Coronary risk scores stop giving one number: eight biological axes separate people with the same genetic liability
Polygenic risk for coronary artery disease no longer collapses into a single number. Conventional scores identify who is at high risk but not which biological processes drive that risk. Decomposing 526 genome-wide significant variants by their associations with 78 CAD-related traits yielded eight latent components: cholesterol-enriched lipoproteins, triglyceride-rich lipoproteins, lipoprotein(a), metabolically unhealthy normal weight, obesity, endothelial dysfunction, coagulation and cardiac remodeling. Process-specific scores built in UK Biobank, SCAPIS and Mass General Brigham Biobank tracked clinical coronary events, subclinical atherosclerosis and distinct biomarker and comorbidity profiles.