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Lee WH, Larsson SC, Wood A, Di Angelantonio E, Butterworth AS, Burgess S, Allara E. Genetically predicted plasma cortisol and common chronic diseases: A Mendelian randomization study. Clin Endocrinol (Oxf) 2024; 100:238-244. [PMID: 37667866 PMCID: PMC7615603 DOI: 10.1111/cen.14966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 05/29/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Cushing's syndrome is characterized by hypercortisolaemia and is frequently accompanied by comorbidities such as type 2 diabetes, hypertension, osteoporosis, depression and schizophrenia. It is unclear whether moderate but lifelong hypercortisolaemia is causally associated with these diseases in the general population. We aimed to address this research gap using a Mendelian randomization approach. METHODS We used three cortisol-associated genetic variants in the SERPINA6/SERPINA1 region as genetic instruments in a two-sample, inverse-variance-weighted Mendelian randomization analysis. We obtained summary-level statistics for cortisol and disease outcomes from publicly available genetic consortia, and meta-analysed them as appropriate. We conducted a multivariable Mendelian randomization analysis to assess potential mediating effects. RESULTS A 1 standard deviation higher genetically predicted plasma cortisol was associated with greater odds of hypertension (odds ratio: 1.12; 95% confidence interval [CI]: 1.05-1.18) as well as higher systolic blood pressure (mean difference [MD]: 0.03 SD change; 95% CI: 0.01-0.05) and diastolic blood pressure (MD: 0.03 SD change; 95% CI: 0.01-0.04). There was no evidence of association with type 2 diabetes, osteoporosis, depression and schizophrenia. The association with hypertension was attenuated upon adjustment for waist circumference, suggesting potential mediation through central obesity. CONCLUSION There is strong evidence for a causal association between plasma cortisol and greater risk for hypertension, potentially mediated by obesity.
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Affiliation(s)
- Wei-Hsuan Lee
- British Heart Foundation Cardiovascular Epidemiology Uni, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Susanna C. Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Angela Wood
- British Heart Foundation Cardiovascular Epidemiology Uni, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Philip Dahdaleh National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, Cambridge, UK
- Cambridge Centre of Artificial Intelligence in Medicine, Cambridge, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Uni, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Philip Dahdaleh National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, Cambridge, UK
- Health Data Science Research Centre, Human Technopole, Milan, Italy
| | - Adam S. Butterworth
- British Heart Foundation Cardiovascular Epidemiology Uni, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Philip Dahdaleh National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, Cambridge, UK
| | - Stephen Burgess
- British Heart Foundation Cardiovascular Epidemiology Uni, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Elias Allara
- British Heart Foundation Cardiovascular Epidemiology Uni, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Philip Dahdaleh National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
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2
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Guo J, Walter K, Quiros PM, Gu M, Baxter EJ, Danesh J, Di Angelantonio E, Roberts D, Guglielmelli P, Harrison CN, Godfrey AL, Green AR, Vassiliou GS, Vuckovic D, Nangalia J, Soranzo N. Inherited polygenic effects on common hematological traits influence clonal selection on JAK2 V617F and the development of myeloproliferative neoplasms. Nat Genet 2024; 56:273-280. [PMID: 38233595 PMCID: PMC10864174 DOI: 10.1038/s41588-023-01638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/01/2023] [Indexed: 01/19/2024]
Abstract
Myeloproliferative neoplasms (MPNs) are chronic cancers characterized by overproduction of mature blood cells. Their causative somatic mutations, for example, JAK2V617F, are common in the population, yet only a minority of carriers develop MPN. Here we show that the inherited polygenic loci that underlie common hematological traits influence JAK2V617F clonal expansion. We identify polygenic risk scores (PGSs) for monocyte count and plateletcrit as new risk factors for JAK2V617F positivity. PGSs for several hematological traits influenced the risk of different MPN subtypes, with low PGSs for two platelet traits also showing protective effects in JAK2V617F carriers, making them two to three times less likely to have essential thrombocythemia than carriers with high PGSs. We observed that extreme hematological PGSs may contribute to an MPN diagnosis in the absence of somatic driver mutations. Our study showcases how polygenic backgrounds underlying common hematological traits influence both clonal selection on somatic mutations and the subsequent phenotype of cancer.
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Affiliation(s)
- Jing Guo
- Wellcome Sanger Institute, Hinxton, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | | | - Pedro M Quiros
- Wellcome Sanger Institute, Hinxton, UK
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, UK
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Muxin Gu
- Wellcome Sanger Institute, Hinxton, UK
| | - E Joanna Baxter
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - John Danesh
- Wellcome Sanger Institute, Hinxton, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Emanuele Di Angelantonio
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Fondazione Human Technopole, Milan, Italy
| | - David Roberts
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant-Oxford Centre, John Radcliffe Hospital and Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine, Center for Research and Innovation of Myeloproliferative Neoplasms (CRIMM), AOU Careggi, University of Florence, Florence, Italy
| | - Claire N Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Anthony R Green
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - George S Vassiliou
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Dragana Vuckovic
- Wellcome Sanger Institute, Hinxton, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Jyoti Nangalia
- Wellcome Sanger Institute, Hinxton, UK.
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, UK.
- Cambridge University Hospitals NHS Trust, Cambridge, UK.
- Department of Haematology, University of Cambridge, Cambridge, UK.
| | - Nicole Soranzo
- Wellcome Sanger Institute, Hinxton, UK.
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK.
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK.
- Fondazione Human Technopole, Milan, Italy.
- Department of Haematology, University of Cambridge, Cambridge, UK.
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3
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Affiliation(s)
- Lisa Pennells
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Stephen Kaptoge
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Emanuele Di Angelantonio
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Science Centre, Human Technopole, Milan, Italy
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4
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Sofianopoulou E, Kaptoge SK, Afzal S, Jiang T, Gill D, Gundersen TE, Bolton TR, Allara E, Arnold MG, Mason AM, Chung R, Pennells LAM, Shi F, Sun L, Willeit P, Forouhi NG, Langenberg C, Sharp SJ, Panico S, Engström G, Melander O, Tong TYN, Perez-Cornago A, Norberg M, Johansson I, Katzke V, Srour B, Sánchez MJ, Redondo-Sánchez D, Olsen A, Dahm CC, Overvad K, Brustad M, Skeie G, Moreno-Iribas C, Onland-Moret NC, van der Schouw YT, Tsilidis KK, Heath AK, Agnoli C, Krogh V, de Boer IH, Kobylecki CJ, Çolak Y, Zittermann A, Sundström J, Welsh P, Weiderpass E, Aglago EK, Ferrari P, Clarke R, Boutron MC, Severi G, MacDonald C, Providencia R, Masala G, Zamora-Ros R, Boer J, Verschuren WMM, Cawthon P, Schierbeck LL, Cooper C, Schulze MB, Bergmann MM, Hannemann A, Kiechl S, Brenner H, van Schoor NM, Albertorio JR, Sacerdote C, Linneberg A, Kårhus LL, Huerta JM, Imaz L, Joergensen C, Ben-Shlomo Y, Lundqvist A, Gallacher J, Sattar N, Wood AM, Wareham NJ, Nordestgaard BG, Di Angelantonio E, Danesh J, Butterworth AS, Burgess S. Estimating dose-response relationships for vitamin D with coronary heart disease, stroke, and all-cause mortality: observational and Mendelian randomisation analyses. Lancet Diabetes Endocrinol 2024; 12:e2-e11. [PMID: 38048800 PMCID: PMC7615586 DOI: 10.1016/s2213-8587(23)00287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Randomised trials of vitamin D supplementation for cardiovascular disease and all-cause mortality have generally reported null findings. However, generalisability of results to individuals with low vitamin D status is unclear. We aimed to characterise dose-response relationships between 25-hydroxyvitamin D (25[OH]D) concentrations and risk of coronary heart disease, stroke, and all-cause mortality in observational and Mendelian randomisation frameworks. METHODS Observational analyses were undertaken using data from 33 prospective studies comprising 500 962 individuals with no known history of coronary heart disease or stroke at baseline. Mendelian randomisation analyses were performed in four population-based cohort studies (UK Biobank, EPIC-CVD, and two Copenhagen population-based studies) comprising 386 406 middle-aged individuals of European ancestries, including 33 546 people who developed coronary heart disease, 18 166 people who had a stroke, and 27 885 people who died. Primary outcomes were coronary heart disease, defined as fatal ischaemic heart disease (International Classification of Diseases 10th revision code I20-I25) or non-fatal myocardial infarction (I21-I23); stroke, defined as any cerebrovascular disease (I60-I69); and all-cause mortality. FINDINGS Observational analyses suggested inverse associations between incident coronary heart disease, stroke, and all-cause mortality outcomes with 25(OH)D concentration at low 25(OH)D concentrations. In population-wide genetic analyses, there were no associations of genetically predicted 25(OH)D with coronary heart disease (odds ratio [OR] per 10 nmol/L higher genetically-predicted 25(OH)D concentration 0·98, 95% CI 0·95-1·01), stroke (1·01, [0·97-1·05]), or all-cause mortality (0·99, 0·95-1·02). Null findings were also observed in genetic analyses for cause-specific mortality outcomes, and in stratified genetic analyses for all outcomes at all observed levels of 25(OH)D concentrations. INTERPRETATION Stratified Mendelian randomisation analyses suggest a lack of causal relationship for 25(OH)D concentrations with both cardiovascular and mortality outcomes for individuals at all levels of 25(OH)D. Our findings suggest that substantial reductions in mortality and cardiovascular morbidity due to long-term low-dose vitamin D supplementation are unlikely even if targeted at individuals with low vitamin D status. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health Research, Health Data Research UK, Cancer Research UK, and International Agency for Research on Cancer.
