The future of genetic risk prediction is anticipated to benefit several areas of research and clinical practice, and democratize the interpretation of personalized medicine. For example, user interfaces such as KardioKompassi in Finland and a mobile app, MyGeneRank, have recently been developed to provide personalized polygenic risk scores for coronary artery disease (101). Contrasting these tools, however, highlights the differences in predictive power; the former tool integrates a risk score computed from the largest genetic scan of cardiovascular disease using genome-wide clumped SNPs (N ~ 50,000) and integrates measured clinical and environmental risk factors. The latter tool, in contrast, is based on only 57 SNPs, meaning the PRS alone is expected to explain ~50% less phenotypic variation (15). While KardioKompassi is therefore expected to be much more informative, because the clinical and environmental effects are learned in Finland, they may have lower generalizability to non-Finnish individuals where environments and medical systems differ, even if the genetic score is equally valid in some countries. Considerable caution is urged with broad public deployment as lack of diversity straightforward explanations provide unmet challenges (56). Researchers have a responsibility to explain the predictive power (or lack thereof) of genetic tools to the broader public.
