Genes Predict, Habits Protect: Rethinking Heart Disease Risk in Light of New Research

July 2025

A major study published this month in Circulation: Genomic and Precision Medicine (Bhattacharya et al., 2025) explores what drives the risk of developing coronary artery disease (CAD)—one of the world’s leading causes of death. Using data from nearly 300,000 participants in the UK Biobank, the researchers assessed how much heart disease risk can be explained by traditional clinical factors (like hypertension, diabetes, and cholesterol), novel biomarkers (like inflammation and lipoprotein(a)), and genetic predisposition.

The study’s key finding? While high blood pressure remains the single biggest contributor to heart disease, polygenic risk scores (PRS)—a measure of genetic vulnerability—ranked a close second. This makes PRS one of the most powerful predictors of first-time heart attacks in their model, even outperforming diabetes and high cholesterol.

🧬 Prediction vs. Prevention: A Critical Perspective

The authors conclude that genetic risk factors like PRS deserve greater attention in CAD prevention strategies. And while this may be true for population-wide risk modeling, we must ask a critical question:

How does knowing your genetic risk help you prevent a heart attack?

The truth is—it doesn’t. Not directly.

Unlike blood pressure or blood sugar, your genes don’t change. A high PRS can tell you that you’re more likely to develop heart disease—but it can’t tell you how to lower that risk. That’s where the disconnect lies.

🔄 Lifestyle: The Real Game Changer

Multiple studies have consistently shown that lifestyle habits have a much stronger influence on health outcomes than genetic predisposition:

• The INTERHEART study found that 90% of first heart attacks can be explained by just 9 modifiable risk factors, including blood pressure, smoking, obesity, stress, and diet.

• A 2016 NEJM study showed that people with high genetic risk cut their heart disease risk in half through healthy behaviors.

• Global data (Magnussen et al., 2023) confirms that genetics explain less than 10% of heart disease risk, while the rest comes down to modifiable factors.

In Bhattacharya’s study, while PRS stood out as a single predictor, the combined impact of hypertension, diabetes, inflammation, dyslipidemia, obesity, and socioeconomic deprivation far outweighed genetic risk. These are all targets we can influence—through both personal action and public health policy.

🧠 A Better Clinical Translation

Genetic tools like PRS can be helpful, especially for early identification of high-risk individuals who appear healthy. But their real value comes when they lead to actionable interventions—not just anxiety.

Here's how we can translate this research into better care:

1. Screen smarter: Use PRS to flag hidden risk early—but follow up with real-world interventions.

2. Treat what’s treatable: Focus on controlling blood pressure, reducing inflammation, improving metabolic health.

3. Support the whole person: Address diet, sleep, stress, environment—not just genetics.

4. Empower, not scare: Help patients see their risk as modifiable, not inevitable.

💡 Final Thoughts

Yes, your genes matter—but they are your blueprint, not your destiny. The most powerful tools for preventing heart disease are still the simplest: a balanced diet, regular movement, restorative sleep, stress regulation, and meaningful connection.

Let’s not confuse prediction with prevention. Genetic insights are exciting, but the heart still responds best to what you do—day by day, step by step.

Reference

Bhattacharya R, Marnell CS, Cho SMJ, et al. Importance of Clinical, Laboratory, and Genetic Risk Factors for Incident CAD. Circ Genom Precis Med. 2025;18:e004937. doi:10.1161/CIRCGEN.124.004937