on potential threats to their health in the future, and some of Dr. Rader even put off undergoing polygenic risk tests after recommending them.

The real need, these critics say, is with the huge group of elderly people who need cholesterol-lowering treatment but don’t get it, or who are waiving their prescriptions. In one study, about 40 percent of people age 65 and older who have had a heart attack and need lipid-lowering drugs for the rest of their lives stop taking statins within two years.

Others, such as Dr. Rita F. Redberg, a cardiologist at the University of California, San Francisco, the editor at JAMA Internal Medicine and a critic of statin overuse, is concerned that polygenic risk scores could introduce new problems.

“There are a lot of downsides to labeling people with a disease,” she said.

The label, she added, “inexorably leads to testing and the search for treatments.” And, she said, “because the person who has now become a ‘patient’ is asymptomatic, more tests and possible treatments won’t make the person feel better in most cases.”

People may think of themselves as healthy to come to think of themselves as having a disease. “Now, when they experience life’s common aches, pains, and stabs, they wonder if it’s because they have this ‘disease,'” said Dr. Redberg. “And they can then go to the doctor or even the emergency room for things they wouldn’t have before. And that will also lead to more testing and procedures, with the associated risk of harm.”

Others, while excited about the prospects for polygenic risk scores, say doctors need to know more about how effective early intervention might be.

Dr. Iftikhar Kullo of the Mayo Clinic in Rochester, Minn., asked, “Do you actually improve long-term outcomes” by using the tests and acting on them?