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Affiliation(s)
- Emerging Risk Factors Collaboration/EPIC-CVD/Vitamin D Studies Collaboration
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Denmark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Vitas Ltd, Oslo, Norway
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, UK
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, UK
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
- Medical Research Council Epidemiology Unit, University of Cambridge, UK
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Italy
- Department of Clinical Sciences Malmö, Lund University, Sweden
- Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
- Department of Odontology, Umeå University, Sweden
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- EPIC Granada, Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health. University of Granada. Granada, Spain
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Aarhus University, Denmark
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Norway
- The Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
- Epidemiology, Prevention and Promotion Health Service, Public Health Institute of Navarra, Spain
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
- School of Medicine, University of Ioannina, Greece
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
- Department of Medicine, University of Washington, USA
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Ruhr University Bochum, Germany
- Department of Medical Sciences, Uppsala University, Sweden
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- International Agency for Research on Cancer, France
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Équipe "Exposome et Hérédité", CESP, Gustave Roussy, France
- Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy
- Institute of Health Informatics Research, University College London, London, UK
- Institute for Cancer Research, Prevention and Clinical Network – ISPRO, Italy
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Centre for Nutrition and Health, National Institute for Public Health and the Environment (RIVM)
- Research Institute, California Pacific Medical Center, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Cardiology Department, Nordsjælland University Hospital, Hillerød, Denmark
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Germany
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Netherlands
- Coalition to End Loneliness, USA
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark
- Department of Epidemiology, Murcia Regional Health Council, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
- Public Health Division of Bizkaia, Ministry of Health of the Basque Government, Spain
- Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
- Steno Diabetes Center, Copenhagen, Denmark
- Population Health Sciences, University of Bristol, UK
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Oxford, Oxford, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK
- The Alan Turing Institute, UK
- The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
- Medical Research Council Biostatistics Unit, University of Cambridge, UK
| | - Eleni Sofianopoulou
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Stephen K Kaptoge
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Shoaib Afzal
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Tao Jiang
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | - Thomas R Bolton
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, UK
| | - Elias Allara
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, UK
| | - Matthew G Arnold
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Amy M Mason
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Ryan Chung
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, UK
| | - Lisa AM Pennells
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Fanchao Shi
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Luanluan Sun
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Peter Willeit
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge, UK
| | - Claudia Langenberg
- Medical Research Council Epidemiology Unit, University of Cambridge, UK
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stephen J Sharp
- Medical Research Council Epidemiology Unit, University of Cambridge, UK
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Italy
| | - Gunnar Engström
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Sweden
- Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Tammy YN Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | | | - Verena Katzke
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bernard Srour
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - María José Sánchez
- EPIC Granada, Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health. University of Granada. Granada, Spain
| | - Daniel Redondo-Sánchez
- EPIC Granada, Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Aarhus University, Denmark
| | | | - Kim Overvad
- Department of Public Health, Aarhus University, Denmark
| | - Magritt Brustad
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Norway
- The Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Norway
| | - Conchi Moreno-Iribas
- The Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Netherlands
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
- School of Medicine, University of Ioannina, Greece
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Ian H de Boer
- Department of Medicine, University of Washington, USA
| | - Camilla Jannie Kobylecki
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Denmark
| | - Yunus Çolak
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Denmark
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Ruhr University Bochum, Germany
| | | | - Paul Welsh
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | | | | | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Oxford, UK
| | - Marie-Christine Boutron
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Équipe "Exposome et Hérédité", CESP, Gustave Roussy, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Équipe "Exposome et Hérédité", CESP, Gustave Roussy, France
- Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy
| | - Conor MacDonald
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Équipe "Exposome et Hérédité", CESP, Gustave Roussy, France
| | - Rui Providencia
- Institute of Health Informatics Research, University College London, London, UK
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network – ISPRO, Italy
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Jolanda Boer
- Centre for Nutrition and Health, National Institute for Public Health and the Environment (RIVM)
| | - WM Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Netherlands
- Centre for Nutrition and Health, National Institute for Public Health and the Environment (RIVM)
| | - Peggy Cawthon
- Research Institute, California Pacific Medical Center, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | | | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Matthias B Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Germany
| | - Manuela M Bergmann
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Germany
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Netherlands
| | | | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark
| | - Line L Kårhus
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
| | - Liher Imaz
- Public Health Division of Bizkaia, Ministry of Health of the Basque Government, Spain
- Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | | | | | | | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Angela M Wood
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, UK
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK
- The Alan Turing Institute, UK
| | | | - Børge G Nordestgaard
- Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital
| | - Emanuele Di Angelantonio
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, UK
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK
| | - John Danesh
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, UK
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Adam S Butterworth
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, UK
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK
| | - Stephen Burgess
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, UK
- Medical Research Council Biostatistics Unit, University of Cambridge, UK
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5
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Stefanucci L, Collins J, Sims MC, Barrio-Hernandez I, Sun L, Burren OS, Perfetto L, Bender I, Callahan TJ, Fleming K, Guerrero JA, Hermjakob H, Martin MJ, Stephenson J, Paneerselvam K, Petrovski S, Porras P, Robinson PN, Wang Q, Watkins X, Frontini M, Laskowski RA, Beltrao P, Di Angelantonio E, Gomez K, Laffan M, Ouwehand WH, Mumford AD, Freson K, Carss K, Downes K, Gleadall N, Megy K, Bruford E, Vuckovic D. The effects of pathogenic and likely pathogenic variants for inherited hemostasis disorders in 140 214 UK Biobank participants. Blood 2023; 142:2055-2068. [PMID: 37647632 PMCID: PMC10733830 DOI: 10.1182/blood.2023020118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
Rare genetic diseases affect millions, and identifying causal DNA variants is essential for patient care. Therefore, it is imperative to estimate the effect of each independent variant and improve their pathogenicity classification. Our study of 140 214 unrelated UK Biobank (UKB) participants found that each of them carries a median of 7 variants previously reported as pathogenic or likely pathogenic. We focused on 967 diagnostic-grade gene (DGG) variants for rare bleeding, thrombotic, and platelet disorders (BTPDs) observed in 12 367 UKB participants. By association analysis, for a subset of these variants, we estimated effect sizes for platelet count and volume, and odds ratios for bleeding and thrombosis. Variants causal of some autosomal recessive platelet disorders revealed phenotypic consequences in carriers. Loss-of-function variants in MPL, which cause chronic amegakaryocytic thrombocytopenia if biallelic, were unexpectedly associated with increased platelet counts in carriers. We also demonstrated that common variants identified by genome-wide association studies (GWAS) for platelet count or thrombosis risk may influence the penetrance of rare variants in BTPD DGGs on their associated hemostasis disorders. Network-propagation analysis applied to an interactome of 18 410 nodes and 571 917 edges showed that GWAS variants with large effect sizes are enriched in DGGs and their first-order interactors. Finally, we illustrate the modifying effect of polygenic scores for platelet count and thrombosis risk on disease severity in participants carrying rare variants in TUBB1 or PROC and PROS1, respectively. Our findings demonstrate the power of association analyses using large population datasets in improving pathogenicity classifications of rare variants.
