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Mayo Clin Proc. 2018 Nov;93(11):1600-1610. doi: 10.1016/j.mayocp.2018.06.026.

The Return of Actionable Variants Empirical (RAVE) Study, a Mayo Clinic Genomic Medicine Implementation Study: Design and Initial Results.

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Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Electronic address:
Department of Health Sciences Research, Biomedical Ethics Program, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Center for Individualized Medicine-Genomics, Mayo Clinic, Rochester, MN.
Johns Hopkins University, Schools of Medicine, Public Health and Nursing, Baltimore, MD.
National Human Genome Research Institute, Bethesda, MD.
Baylor College of Medicine Human Genome Sequencing Center, Houston, TX.
Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ.
Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Department of Health Sciences Research, Mayo Clinic, Scottsdale, AZ.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.



To identify clinically actionable genetic variants from targeted sequencing of 68 disease-related genes, estimate their penetrance, and assess the impact of disclosing results to participants and providers.


The Return of Actionable Variants Empirical (RAVE) Study investigates outcomes following the return of pathogenic/likely pathogenic (P/LP) variants in 68 disease-related genes. The study was initiated in December 2016 and is ongoing. Targeted sequencing was performed in 2533 individuals with hyperlipidemia or colon polyps. The electronic health records (EHRs) of participants carrying P/LP variants in 36 cardiovascular disease (CVD) genes were manually reviewed to ascertain the presence of relevant traits. Clinical outcomes, health care utilization, family communication, and ethical and psychosocial implications of disclosure of genomic results are being assessed by surveys, telephone interviews, and EHR review.


Of 29,208 variants in the 68 genes, 1915 were rare (frequency <1%) and putatively functional, and 102 of these (60 in 36 CVD genes) were labeled P/LP based on the American College of Medical Genetics and Genomics framework. Manual review of the EHRs of participants (n=73 with P/LP variants in CVD genes) revealed that 33 had the expected trait(s); however, only 6 of 45 participants with non-familial hypercholesterolemia (FH) P/LP variants had the expected traits.


Expected traits were present in 13% of participants with P/LP variants in non-FH CVD genes, suggesting low penetrance; this estimate may change with additional testing performed as part of the clinical evaluation. Ongoing analyses of the RAVE Study will inform best practices for genomic medicine.

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