Association of Cardiovascular Health Through Young Adulthood With Genome-Wide DNA Methylation Patterns in Midlife: The CARDIA Study

BACKGROUND

Cardiovascular health (CVH) from young adulthood is strongly associated with an individual's future risk of cardiovascular disease (CVD) and total mortality. Defining epigenomic biomarkers of lifelong CVH exposure and understanding their roles in CVD development may help develop preventive and therapeutic strategies for CVD.

METHODS

In 1085 CARDIA study (Coronary Artery Risk Development in Young Adults) participants, we defined a clinical cumulative CVH score that combines body mass index, blood pressure, total cholesterol, and fasting glucose measured longitudinally from young adulthood through middle age over 20 years (mean age, 25-45). Blood DNA methylation at >840 000 methylation markers was measured twice over 5 years (mean age, 40 and 45). Epigenome-wide association analyses on the cumulative CVH score were performed in CARDIA and compared in the FHS (Framingham Heart Study). We used penalized regression to build a methylation-based risk score to evaluate the risk of incident coronary artery calcification and clinical CVD events.

RESULTS

We identified 45 methylation markers associated with cumulative CVH at false discovery rate <0.01 (P=4.7E-7-5.8E-17) in CARDIA and replicated in FHS. These associations were more pronounced with methylation measured at an older age. CPT1A, ABCG1, and SREBF1 appeared as the most prominent genes. The 45 methylation markers were mostly located in transcriptionally active chromatin and involved lipid metabolism, insulin secretion, and cytokine production pathways. Three methylation markers located in genes SARS1, SOCS3, and LINC-PINT statistically mediated 20.4% of the total effect between CVH and risk of incident coronary artery calcification. The methylation risk score added information and significantly (P=0.004) improved the discrimination capacity of coronary artery calcification status versus CVH score alone and showed association with risk of incident coronary artery calcification 5 to 10 years later independent of cumulative CVH score (odds ratio, 1.87; P=9.66E-09). The methylation risk score was also associated with incident clinical CVD in FHS (hazard ratio, 1.28; P=1.22E-05).

CONCLUSIONS

Cumulative CVH from young adulthood contributes to midlife epigenetic programming over time. Our findings demonstrate the role of epigenetic markers in response to CVH changes and highlight the potential of epigenomic markers for precision CVD prevention, and earlier detection of subclinical CVD, as well.

Development and Validation of a Large Synthetic Cohort for the Study of Cardiovascular Health Across the Life Span

We developed and validated a synthetic cohort approach to examine numbers of cardiovascular risk factors (CRFs) and adverse clinical events, including incident cardiovascular disease and all-cause mortality, across the life span from ages 20 years to 90 years. The current analysis included 40,875 participants from 7 large, population-based longitudinal epidemiologic studies (1948-2016). On the basis of a joint multilevel imputation model, we multiply imputed each participant's life-span numbers of CRFs and events using available records. To validate the imputed values, we partially removed the observed data and then compared the imputed and observed values. The complete life-span synthetic data set reflected the original observed data trends well. In our validation sample, the distributions of imputed CRFs and events were close to the observed distributions but with less variability. Bland-Altman plots indicated that there was a slightly negative trend in general, and the agreement bias was relatively small for the continuous CRFs. The hypothetical linear regression model suggested that the relationships between the CRFs and events were preserved in the imputed data set. This approach generated valid estimates of CRFs and events across the life span for African-American and White participants. The synthetic cohort may be sufficiently accurate to be useful in assessing the origins and timing of accumulating cardiovascular risk that can inform efforts to avoid cardiovascular disease development.

Epigenetic Age Acceleration Reflects Long-Term Cardiovascular Health

[Figure: see text].

Abstract MP33: Cardiac Structure And Function Phenogroups And Risk Of Incident Heart Failure: Multi-ethnic Study Of Atherosclerosis

Introduction: Indices of cardiac structure and function, such as left ventricular (LV) mass and ejection fraction (EF), have individually been associated with development of incident heart failure (HF). Identifying HF risk groups (or phenogroups) based on imaging parameters may help inform distinct imaging phenotypes to target for prevention.

Objectives: To identify phenogroups based on cardiovascular magnetic resonance imaging (cMRI) parameters in participants free of cardiovascular disease at baseline and examine longitudinal risk of incident HF.

