Can a DNA test tell if you are at risk for heart attack?

Advancements in genetic testing: This detailed visualization of DNA highlights its role in assessing heart disease risk, paving the way for personalized health strategies.

When you go to the doctor, they might estimate your risk of having a heart attack based on things like your age, blood pressure, cholesterol, and whether you smoke or have diabetes. This is called a traditional risk score.

But here’s the problem:

Many people who seem “low risk” on paper still end up having heart attacks. And some who are told they’re “high risk” may never develop heart disease at all.

That’s where a new tool comes in: polygenic risk scores (PRS). These are DNA-based tests that look at hundreds or thousands of tiny genetic markers to estimate your inherited risk of heart disease.

What New Research Says (2024–2025) about DNA tests

Recent large studies in the U.S. and Europe, including data from hundreds of thousands of people, have shown:

1. Your Genes Might Say You’re High Risk — Even If Your Cholesterol Is Normal

• People who looked “low risk” using standard calculators were found to be quietly high risk when their genetic risk was taken into account.

• These people had a higher chance of heart attacks in the next 10 years and would benefit from earlier preventive treatment, like starting statins.

2. This Is Especially True for People Under 50

• Traditional calculators often miss risk in younger people because age is such a strong factor.

• PRS helped doctors catch risk earlier — before someone’s first symptom is a heart attack.

3. Works Across Ethnic Backgrounds

• In a large U.S. Veterans study, PRS improved heart risk prediction in people of White, Black, Hispanic, and South Asian backgrounds (but with caveat, see below).

4. Better at Sorting People Into True Risk Groups

• People who were “borderline” or “intermediate” risk using old tools were more accurately reclassified into high or low risk using PRS.

• In some studies, up to 30% of people were moved to a better-fitting risk category.

What This Means for You

• If you’ve ever been told, “Your risk is low”, PRS might tell a different story—especially if you have a family history of early heart disease.

• If your risk is genetically low, you may be able to avoid medications like statins that you might not need.

Should You Get a DNA Test?

• PRS testing is becoming more available through certain health systems and consumer DNA companies.

• It’s most useful if you’re:

  
  

  • Between 30 and 60 years old

  • Not already on medications for heart disease

  • Interested in knowing your personal genetic risk and taking action early

  
  

Bottom Line

Your DNA holds powerful clues about your heart health—even if your cholesterol, blood pressure, and lifestyle all look “normal.”

Adding a genetic risk score can give a fuller picture of your risk and help you make smarter choices earlier in life.

5 reasons to be cautious of Polygenic risk score

1. Limited Clinical Impact So Far

• Criticism: Even though PRS improves statistical risk prediction (e.g., with better net reclassification), the actual number of clinical decisions (like starting or stopping statins) that change may be relatively small.

• Example: In the UK Biobank JAMA study, while a significant portion was reclassified, it’s unclear if this would meaningfully alter clinical outcomes unless linked to action like earlier medication or intensive lifestyle intervention.

2. Eurocentric Bias in PRS Development

• Criticism: Many PRS models are derived mostly from European ancestry data, particularly UK Biobank.

• Concern: PRS performs less accurately in people of African, South Asian, or Hispanic descent unless specifically recalibrated.

• Example: Although the Million Veteran Program made strides in multi-ethnic modeling, most PRS still lag in equity, and using them in diverse populations risks misclassification.

3. PRS Doesn’t Include Modifiable Risk Factors

• Criticism: PRS captures inherited risk, but ignores lifestyle, environment, and social determinants of health.

• This means someone with high genetic risk but excellent lifestyle may not need the same interventions as someone with both poor genes and habits — but PRS doesn’t adjust for that nuance.

4. Over interpretation of Reclassification Metrics

• Criticism: Some studies highlight continuous net reclassification improvement (NRI), which can look impressive (>30%), but that metric includes small risk shifts that may not change care.

• Clinical NRI (how many people actually cross a treatment threshold, like needing statins) is often much smaller — typically 1–4%.

5. Cost-Effectiveness and Accessibility

• Criticism: PRS tests are not yet widely covered by insurance, and can cost $100–300+.

• There’s limited real-world evidence that using PRS changes long-term outcomes in a way that justifies cost for routine use in average-risk individuals.

6. Risk of Psychological Harm or Misuse

• Criticism: Knowing you have “high genetic risk” may lead to anxiety or unnecessary medicalization in low-risk people, or false reassurance in those with “low risk” but poor health habits.

• PRS results must be interpreted with counseling to avoid confusion or misuse.

Also read : https://www.preventiononly.com/post/unlocking-your-genetic-code-what-you-need-to-know-about-genetic-testing

References

Recent findings supporting the role of polygenic risk scores (PRS) in cardiovascular risk prediction come from several large, peer-reviewed studies. A 2024 study in JAMA Cardiology using data from the UK Biobank found that PRS reclassified a significant portion of individuals initially considered borderline or intermediate risk into more accurate categories, improving statin decision-making, especially among adults under 50 [1]. The Million Veteran Program study (2024) also demonstrated improved risk discrimination across diverse racial and ethnic groups using PRS, with significant net reclassification improvements [2]. The GENVASC study in England (2024) showed that adding PRS to traditional tools like QRISK2 increased early identification of at-risk individuals, particularly in those aged 40–54 [3]. A related analysis published in the European Heart Journal demonstrated that combining SCORE2 with PRS provided more accurate prediction of future cardiovascular events [4]. Collectively, these studies show that PRS testing can uncover hidden cardiovascular risk not captured by standard calculators, enabling more personalized and earlier preventive care.