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Affiliation(s)
- Luca Stefanucci
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
- British Heart Foundation, BHF Centre of Research Excellence, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Janine Collins
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Haematology, Barts Health NHS Trust, London, United Kingdom
| | - Matthew C. Sims
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Inigo Barrio-Hernandez
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Luanluan Sun
- Department of Public Health and Primary Care, BHF Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Oliver S. Burren
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Livia Perfetto
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
- Department of Biology and Biotechnology “C.Darwin,” Sapienza University of Rome, Rome, Italy
| | - Isobel Bender
- Department of Biochemistry, University of Oxford, Oxford, United Kingdom
| | - Tiffany J. Callahan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY
| | - Kathryn Fleming
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Jose A. Guerrero
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Haematology, Barts Health NHS Trust, London, United Kingdom
| | - Henning Hermjakob
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Maria J. Martin
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - James Stephenson
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - NIHR BioResource
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
- British Heart Foundation, BHF Centre of Research Excellence, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Haematology, Barts Health NHS Trust, London, United Kingdom
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
- Department of Public Health and Primary Care, BHF Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
- Department of Biology and Biotechnology “C.Darwin,” Sapienza University of Rome, Rome, Italy
- Department of Biochemistry, University of Oxford, Oxford, United Kingdom
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
- Centre for Genomics Research, Discovery Sciences, AstraZeneca, Cambridge, United Kingdom
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
- Genomic Medicine, The Jackson Laboratory, Farmington, CT
- Institute for Systems Genomics, University of Connecticut, Farmington, CT
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences RILD Building, University of Exeter Medical School, Exeter, United Kingdom
- Institute of Molecular Systems Biology, ETH Zürich, Zürich, Switzerland
- Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Health Data Science Centre, Human Technopole, Milan, Italy
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, United Kingdom
- Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
- Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KULeuven, Leuven, Belgium
- Cambridge Genomics Laboratory, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Kalpana Paneerselvam
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Slavé Petrovski
- Centre for Genomics Research, Discovery Sciences, AstraZeneca, Cambridge, United Kingdom
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Pablo Porras
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Peter N. Robinson
- Genomic Medicine, The Jackson Laboratory, Farmington, CT
- Institute for Systems Genomics, University of Connecticut, Farmington, CT
| | - Quanli Wang
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Xavier Watkins
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Mattia Frontini
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
- British Heart Foundation, BHF Centre of Research Excellence, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences RILD Building, University of Exeter Medical School, Exeter, United Kingdom
| | - Roman A. Laskowski
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Pedro Beltrao
- Institute of Molecular Systems Biology, ETH Zürich, Zürich, Switzerland
| | - Emanuele Di Angelantonio
- British Heart Foundation, BHF Centre of Research Excellence, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Public Health and Primary Care, BHF Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Mike Laffan
- Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
| | - Willem H. Ouwehand
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom
| | - Andrew D. Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Kathleen Freson
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KULeuven, Leuven, Belgium
| | - Keren Carss
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Kate Downes
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Cambridge Genomics Laboratory, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Nick Gleadall
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Karyn Megy
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Elspeth Bruford
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Dragana Vuckovic
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
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6
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Chen JY, Ardissino M, Reddy RK, Mason AM, Raisi‐Estabragh Z, Di Angelantonio E, Burgess S, Ng FS. Genetically predicted androgenic profiles and adverse cardiac markers: a sex-specific Mendelian randomization study. ESC Heart Fail 2023; 10:3525-3537. [PMID: 37736873 PMCID: PMC10682908 DOI: 10.1002/ehf2.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
AIMS Observational evidence suggests associations between sex hormone levels and heart failure (HF). We used sex-specific genetic variants associated with androgenic sex hormone profiles to investigate the causal relevance of androgenic sex hormone profiles on cardiac structure and function and HF using Mendelian randomization (MR). METHODS AND RESULTS Sex-specific uncorrelated genome-wide significant (P < 5 × 10-8 ) variants predicting sex hormone-binding globulin (SHBG), total testosterone, and bioavailable testosterone were extracted from summary statistics of genome-wide association study (GWAS) on 425 097 participants in the UK Biobank. Sex-specific gene-outcome association estimates were computed for left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV, respectively), left ventricular stroke volume (LVSV), cardiac index, and cardiac output in 11 528 female and 14 356 male UK Biobank Imaging Study participants and for incident or prevalent HF in an external cohort of 47 309 cases and 930 014 controls. Inverse-variance weighted MR was the primary analysis method. In females, higher genetically predicted bioavailable testosterone was associated with lower LVEDV [β per nmol/L = -0.11 (-0.19 to -0.03), P = 0.006], lower LVESV [β = -0.09 (-0.17 to -0.01), P = 0.022], lower LVSV [β = -0.11 (-0.18 to -0.03), P = 0.005], lower cardiac output [β = -0.08 (-0.16 to 0.00), P = 0.046], and lower cardiac index [β = -0.08 (-0.16 to -0.01), P = 0.034] and a higher risk of HF [odds ratio 1.10 (1.01-1.19), P = 0.026] on external validation analysis in larger scale, sex-adjusted GWAS data. Higher genetically predicted SHBG was associated with higher LVEDV [β per nmol/L = 0.17 (0.08-0.25), P = 2 × 10-4 ], higher LVESV [β = 0.13 (0.05-0.22), P = 0.003], and higher LVSV [β = 0.18 (0.08-0.28), P = 2 × 10-4 ]. In males, higher genetically predicted total and bioavailable testosterone was associated with lower LVESV [β = -0.07 (-0.12 to -0.02), P = 0.007] and LVEF [β = -0.11 (-0.18 to -0.04), P = 0.003], respectively. CONCLUSIONS This study supports a causal effect of pro-androgenic sex hormone profiles in females on adverse markers of left ventricular structure and function typically associated with HF with preserved ejection fraction and with HF. There was weaker evidence of association in males.
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Affiliation(s)
- Jun Yu Chen
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Maddalena Ardissino
- National Heart and Lung InstituteImperial College LondonLondonUK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Rohin K. Reddy
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Amy Marie Mason
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
| | - Zahra Raisi‐Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research CentreQueen Mary University of LondonLondonUK
- Barts Heart Centre, St Bartholomew's HospitalBarts Health NHS TrustLondonUK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUK
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Stephen Burgess
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUK
| | - Fu Siong Ng
- National Heart and Lung InstituteImperial College LondonLondonUK
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7
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Hageman SHJ, Dorresteijn JAN, Pennells L, van Smeden M, Bots ML, Di Angelantonio E, Visseren FLJ. The relevance of competing risk adjustment in cardiovascular risk prediction models for clinical practice. Eur J Prev Cardiol 2023; 30:1741-1747. [PMID: 37338108 DOI: 10.1093/eurjpc/zwad202] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/17/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Many models developed for predicting the risk of cardiovascular disease (CVD) are adjusted for the competing risk of non-CVD mortality, which has been suggested to reduce potential overestimation of cumulative incidence in populations where the risk of competing events is high. The objective was to evaluate and illustrate the clinical impact of competing risk adjustment when deriving a CVD prediction model in a high-risk population. METHODS AND RESULTS Individuals with established atherosclerotic CVD were included from the Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease (UCC-SMART). In 8355 individuals, followed for a median of 8.2 years (IQR 4.2-12.5), two similar prediction models for the estimation of 10-year residual CVD risk were derived: with competing risk adjustment using a Fine and Gray model and without competing risk adjustment using a Cox proportional hazards model. On average, predictions were higher from the Cox model. The Cox model predictions overestimated the cumulative incidence [predicted-observed ratio 1.14 (95% CI 1.09-1.20)], which was most apparent in the highest risk quartiles and in older persons. Discrimination of both models was similar. When determining treatment eligibility on thresholds of predicted risks, more individuals would be treated based on the Cox model predictions. If, for example, individuals with a predicted risk > 20% were considered eligible for treatment, 34% of the population would be treated according to the Fine and Gray model predictions and 44% according to the Cox model predictions. INTERPRETATION Individual predictions from the model unadjusted for competing risks were higher, reflecting the different interpretations of both models. For models aiming to accurately predict absolute risks, especially in high-risk populations, competing risk adjustment must be considered.