Methods: We included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) who had completed baseline cMRI between 2000 and 2002. We applied latent class analysis to define phenogroups based on cMRI parameters of right ventricular and LV structure and function (including circumferential strain) at baseline (using the Bayesian Information Criterion as well as visual inspection). We used Cox-proportional hazard models to assess the association between membership in a phenogroup and risk of incident HF adjusted for age, sex, race, hypertension, diabetes, and hyperlipidemia.

Results: Of 1484 participants, 48% were female and mean age was 65 (10) years. Over a median follow-up of 13 years, a total of 91 incident HF events occurred. We identified 3 distinct phenogroups that differed in terms of cardiac structure and function. Adjusted hazards ratio (95% confidence interval) for incident HF was higher among participants in Group 3 (2.08 [1.17, 3.71]) and Group 2 (2.24 [1.15, 4.37]), compared with Group 1 as the referent ( Table ).

Conclusion: Phenogroups based on cMRI were differentially associated with risk of HF. Classification of cardiovascular imaging phenogroups integrating traditional and strain parameters within the normal range may be useful in identifying risk for HF; further validation is required before implementation.

Abstract 043: Community-level Social Determinants Of Covid19 Mortality In The Chicago Area

Introduction: Since the onset of the COVID-19 pandemic, large geographic differences in mortality rates have emerged, with higher rates in predominantly Black and Latinx neighborhoods. In this analysis we examined community-level differences across the city of Chicago to better understand how geographic differences are associated with COVID19 mortality.

Hypothesis: We hypothesized there would be an association between higher community-level social vulnerability and COVID19 mortality rates.

Methods: We examined publicly available data from the Cook County Medical Examiner data (Illinois) of all known COVID-19 deaths as of August 21, 2020. Decedent addresses (N = 2397) were restricted to the city of Chicago, geocoded, and classified according to the 77 recognized community areas in the city. Poisson regression models were used to determine significant community-level predictors of COVID19 mortality based on community-level demographic, social, health, and healthcare characteristics collected from the Chicago Health Atlas.

Results: There was at least one COVID19-related death in each Chicago community area, with a crude mortality rate ranging from 0.571 - 24.5 deaths per 10,000 persons. In the fully adjusted model with 14 community-level predictors, higher community-level population density, percentage of males, living in crowded housing, and limited food access were associated with higher rates of COVID19 mortality. Higher community-level proportion of the population aged 65+ years and having a primary care provider were associated with lower COVID19 mortality. Differences by Black and Latinx race/ethnicity community-level demographics were not significant in the final model.

Conclusions: Community-level factors of greater social vulnerability (crowded living conditions, limited food access) are strong predictors of community-level COVID19 mortality. These factors may limit effective social distancing and increase the necessity to enter public areas, raising community-level COVID19 mortality.

CARDIOVASCULAR HEALTH AND SUCCESSFUL AGING: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS

Individual risk factors have been shown to be associated with successful aging. However, the combined effect of behaviors and biomarkers on successful aging remains unclear. By using the Multi-Ethnic Study of Atherosclerosis (MESA) dataset, this study was to examine the association of AHA’s Cardiovascular Health (CVH) with successful aging. A total of 1,597 who were followed from baseline (2000-2002) at age 49-64 through exam 6 (2016-2018) at age 65-80 were included. CVH, including smoking, body mass index (BMI), physical activity, diet, blood pressure, cholesterol, and blood glucose, was measured at baseline. The CVH score, ranging from 0-14, was divided into ideal (11–14), intermediate (9–10), and poor (0–8) groups. Normal or successful aging, defined as avoiding major disease (including cancer, cardiovascular, or severe lung or kidney diseases), no disability, high cognitive function, high physical functioning, and engagement with life, was assessed at exam 6. We compared the cumulative incidence of successful aging among three groups. Modified Poisson regression model was employed to estimate relative risk (RR) adjusting for age, gender, race, education, income, marital status, and alcohol consumption. Among study participants at baseline, 36% were in ideal, 39% in Intermediate, and 25% in poor CVH. By exam 6, only 18% met the criteria for successful aging. Compared with the poor group, the adjusted RRs (95 % CI) of successful aging for the intermediate and ideal groups were 1.78 (1.23-2.56) and 2.56 (1.79-3.67). Our data suggest that CVH in midlife is associated with successful aging in later life.