# Ancestryverschillen in hartfalen en MACE bij volwassenen met aangeboren hartafwijkingen — All of Us

*geplaatst 2026-10-06 · Nierziekte · American journal of physiology. Heart and circulatory physiology · doi 10.1152/ajpheart.90019.2026 · https://hartvaat.nl/2026/09/29/ancestryverschillen-in-hartfalen-en-mace-bij-volwassenen-met-aangeboren-hartafwi/*

Een retrospectieve cohortstudie onder 6.771 volwassenen met aangeboren hartafwijkingen (ACHD) uit het All of Us-programma toont aanzienlijke ances-gerelateerde verschillen in cardiovasculaire uitkomsten. Zwarte patiënten ontwikkelden hartfalen 11 jaar eerder en hadden een hoger risico op MACE (56,3% vs. 47,5% bij Hispanic; p=0,001), hoewel het verschil na correctie voor comorbiditeiten (waarbij chronische nierziekte 58,6% van het effect verklaarde) afnam. Polygenische risicoscores verbeterden de voorspellende waarde niet en konden de dispariteit niet verklaren. Deze bevindingen benadrukken de noodzaak van gerichte zorg en het beperkte nut van huidige polygenische scores in deze kwetsbare populatie.

## English: Ancestry-Based Disparities in Cardiovascular Outcomes and Polygenic Risk Among Adults with Congenital Heart Disease in the All of Us Research Program.

A retrospective cohort analysis of 6,771 adults with congenital heart disease (ACHD) from the All of Us Research Program reveals significant ancestry-based disparities in cardiovascular outcomes. Black patients developed heart failure 11 years earlier and experienced higher rates of MACE (56.3% vs. 47.5% in Hispanic patients; p=0.001), though adjustment for comorbidities—particularly chronic kidney disease, which accounted for 58.6% of the effect—attenuated these differences. Polygenic risk scores failed to improve risk discrimination or explain the observed disparities. These findings highlight persistent outcome gaps in ACHD care and underscore the current limitations of polygenic risk assessment in diverse populations.

## Abstract (original, from the publication)

Most individuals born with congenital heart disease now survive to adulthood, producing a growing population at risk for major adverse cardiovascular events (MACE). Ancestry-based disparities are incompletely characterized and polygenic risk has not been related to outcomes. We analyzed 6,771 adult ACHD participants in All of Us (White n=5,065, Hispanic n=882, Black n=824) and computed five polygenic scores: one for coronary artery disease and four for heart failure trained on African, European, Hispanic or Latin American, and multi-ancestry data. MACE was present in 51.0% and differed by ancestry (Black 56.3%, White 50.7%, Hispanic 47.5%; P=0.001). Black participants developed heart failure 11 years earlier (median 54 vs. 65 years). The pooled disparity attenuated to the null after comorbidity adjustment, with chronic kidney disease accounting for 58.6% of the age- and sex-adjusted effect, but age-specific estimates opposed one another (adjusted OR 1.78 at 40, 0.66 at 80; interaction P<0.001); survivor selection may contribute at older ages. No score improved discrimination or explained the disparity (area under the curve change ≤0.0047). The African-ancestry score was associated with heart failure alone (OR 1.09 per SD, q=0.022); the European and multi-ancestry scores with heart failure, arrhythmia, and MACE alike. Performance did not track training-population ancestry. The coronary and African-ancestry scores ordered the same participants in opposite directions (r=-0.198), indicating between-group offsets reflect allele frequency rather than genomic risk. Black participants underwent fewer structural cardiac reinterventions (8.6% vs. 16.4%; adjusted OR 0.47, P<0.001) despite comparable adjusted ACE inhibitor or angiotensin receptor blocker prescription.

Auteurs: Tobias K Fuchs, Anthony Collura, Ramu Anandakrishnan

---
Bron: American journal of physiology. Heart and circulatory physiology, https://doi.org/10.1152/ajpheart.90019.2026. Bijgewerkt 2026-09-30T00:48:56Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.