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Affiliation(s)
- Steven H J Hageman
- Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Postbus 85500 3508 GA Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Postbus 85500 3508 GA Utrecht, The Netherlands
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Papworth Road, Trumpington, Cambridge CB2 0BB, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Papworth Road, Trumpington, Cambridge CB2 0BB, UK
| | - Maarten van Smeden
- Julius Centre for Health Science and Primary Care, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, Postbus 85500 3508 GA Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Centre for Health Science and Primary Care, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, Postbus 85500 3508 GA Utrecht, The Netherlands
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Papworth Road, Trumpington, Cambridge CB2 0BB, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Papworth Road, Trumpington, Cambridge CB2 0BB, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, CB2 0BB Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, CB2 0BB Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, CB10 1SA Cambridge, UK
- Health Data Science Research Centre, Human Technopole, 20157 Milan, Italy
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Postbus 85500 3508 GA Utrecht, The Netherlands
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8
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Burger PM, Savarese G, Tromp J, Adamson C, Jhund PS, Benson L, Hage C, Tay WT, Solomon SD, Packer M, Rossello X, McEvoy JW, De Bacquer D, Timmis A, Vardas P, Graham IM, Di Angelantonio E, Visseren FLJ, McMurray JJV, Lam CSP, Lund LH, Koudstaal S, Dorresteijn JAN, Mosterd A. Personalized lifetime prediction of survival and treatment benefit in patients with heart failure with reduced ejection fraction: The LIFE-HF model. Eur J Heart Fail 2023; 25:1962-1975. [PMID: 37691140 DOI: 10.1002/ejhf.3028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023] Open
Abstract
AIMS Although trials have proven the group-level effectiveness of various therapies for heart failure with reduced ejection fraction (HFrEF), important differences in absolute effectiveness exist between individuals. We developed and validated the LIFEtime-perspective for Heart Failure (LIFE-HF) model for the prediction of individual (lifetime) risk and treatment benefit in patients with HFrEF. METHODS AND RESULTS Cox proportional hazards functions with age as the time scale were developed in the PARADIGM-HF and ATMOSPHERE trials (n = 15 415). Outcomes were cardiovascular death, heart failure (HF) hospitalization or cardiovascular death, and non-cardiovascular mortality. Predictors were age, sex, New York Heart Association class, prior HF hospitalization, diabetes mellitus, extracardiac vascular disease, systolic blood pressure, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and glomerular filtration rate. The functions were combined in life-tables to predict individual overall and HF hospitalization-free survival. External validation was performed in the SwedeHF registry, ASIAN-HF registry, and DAPA-HF trial (n = 51 286). Calibration of 2- to 10-year risk was adequate, and c-statistics were 0.65-0.74. An interactive tool was developed combining the model with hazard ratios from trials to allow estimation of an individual's (lifetime) risk and treatment benefit in clinical practice. Applying the tool to the development cohort, combined treatment with a mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor, and angiotensin receptor-neprilysin inhibitor was estimated to afford a median of 2.5 (interquartile range [IQR] 1.7-3.7) and 3.7 (IQR 2.4-5.5) additional years of overall and HF hospitalization-free survival, respectively. CONCLUSION The LIFE-HF model enables estimation of lifelong overall and HF hospitalization-free survival, and (lifetime) treatment benefit for individual patients with HFrEF. It could serve as a tool to improve the management of HFrEF by facilitating personalized medicine and shared decision-making.
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Affiliation(s)
- Pascal M Burger
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- National University Health System Singapore, Singapore, Singapore
| | - Carly Adamson
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Lina Benson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Hage
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Centre, Dallas, TX, USA
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Adam Timmis
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Ian M Graham
- School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin, Ireland
| | | | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
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9
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Hageman SHJ, Petitjean C, Pennells L, Kaptoge S, Pajouheshnia R, Tillmann T, Blaha MJ, McClelland RL, Matsushita K, Nambi V, Klungel OH, Souverein PC, van der Schouw YT, Verschuren WMM, Lehmann N, Erbel R, Jöckel KH, Di Angelantonio E, Visseren FLJ, Dorresteijn JAN. Improving 10-year cardiovascular risk prediction in apparently healthy people: flexible addition of risk modifiers on top of SCORE2. Eur J Prev Cardiol 2023; 30:1705-1714. [PMID: 37264679 PMCID: PMC10600319 DOI: 10.1093/eurjpc/zwad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023]
Abstract
AIMS In clinical practice, factors associated with cardiovascular disease (CVD) like albuminuria, education level, or coronary artery calcium (CAC) are often known, but not incorporated in cardiovascular risk prediction models. The aims of the current study were to evaluate a methodology for the flexible addition of risk modifying characteristics on top of SCORE2 and to quantify the added value of several clinically relevant risk modifying characteristics. METHODS AND RESULTS Individuals without previous CVD or DM were included from the UK Biobank; Atherosclerosis Risk in Communities (ARIC); Multi-Ethnic Study of Atherosclerosis (MESA); European Prospective Investigation into Cancer, The Netherlands (EPIC-NL); and Heinz Nixdorf Recall (HNR) studies (n = 409 757) in whom 16 166 CVD events and 19 149 non-cardiovascular deaths were observed over exactly 10.0 years of follow-up. The effect of each possible risk modifying characteristic was derived using competing risk-adjusted Fine and Gray models. The risk modifying characteristics were applied to individual predictions with a flexible method using the population prevalence and the subdistribution hazard ratio (SHR) of the relevant predictor. Risk modifying characteristics that increased discrimination most were CAC percentile with 0.0198 [95% confidence interval (CI) 0.0115; 0.0281] and hs-Troponin-T with 0.0100 (95% CI 0.0063; 0.0137). External validation was performed in the Clinical Practice Research Datalink (CPRD) cohort (UK, n = 518 015, 12 675 CVD events). Adjustment of SCORE2-predicted risks with both single and multiple risk modifiers did not negatively affect calibration and led to a modest increase in discrimination [0.740 (95% CI 0.736-0.745) vs. unimproved SCORE2 risk C-index 0.737 (95% CI 0.732-0.741)]. CONCLUSION The current paper presents a method on how to integrate possible risk modifying characteristics that are not included in existing CVD risk models for the prediction of CVD event risk in apparently healthy people. This flexible methodology improves the accuracy of predicted risks and increases applicability of prediction models for individuals with additional risk known modifiers.
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Affiliation(s)
- Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Carmen Petitjean
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Stephen Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Taavi Tillmann
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Baltimore, USA
| | | | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Vijay Nambi
- Center for Cardiovascular Disease Prevention, Michael E DeBakey Veterans Affairs Hospital, Houston, USA
- Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - W M Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Health Data Science Research Centre, Human Technopole, Milan, Italy
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, Christodorescu RM, Crawford C, Di Angelantonio E, Eliasson B, Espinola-Klein C, Fauchier L, Halle M, Herrington WG, Kautzky-Willer A, Lambrinou E, Lesiak M, Lettino M, McGuire DK, Mullens W, Rocca B, Sattar N. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44:4043-4140. [PMID: 37622663 DOI: 10.1093/eurheartj/ehad192] [Citation(s) in RCA: 89] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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11
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Aung N, Wang Q, van Duijvenboden S, Burns R, Stoma S, Raisi-Estabragh Z, Ahmet S, Allara E, Wood A, Di Angelantonio E, Danesh J, Munroe PB, Young A, Harvey NC, Codd V, Nelson CP, Petersen SE, Samani NJ. Association of Longer Leukocyte Telomere Length With Cardiac Size, Function, and Heart Failure. JAMA Cardiol 2023; 8:808-815. [PMID: 37494011 PMCID: PMC10372756 DOI: 10.1001/jamacardio.2023.2167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/31/2023] [Indexed: 07/27/2023]
Abstract
Importance Longer leukocyte telomere length (LTL) is associated with a lower risk of adverse cardiovascular outcomes. The extent to which variation in LTL is associated with intermediary cardiovascular phenotypes is unclear. Objective To evaluate the associations between LTL and a diverse set of cardiovascular imaging phenotypes. Design, Setting, and Participants This is a population-based cross-sectional study of UK Biobank participants recruited from 2006 to 2010. LTL was measured using a quantitative polymerase chain reaction method. Cardiovascular measurements were derived from cardiovascular magnetic resonance using machine learning. The median (IQR) duration of follow-up was 12.0 (11.3-12.7) years. The associations of LTL with imaging measurements and incident heart failure (HF) were evaluated by multivariable regression models. Genetic associations between LTL and significantly associated traits were investigated by mendelian randomization. Data were analyzed from January to May 2023. Exposure LTL. Main Outcomes and Measures Cardiovascular imaging traits and HF. Results Of 40 459 included participants, 19 529 (48.3%) were men, and the mean (SD) age was 55.1 (7.6) years. Longer LTL was independently associated with a pattern of positive cardiac remodeling (higher left ventricular mass, larger global ventricular size and volume, and higher ventricular and atrial stroke volumes) and a lower risk of incident HF (LTL fourth quartile vs first quartile: hazard ratio, 0.86; 95% CI, 0.81-0.91; P = 1.8 × 10-6). Mendelian randomization analysis suggested a potential causal association between LTL and left ventricular mass, global ventricular volume, and left ventricular stroke volume. Conclusions and Relevance In this cross-sectional study, longer LTL was associated with a larger heart with better cardiac function in middle age, which could potentially explain the observed lower risk of incident HF.
