JACC | Polygenic Risk Based Detection and Treatment of Subclinical Coronary Atherosclerosis in the PROACT Clinical Trials

This Landmark JAMA 2026 PROACT trials showed that adults with high coronary artery disease (CAD)
polygenic risk scores but low clinical risk were prospectively identified from a biobank and evaluated
with coronary CT angiography, demonstrating that about half had previously undetected subclinical
plaque despite favorable cardiovascular health. These findings show the feasibility of genome-first
prevention strategies and suggest that polygenic risk–guided identification could enable earlier targeted
pharmacologic prevention in individuals overlooked by conventional risk models.