Tuesday, April 24, 2007

Heart Risk Genes in Question

In the April 11th issue of JAMA Tom Morgan and Rick Lifton report a large "Replication" Study intended to identify at risk polymorphisms. I remember Tom running all over Yale collecting samples while I was a medical student rotating through genetics there. Personally I am surprised that the press did not jump all over this study. They evaluated 85 previously studied markers and found absolutely none were linked to increased risk of heart attack.
However family history of MI was higher in cases than controls, the racial subtype was Caucasian, the study identified each gene polymorphism individually. What this alerts me to is the shortcoming of candidate gene analysis (looking for genes based on mechanism of disease process). More importantly it puts an ALERT out that testing for MI predisposition is not ready for prime time quite yet, at least in a pan screening form. Perhaps nuanced testing in specific groups like ALOX5AP in Icelandic and Scottish patients will be the best way to stratify care.
The Gene Sherpa says- Hold on to testing for MI for now. Subgroup analysis will need to be done....again. Soon we will have whole genome analysis of risk genes and that will help solve this mystery. I hope Tom is doing well at Wash U St Louis. If anyone sees him tell him Steve Murphy says hi.


Bertalan Meskó said...

How could I miss your great blog? Personalized medicine, clinical genetics, all of my favourite subjects. Welcome in the medical blogosphere!

I plan to become a clinical geneticist, so your blog means even more to me.

Anyway, I'd like to send you an e-mail, but can't find your address on your blog. Would you be so kind as to send me one so I can show you a clinical genetics related work. Thanks in advance!

Berci.mesko [at] gmail.com

Steve Murphy MD said...

Glad you enjoy the material. Where are you currently studying. I have put my email address up now. Send me a line.