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Affiliation(s)
- Nay Aung
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Qingning Wang
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Stefan van Duijvenboden
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Richard Burns
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Svetlana Stoma
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Selda Ahmet
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Elias Allara
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Angela Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Cambridge Centre of Artificial Intelligence in Medicine, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Department of Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Patricia B. Munroe
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Alistair Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Veryan Codd
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Christopher P. Nelson
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Steffen E. Petersen
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
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12
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Akbari P, Vuckovic D, Stefanucci L, Jiang T, Kundu K, Kreuzhuber R, Bao EL, Collins JH, Downes K, Grassi L, Guerrero JA, Kaptoge S, Knight JC, Meacham S, Sambrook J, Seyres D, Stegle O, Verboon JM, Walter K, Watkins NA, Danesh J, Roberts DJ, Di Angelantonio E, Sankaran VG, Frontini M, Burgess S, Kuijpers T, Peters JE, Butterworth AS, Ouwehand WH, Soranzo N, Astle WJ. A genome-wide association study of blood cell morphology identifies cellular proteins implicated in disease aetiology. Nat Commun 2023; 14:5023. [PMID: 37596262 PMCID: PMC10439125 DOI: 10.1038/s41467-023-40679-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/07/2023] [Indexed: 08/20/2023] Open
Abstract
Blood cells contain functionally important intracellular structures, such as granules, critical to immunity and thrombosis. Quantitative variation in these structures has not been subjected previously to large-scale genetic analysis. We perform genome-wide association studies of 63 flow-cytometry derived cellular phenotypes-including cell-type specific measures of granularity, nucleic acid content and reactivity-in 41,515 participants in the INTERVAL study. We identify 2172 distinct variant-trait associations, including associations near genes coding for proteins in organelles implicated in inflammatory and thrombotic diseases. By integrating with epigenetic data we show that many intracellular structures are likely to be determined in immature precursor cells. By integrating with proteomic data we identify the transcription factor FOG2 as an early regulator of platelet formation and α-granularity. Finally, we show that colocalisation of our associations with disease risk signals can suggest aetiological cell-types-variants in IL2RA and ITGA4 respectively mirror the known effects of daclizumab in multiple sclerosis and vedolizumab in inflammatory bowel disease.
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Affiliation(s)
- Parsa Akbari
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- Department of Human Genetics, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1HH, UK
- Medical Research Council Biostatistics Unit, University of Cambridge, East Forvie Building, Cambridge Biomedical Campus, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
| | - Dragana Vuckovic
- Department of Human Genetics, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1HH, UK
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Luca Stefanucci
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Tao Jiang
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, CB2 0BB, UK
| | - Kousik Kundu
- Department of Human Genetics, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1HH, UK
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
| | - Roman Kreuzhuber
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
| | - Erik L Bao
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, 1 Blackfan Circle, Boston, MA, 02115, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02115, USA
- Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA, 02142, USA
- Harvard-MIT Health Sciences and Technology, Harvard Medical School, 77 Massachusetts Ave, Cambridge, MA, 02139, USA
| | - Janine H Collins
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- Department of Haematology, Barts Health National Health Service Trust, London, E1 1BB, UK
| | - Kate Downes
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
| | - Luigi Grassi
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Institute for Health and Care Research Cambridge BioResource, Box 229, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Jose A Guerrero
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
| | - Stephen Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, CB2 0BB, UK
| | - Julian C Knight
- Wellcome Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, OX3 7BN, UK
| | - Stuart Meacham
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
| | - Jennifer Sambrook
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Institute for Health and Care Research Cambridge BioResource, Box 229, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Denis Seyres
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Institute for Health and Care Research Cambridge BioResource, Box 229, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Oliver Stegle
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
- European Molecular Biology Laboratory, Genome Biology Unit, 69117, Heidelberg, Germany
- Division of Computational Genomics and Systems Genetics, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Jeffrey M Verboon
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, 1 Blackfan Circle, Boston, MA, 02115, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02115, USA
- Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA, 02142, USA
| | - Klaudia Walter
- Department of Human Genetics, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1HH, UK
| | - Nicholas A Watkins
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- Department of Human Genetics, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1HH, UK
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, CB2 0BB, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - David J Roberts
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Headley Way, Headington, Oxford, OX3 9DU, UK
- National Institute for Health Research Oxford Biomedical Research Centre-Haematology Theme, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
- National Health Service Blood and Transplant, Oxford Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, CB2 0BB, UK
- Health Data Science Research Centre, Fondazione Human Technopole, Viale Rita Levi Montalcini 1, Milan, 20157, Italy
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, 1 Blackfan Circle, Boston, MA, 02115, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02115, USA
- Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA, 02142, USA
| | - Mattia Frontini
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, RILD Building, Barrack Road, Exeter, EX2 5DW, UK
| | - Stephen Burgess
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK
- Medical Research Council Biostatistics Unit, University of Cambridge, East Forvie Building, Cambridge Biomedical Campus, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, CB2 0BB, UK
| | - Taco Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, CB2 0PT, UK
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Sanquin, University of Amsterdam, Amsterdam, Netherlands
| | - James E Peters
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Department of Immunology and Inflammation, Imperial College London, Commonwealth Building, The Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK.
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK.
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, CB2 0BB, UK.
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK.
| | - Willem H Ouwehand
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK.
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK.
- Department of Haematology, University College London Hospitals, WC1E 6AS, London, UK.
| | - Nicole Soranzo
- Department of Human Genetics, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1HH, UK.
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK.
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK.
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
- Genomics Research Centre, Fondazione Human Technopole, Viale Rita Levi Montalcini 1, Milan, 20157, Italy.
| | - William J Astle
- Medical Research Council Biostatistics Unit, University of Cambridge, East Forvie Building, Cambridge Biomedical Campus, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
- The National Institute for Health and Care Research Blood and Transplant Unit in Donor Health and Genomics, Strangeways Research Laboratory, Strangeways Research Laboratory, University of Cambridge, Wort's Causeway, Cambridge, CB1 8RN, UK.
- National Health Service Blood and Transplant, Cambridge Centre, Cambridge Biomedical Campus, Long Road, Cambridge, CB2 0PT, UK.
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McMahon A, Kaptoge S, Walker M, Mehenny S, Gilchrist PT, Sambrook J, Akhtar N, Sweeting M, Wood AM, Stirrups K, Chung R, Fahle S, Johnson E, Cullen D, Godfrey R, Duthie S, Allen L, Harvey P, Berkson M, Allen E, Watkins NA, Bradley JR, Kingston N, Miflin G, Armitage J, Roberts DJ, Danesh J, Di Angelantonio E. Evaluation of interventions to prevent vasovagal reactions among whole blood donors: rationale and design of a large cluster randomised trial. Trials 2023; 24:512. [PMID: 37563721 PMCID: PMC10413586 DOI: 10.1186/s13063-023-07473-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/23/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Vasovagal reactions (VVRs) are the most common acute complications of blood donation. Responsible for substantial morbidity, they also reduce the likelihood of repeated donations and are disruptive and costly for blood services. Although blood establishments worldwide have adopted different strategies to prevent VVRs (including water loading and applied muscle tension [AMT]), robust evidence is limited. The Strategies to Improve Donor Experiences (STRIDES) trial aims to reliably assess the impact of four different interventions to prevent VVRs among blood donors. METHODS STRIDES is a cluster-randomised cross-over/stepped-wedge factorial trial of four interventions to reduce VVRs involving about 1.4 million whole blood donors enrolled from all 73 blood donation sites (mobile teams and donor centres) of National Health Service Blood and Transplant (NHSBT) in England. Each site ("cluster") has been randomly allocated to receive one or more interventions during a 36-month period, using principles of cross-over, stepped-wedge and factorial trial design to assign the sequence of interventions. Each of the four interventions is compared to NHSBT's current practices: (i) 500-ml isotonic drink before donation (vs current 500-ml plain water); (ii) 3-min rest on donation chair after donation (vs current 2 min); (iii) new modified AMT (vs current practice of AMT); and (iv) psychosocial intervention using preparatory materials (vs current practice of nothing). The primary outcome is the number of in-session VVRs with loss of consciousness (i.e. episodes involving loss of consciousness of any duration, with or without additional complications). Secondary outcomes include all in-session VVRs (i.e. with and without loss of consciousness), all delayed VVRs (i.e. those occurring after leaving the venue) and any in-session non-VVR adverse events or reactions. DISCUSSION The STRIDES trial should yield novel information about interventions, singly and in combination, for the prevention of VVRs, with the aim of generating policy-shaping evidence to help inform blood services to improve donor health, donor experience, and service efficiency. TRIAL REGISTRATION ISRCTN: 10412338. Registration date: October 24, 2019.
