Understanding the influence of lifestyle and genetic risk factors on the lifetime risk of coronary heart disease (CHD) is critical for enhancing public health programs. In a population-based cohort study, researchers aimed to assess residual lifetime risk and years free of CHD based on polygenic risk and the American Heart Association’s Life’s Simple 7 (LS7) recommendations. The research included data from the ARIC (Atherosclerosis Risk in Communities) project, which comprised 8,372 White and 2,314 Black people aged 45 and older and free of CHD at baseline. A polygenic risk score (PRS) of more than 6 million genetic variations was divided into three categories: low (<20th percentile), moderate (<20th percentile), and high (>80th percentile). At the outset, an overall LS7 score was generated and classified as “poor,” “moderate,” or “excellent” cardiovascular health. Lifetime risk and CHD-free years were calculated using polygenic risk and LS7 categories.

The total remaining lifetime risk was 27%, ranging from 16.6% in persons with an optimal LS7 score to 43.1% in individuals with a low LS7 score. The relationship between PRS and lifetime risk changed depending on ancestry. According to rising PRS categories, White individuals’ remaining lifetime risk varied from 19.8% to 39.3%. Individuals with a high PRS and a bad LS7 had a 67.1% residual lifetime risk and 15.9 fewer CHD-free years than those with intermediate polygenic risk and LS7 score. When compared to bad LS7 in the high-PRS group, perfect LS7 was related to 20.2 additional CHD-free years. The remaining lifetime risk among Black individuals varied from 19.1% to 28.6% as the PRS category increased. Individuals with weak LS7 had similar lifetime risk estimations regardless of the PRS category. An ideal LS7 score was related to just 4.5 extra CHD-free years in the high-PRS group compared to a bad LS7 score.

Adherence to LS7 guidelines was linked to a decreased lifetime risk of CHD in all people, particularly those with a high genetic vulnerability. Adherence to LS7 recommendations correlated to a lifetime risk of CHD in Black individuals more than present PRSs. Improved PRSs were required to accurately assess genetic susceptibility to CHD in varied populations.