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. 2023 Jul 11;11:1139496. doi: 10.3389/fpubh.2023.1139496

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Copyright © 2023 Mujwara, Kintzle, Di Domenico, Busby and Bottà.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Markov model schematic. This figure shows the Markov model schematic with 22 health states representing the risk of CAD, health outcomes, statin side effects, and death: 6 of 22 health states represented the risk of CAD based on PCE (low PCE risk, moderate PCE risk, and high PCE risk) and CAD-PRS (low CAD-PRS = bottom 80% of the PRS distribution and high CAD-PRS = top 20% of the PRS distribution); 3 of 22 health states represented statin side effects (myopathy, diabetes, and hemorrhagic stroke); 2 of 22 health states represented the primary health outcomes (CAD and ischemic stroke); 10 of 22 health states represented comorbidities of statin side effects and/or primary health outcomes; finally, 1/22 health states represented death. Outcomes were examined for the proportion of the cohort that was eligible for prevention intervention (i.e., high CAD-PRS with high/moderate PCE risk; low CAD-PRS and high PCE risk). In the CardioriskSCORE strategy, all the cohorts eligible for prevention intervention initiated statin preventive therapy to reduce the risk of CAD and ischemic stroke, while for the Standard-WHP strategy, only a proportion with high PCE risk initiated prevention therapy, and none in the No-WHP. CAD, coronary artery disease; CAD-PRS, polygenic risk score for coronary artery disease; PCE, pooled cohort equation.