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Affiliation(s)
- Amy McMahon
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK.
| | - Stephen Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Matthew Walker
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Susan Mehenny
- NHS Blood & Transplant, Blood Donation, Barnsley, UK
| | - Philippe T Gilchrist
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Jennifer Sambrook
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Institute for Health and Care Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Michael Sweeting
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- University of Leicester, Leicester, UK
| | - Angela M Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Cambridge Centre of Artificial Intelligence in Medicine, University of Cambridge, Cambridge, UK
| | - Kathleen Stirrups
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Institute for Health and Care Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Ryan Chung
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Sarah Fahle
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Elisha Johnson
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Donna Cullen
- NHS Blood & Transplant, John Radcliffe Hospital, Oxford, UK
| | | | - Shannon Duthie
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | | | - Paul Harvey
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Michael Berkson
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Elizabeth Allen
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Nicholas A Watkins
- Data, Analytics and Surveillance, UK Health Security Agency, Nobel House, London, UK
| | - John R Bradley
- National Institute for Health and Care Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Nathalie Kingston
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Institute for Health and Care Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Jane Armitage
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David J Roberts
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- NHS Blood & Transplant, John Radcliffe Hospital, Oxford, UK
- Radcliffe Dept of Medicine and BRC Haematology Theme, University of Oxford, Oxford, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Science Centre, Human Technopole, Milan, 20157, Italy
- NHS Blood and Transplant, Cambridge, UK
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14
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Chung R, Xu Z, Arnold M, Ip S, Harrison H, Barrett J, Pennells L, Kim LG, Di Angelantonio E, Paige E, Ritchie SC, Inouye M, Usher‐Smith JA, Wood AM. Using Polygenic Risk Scores for Prioritizing Individuals at Greatest Need of a Cardiovascular Disease Risk Assessment. J Am Heart Assoc 2023; 12:e029296. [PMID: 37489768 PMCID: PMC7614905 DOI: 10.1161/jaha.122.029296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
Background The aim of this study was to provide quantitative evidence of the use of polygenic risk scores for systematically identifying individuals for invitation for full formal cardiovascular disease (CVD) risk assessment. Methods and Results A total of 108 685 participants aged 40 to 69 years, with measured biomarkers, linked primary care records, and genetic data in UK Biobank were used for model derivation and population health modeling. Prioritization tools using age, polygenic risk scores for coronary artery disease and stroke, and conventional risk factors for CVD available within longitudinal primary care records were derived using sex-specific Cox models. We modeled the implications of initiating guideline-recommended statin therapy after prioritizing individuals for invitation to a formal CVD risk assessment. If primary care records were used to prioritize individuals for formal risk assessment using age- and sex-specific thresholds corresponding to 5% false-negative rates, then the numbers of men and women needed to be screened to prevent 1 CVD event are 149 and 280, respectively. In contrast, adding polygenic risk scores to both prioritization and formal assessments, and selecting thresholds to capture the same number of events, resulted in a number needed to screen of 116 for men and 180 for women. Conclusions Using both polygenic risk scores and primary care records to prioritize individuals at highest risk of a CVD event for a formal CVD risk assessment can efficiently prioritize those who need interventions the most than using primary care records alone. This could lead to better allocation of resources by reducing the number of risk assessments in primary care while still preventing the same number of CVD events.
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Affiliation(s)
- Ryan Chung
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Zhe Xu
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Matthew Arnold
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Hannah Harrison
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Jessica Barrett
- Medical Research Council Biostatistics UnitUniversity of CambridgeUnited Kingdom
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Lois G. Kim
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Ellie Paige
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraAustralia
- The George Institute for Global HealthUNSW SydneyAustralia
| | - Scott C. Ritchie
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Michael Inouye
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- The George Institute for Global HealthUNSW SydneyAustralia
- Cambridge Baker Systems Genomics InitiativeBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Juliet A. Usher‐Smith
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- Cambridge Centre of Artificial Intelligence in MedicineUniversity of CambridgeUnited Kingdom
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15
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Pennells L, Kaptoge S, Østergaard HB, Read SH, Carinci F, Franch-Nadal J, Petitjean C, Taylor O, Hageman SHJ, Xu Z, Shi F, Spackman S, Gualdi S, Holman N, Da Providencia E Costa RB, Bonnet F, Brenner H, Gillum RF, Kiechl S, Lawlor DA, Potier L, Schöttker B, Sofat R, Völzke H, Willeit J, Baltane Z, Fava S, Janos S, Lavens A, Pildava S, Poljicanin T, Pristas I, Rossing P, Sascha R, Scheidt-Nave C, Stotl I, Tibor G, Urbančič-Rovan V, Vanherwegen AS, Vistisen D, Du Y, Walker MR, Willeit P, Ference B, De Bacquer D, Halle M, Huculeci R, McEvoy JW, Timmis A, Vardas P, Dorresteijn JAN, Graham I, Wood A, Eliasson B, Herrington W, Danesh J, Mauricio D, Benedetti MM, Sattar N, Visseren FLJ, Wild S, Di Angelantonio E, Balkau B, Bonnet F, Fumeron F, Stocker H, Holleczek B, Schipf S, Schmidt CO, Dörr M, Tilg H, Leitner C, Notdurfter M, Taylor J, Dale C, Prieto-Merino D, Gillum RF, Lavens A, Vanherwegen AS, Poljicanin T, Pristas I, Buble T, Ivanko P, Rossing P, Carstensen B, Heidemann C, Du Y, Scheidt-Nave C, Gall T, Sandor J, Baltane Z, Pildava S, Lepiksone J, Magri CJ, Azzopardi J, Stotl I, Real J, Vlacho B, Mata-Cases M. SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe. Eur Heart J 2023; 44:2544-2556. [PMID: 37247330 PMCID: PMC10361012 DOI: 10.1093/eurheartj/ehad260] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
AIMS To develop and validate a recalibrated prediction model (SCORE2-Diabetes) to estimate the 10-year risk of cardiovascular disease (CVD) in individuals with type 2 diabetes in Europe. METHODS AND RESULTS SCORE2-Diabetes was developed by extending SCORE2 algorithms using individual-participant data from four large-scale datasets comprising 229 460 participants (43 706 CVD events) with type 2 diabetes and without previous CVD. Sex-specific competing risk-adjusted models were used including conventional risk factors (i.e. age, smoking, systolic blood pressure, total, and HDL-cholesterol), as well as diabetes-related variables (i.e. age at diabetes diagnosis, glycated haemoglobin [HbA1c] and creatinine-based estimated glomerular filtration rate [eGFR]). Models were recalibrated to CVD incidence in four European risk regions. External validation included 217 036 further individuals (38 602 CVD events), and showed good discrimination, and improvement over SCORE2 (C-index change from 0.009 to 0.031). Regional calibration was satisfactory. SCORE2-Diabetes risk predictions varied several-fold, depending on individuals' levels of diabetes-related factors. For example, in the moderate-risk region, the estimated 10-year CVD risk was 11% for a 60-year-old man, non-smoker, with type 2 diabetes, average conventional risk factors, HbA1c of 50 mmol/mol, eGFR of 90 mL/min/1.73 m2, and age at diabetes diagnosis of 60 years. By contrast, the estimated risk was 17% in a similar man, with HbA1c of 70 mmol/mol, eGFR of 60 mL/min/1.73 m2, and age at diabetes diagnosis of 50 years. For a woman with the same characteristics, the risk was 8% and 13%, respectively. CONCLUSION SCORE2-Diabetes, a new algorithm developed, calibrated, and validated to predict 10-year risk of CVD in individuals with type 2 diabetes, enhances identification of individuals at higher risk of developing CVD across Europe.
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16
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Ismail SR, Mohammad MSF, Butterworth AS, Chowdhury R, Danesh J, Di Angelantonio E, Griffin SJ, Pennells L, Wood AM, Md Noh MF, Shah SA. Risk Factors of Secondary Cardiovascular Events in a Multi-Ethnic Asian Population with Acute Myocardial Infarction: A Retrospective Cohort Study from Malaysia. J Cardiovasc Dev Dis 2023; 10:250. [PMID: 37367415 PMCID: PMC10299045 DOI: 10.3390/jcdd10060250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
This retrospective cohort study investigated the incidence and risk factors of major adverse cardiovascular events (MACE) after 1 year of first-documented myocardial infarctions (MIs) in a multi-ethnic Asian population. Secondary MACE were observed in 231 (14.3%) individuals, including 92 (5.7%) cardiovascular-related deaths. Both histories of hypertension and diabetes were associated with secondary MACE after adjustment for age, sex, and ethnicity (HR 1.60 [95%CI 1.22-2.12] and 1.46 [95%CI 1.09-1.97], respectively). With further adjustments for traditional risk factors, individuals with conduction disturbances demonstrated higher risks of MACE: new left-bundle branch block (HR 2.86 [95%CI 1.15-6.55]), right-bundle branch block (HR 2.09 [95%CI 1.02-4.29]), and second-degree heart block (HR 2.45 [95%CI 0.59-10.16]). These associations were broadly similar across different age, sex, and ethnicity groups, although somewhat greater for history of hypertension and BMI among women versus men, for HbA1c control in individuals aged >50 years, and for LVEF ≤ 40% in those with Indian versus Chinese or Bumiputera ethnicities. Several traditional and cardiac risk factors are associated with a higher risk of secondary major adverse cardiovascular events. In addition to hypertension and diabetes, the identification of conduction disturbances in individuals with first-onset MI may be useful for the risk stratification of high-risk individuals.
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Affiliation(s)
- Sophia Rasheeqa Ismail
- Nutrition, Metabolic and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (S.R.I.)
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | | | - Adam S. Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0BB, UK (E.D.A.)
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB2 0BB, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge CB2 0BB, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus, University of Cambridge, Cambridge CB10 1SA, UK
| | - Rajiv Chowdhury
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0BB, UK (E.D.A.)
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33174, USA
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0BB, UK (E.D.A.)
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB2 0BB, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge CB2 0BB, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus, University of Cambridge, Cambridge CB10 1SA, UK
- Department of Human Genetics, Wellcome Sanger Institute, Cambridge CB10 1SA, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0BB, UK (E.D.A.)
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB2 0BB, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge CB2 0BB, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus, University of Cambridge, Cambridge CB10 1SA, UK
- Health Data Science Research Centre, Human Technopole, 20157 Milan, Italy
| | - Simon J. Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0BB, UK
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SL, UK
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0BB, UK (E.D.A.)
| | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0BB, UK (E.D.A.)
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB2 0BB, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge CB2 0BB, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus, University of Cambridge, Cambridge CB10 1SA, UK
- The Alan Turing Institute, London NW1 2DB, UK
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, UK
| | - Mohd Fairulnizal Md Noh
- Nutrition, Metabolic and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (S.R.I.)
| | - Shamsul Azhar Shah
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur 56000, Malaysia
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17
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Xu Y, Ritchie SC, Liang Y, Timmers PRHJ, Pietzner M, Lannelongue L, Lambert SA, Tahir UA, May-Wilson S, Foguet C, Johansson Å, Surendran P, Nath AP, Persyn E, Peters JE, Oliver-Williams C, Deng S, Prins B, Luan J, Bomba L, Soranzo N, Di Angelantonio E, Pirastu N, Tai ES, van Dam RM, Parkinson H, Davenport EE, Paul DS, Yau C, Gerszten RE, Mälarstig A, Danesh J, Sim X, Langenberg C, Wilson JF, Butterworth AS, Inouye M. An atlas of genetic scores to predict multi-omic traits. Nature 2023; 616:123-131. [PMID: 36991119 PMCID: PMC10323211 DOI: 10.1038/s41586-023-05844-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 02/15/2023] [Indexed: 03/30/2023]
Abstract
The use of omic modalities to dissect the molecular underpinnings of common diseases and traits is becoming increasingly common. But multi-omic traits can be genetically predicted, which enables highly cost-effective and powerful analyses for studies that do not have multi-omics1. Here we examine a large cohort (the INTERVAL study2; n = 50,000 participants) with extensive multi-omic data for plasma proteomics (SomaScan, n = 3,175; Olink, n = 4,822), plasma metabolomics (Metabolon HD4, n = 8,153), serum metabolomics (Nightingale, n = 37,359) and whole-blood Illumina RNA sequencing (n = 4,136), and use machine learning to train genetic scores for 17,227 molecular traits, including 10,521 that reach Bonferroni-adjusted significance. We evaluate the performance of genetic scores through external validation across cohorts of individuals of European, Asian and African American ancestries. In addition, we show the utility of these multi-omic genetic scores by quantifying the genetic control of biological pathways and by generating a synthetic multi-omic dataset of the UK Biobank3 to identify disease associations using a phenome-wide scan. We highlight a series of biological insights with regard to genetic mechanisms in metabolism and canonical pathway associations with disease; for example, JAK-STAT signalling and coronary atherosclerosis. Finally, we develop a portal ( https://www.omicspred.org/ ) to facilitate public access to all genetic scores and validation results, as well as to serve as a platform for future extensions and enhancements of multi-omic genetic scores.
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Affiliation(s)
- Yu Xu
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
| | - Scott C Ritchie
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Yujian Liang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Paul R H J Timmers
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Maik Pietzner
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Computational Medicine, Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
| | - Loïc Lannelongue
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Samuel A Lambert
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
| | - Usman A Tahir
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sebastian May-Wilson
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Carles Foguet
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Åsa Johansson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Praveen Surendran
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Artika P Nath
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Elodie Persyn
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - James E Peters
- Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Clare Oliver-Williams
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Shuliang Deng
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Bram Prins
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Lorenzo Bomba
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- BioMarin Pharmaceutical, Novato, CA, USA
| | - Nicole Soranzo
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Genomics Research Centre, Human Technopole, Milan, Italy
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Data Science Research Centre, Human Technopole, Milan, Italy
| | - Nicola Pirastu
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Genomics Research Centre, Human Technopole, Milan, Italy
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Helen Parkinson
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
| | | | - Dirk S Paul
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Health Data Research UK, London, UK
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Broad Institute of Harvard University and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Anders Mälarstig
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pfizer Worldwide Research, Development and Medical, Stockholm, Sweden
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Computational Medicine, Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
| | - James F Wilson
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK.
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
- The Alan Turing Institute, London, UK.
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18
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Kim LG, Bolton T, Sweeting MJ, Bell S, Fahle S, McMahon A, Walker M, Ferguson E, Miflin G, Roberts DJ, Di Angelantonio E, Wood AM. Impact of a post-donation hemoglobin testing strategy on efficiency and safety of whole blood donation in England: A modeling study. Transfusion 2023; 63:541-551. [PMID: 36794597 PMCID: PMC10952564 DOI: 10.1111/trf.17277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Deferrals due to low hemoglobin are time-consuming and costly for blood donors and donation services. Furthermore, accepting donations from those with low hemoglobin could represent a significant safety issue. One approach to reduce them is to use hemoglobin concentration alongside donor characteristics to inform personalized inter-donation intervals. STUDY DESIGN AND METHODS We used data from 17,308 donors to inform a discrete event simulation model comparing personalized inter-donation intervals using "post-donation" testing (i.e., estimating current hemoglobin from that measured by a hematology analyzer at last donation) versus the current approach in England (i.e., pre-donation testing with fixed intervals of 12-weeks for men and 16-weeks for women). We reported the impact on total donations, low hemoglobin deferrals, inappropriate bleeds, and blood service costs. Personalized inter-donation intervals were defined using mixed-effects modeling to estimate hemoglobin trajectories and probability of crossing hemoglobin donation thresholds. RESULTS The model had generally good internal validation, with predicted events similar to those observed. Over 1 year, a personalized strategy requiring ≥90% probability of being over the hemoglobin threshold, minimized adverse events (low hemoglobin deferrals and inappropriate bleeds) in both sexes and costs in women. Donations per adverse event improved from 3.4 (95% uncertainty interval 2.8, 3.7) under the current strategy to 14.8 (11.6, 19.2) in women, and from 7.1 (6.1, 8.5) to 26.9 (20.8, 42.6) in men. In comparison, a strategy incorporating early returns for those with high certainty of being over the threshold maximized total donations in both men and women, but was less favorable in terms of adverse events, with 8.4 donations per adverse event in women (7.0, 10,1) and 14.8 (12.1, 21.0) in men. DISCUSSION Personalized inter-donation intervals using post-donation testing combined with modeling of hemoglobin trajectories can help reduce deferrals, inappropriate bleeds, and costs.
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Affiliation(s)
- Lois G. Kim
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Thomas Bolton
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- BHF Data Science CentreHealth Data ResearchUK
| | | | - Steven Bell
- Dept of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - Sarah Fahle
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Amy McMahon
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Matthew Walker
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
| | - Eamonn Ferguson
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- School of PsychologyUniversity of NottinghamNottinghamUK
| | | | - David J. Roberts
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- NHS Blood & TransplantJohn Radcliffe HospitalOxfordUK
- Radcliffe Dept of MedicineUniversity of OxfordOxfordUK
| | - Emanuele Di Angelantonio
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Angela M. Wood
- Blood and Transplant Research Unit in Donor Health and BehaviourCambridgeUK
- Dept of Public Health & Primary CareUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
- Cambridge Centre of Artificial Intelligence in MedicineCambridgeUK
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19
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Ritchie SC, Surendran P, Karthikeyan S, Lambert SA, Bolton T, Pennells L, Danesh J, Di Angelantonio E, Butterworth AS, Inouye M. Quality control and removal of technical variation of NMR metabolic biomarker data in ~120,000 UK Biobank participants. Sci Data 2023; 10:64. [PMID: 36720882 PMCID: PMC9887579 DOI: 10.1038/s41597-023-01949-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/10/2023] [Indexed: 02/01/2023] Open
Abstract
Metabolic biomarker data quantified by nuclear magnetic resonance (NMR) spectroscopy in approximately 121,000 UK Biobank participants has recently been released as a community resource, comprising absolute concentrations and ratios of 249 circulating metabolites, lipids, and lipoprotein sub-fractions. Here we identify and characterise additional sources of unwanted technical variation influencing individual biomarkers in the data available to download from UK Biobank. These included sample preparation time, shipping plate well, spectrometer batch effects, drift over time within spectrometer, and outlier shipping plates. We developed a procedure for removing this unwanted technical variation, and demonstrate that it increases signal for genetic and epidemiological studies of the NMR metabolic biomarker data in UK Biobank. We subsequently developed an R package, ukbnmr, which we make available to the wider research community to enhance the utility of the UK Biobank NMR metabolic biomarker data and to facilitate rapid analysis.
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Affiliation(s)
- Scott C Ritchie
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia.
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK.
| | - Praveen Surendran
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Rutherford Fund Fellow, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Savita Karthikeyan
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Samuel A Lambert
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Thomas Bolton
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
- The Alan Turing Institute, London, UK
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20
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Matsushita K, Kaptoge S, Hageman SHJ, Sang Y, Ballew SH, Grams ME, Surapaneni A, Sun L, Arnlov J, Bozic M, Brenner H, Brunskill NJ, Chang AR, Chinnadurai R, Cirillo M, Correa A, Ebert N, Eckardt KU, Gansevoort RT, Gutierrez O, Hadaegh F, He J, Hwang SJ, Jafar TH, Jassal SK, Kayama T, Kovesdy CP, Landman GW, Levey AS, Lloyd-Jones DM, Major RW, Miura K, Muntner P, Nadkarni GN, Nowak C, Ohkubo T, Pena MJ, Polkinghorne KR, Sairenchi T, Schaeffner E, Schneider MP, Shalev V, Shlipak MG, Solbu MD, Stempniewicz N, Tollitt J, Valdivielso JM, van der Leeuw J, Wang AYM, Wen CP, Woodward M, Yamagishi K, Yatsuya H, Zhang L, Dorresteijn JAN, Di Angelantonio E, Visseren FLJ, Pennells L, Coresh J. Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP. Eur J Prev Cardiol 2023; 30:8-16. [PMID: 35972749 PMCID: PMC9839538 DOI: 10.1093/eurjpc/zwac176] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 01/17/2023]
Abstract
AIMS The 2021 European Society of Cardiology (ESC) guideline on cardiovascular disease (CVD) prevention categorizes moderate and severe chronic kidney disease (CKD) as high and very-high CVD risk status regardless of other factors like age and does not include estimated glomerular filtration rate (eGFR) and albuminuria in its algorithms, systemic coronary risk estimation 2 (SCORE2) and systemic coronary risk estimation 2 in older persons (SCORE2-OP), to predict CVD risk. We developed and validated an 'Add-on' to incorporate CKD measures into these algorithms, using a validated approach. METHODS In 3,054 840 participants from 34 datasets, we developed three Add-ons [eGFR only, eGFR + urinary albumin-to-creatinine ratio (ACR) (the primary Add-on), and eGFR + dipstick proteinuria] for SCORE2 and SCORE2-OP. We validated C-statistics and net reclassification improvement (NRI), accounting for competing risk of non-CVD death, in 5,997 719 participants from 34 different datasets. RESULTS In the target population of SCORE2 and SCORE2-OP without diabetes, the CKD Add-on (eGFR only) and CKD Add-on (eGFR + ACR) improved C-statistic by 0.006 (95%CI 0.004-0.008) and 0.016 (0.010-0.023), respectively, for SCORE2 and 0.012 (0.009-0.015) and 0.024 (0.014-0.035), respectively, for SCORE2-OP. Similar results were seen when we included individuals with diabetes and tested the CKD Add-on (eGFR + dipstick). In 57 485 European participants with CKD, SCORE2 or SCORE2-OP with a CKD Add-on showed a significant NRI [e.g. 0.100 (0.062-0.138) for SCORE2] compared to the qualitative approach in the ESC guideline. CONCLUSION Our Add-ons with CKD measures improved CVD risk prediction beyond SCORE2 and SCORE2-OP. This approach will help clinicians and patients with CKD refine risk prediction and further personalize preventive therapies for CVD.
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Affiliation(s)
- Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Steven HJ Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shoshana H Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Aditya Surapaneni
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Luanluan Sun
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Johan Arnlov
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Milica Bozic
- Vascular & Renal Translational Research Group, IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ) and Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Nigel J Brunskill
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Alex R Chang
- Department of Nephrology and Kidney Health Research Institute, Geisinger Medical Center, Danville, Pennsylvania
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Massimo Cirillo
- Department of Public Health, University of Naples “Federico II”, Italy
| | | | - Natalie Ebert
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Orlando Gutierrez
- Departments of Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Farzad Hadaegh
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Shih-Jen Hwang
- National Heart, Lung, and Blood Institute, Framingham, Massachusetts
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Department of Medicine, Aga Khan University, Karachi, Pakistan, and Duke Global Health Institute, Durham, Duke University, North Carolina
| | - Simerjot K Jassal
- Division of General Internal Medicine, University of California, San Diego and VA San Diego Healthcare, San Diego, California
| | - Takamasa Kayama
- Global Center of Excellence, Yamagata University Faculty of Medicine, Yamagata, Japan; Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Japan
| | - Csaba P Kovesdy
- Medicine-Nephrology, Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | | | - Rupert W Major
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Girish N Nadkarni
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christoph Nowak
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Michelle J Pena
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Toshimi Sairenchi
- Medical Science of Nursing, Dokkyo Medical University School of Nursing, Mibu, Japan
| | - Elke Schaeffner
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus P Schneider
- Department of Nephrology and Hypertension, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Varda Shalev
- Institute for Health and Research and Innovation, Maccabi Healthcare Services and Tel Aviv University, Tel Aviv, Israel
| | - Michael G Shlipak
- Kidney Health Research Collaborative, University of California, San Francisco, and San Francisco VA Healthcare System, San Francisco
| | - Marit D Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway and UiT The Arctic University of Norway, Tromsø, Norway
| | - Nikita Stempniewicz
- AMGA (American Medical Group Association), Alexandria, Virginia and OptumLabs Visiting Fellow
| | - James Tollitt
- Department of Renal Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK; Renal Department, University of Manchester, Oxford Road, Manchester, United Kingdom
| | - José M Valdivielso
- Vascular & Renal Translational Research Group, IRBLleida, Spain and Spanish Research Network for Renal Diseases (RedInRen. ISCIII) , Lleida , Spain
| | - Joep van der Leeuw
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Chi-Pang Wen
- China Medical University Hospital, Taichung, Taiwan
| | - Mark Woodward
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kazumasa Yamagishi
- George Institute for Global Health, Australia, and George Institute for Global Health, Imperial College, London, United Kingdom
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine, Aichi, Japan and Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Luxia Zhang
- Peking University First Hospital and Peking University, Beijing, China
| | - Jannick AN Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Health Data Science Centre, Human Technopole, Milan, Italy
| | - Frank LJ Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa Pennells
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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21
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Østergaard HB, Hageman SHJ, Read SH, Taylor O, Pennells L, Kaptoge S, Petitjean C, Xu Z, Shi F, McEvoy JW, Herrington W, Visseren FLJ, Wood A, Eliasson B, Sattar N, Wild S, Di Angelantonio E, Dorresteijn JAN. Estimating individual lifetime risk of incident cardiovascular events in adults with Type 2 diabetes: an update and geographical calibration of the DIAbetes Lifetime perspective model (DIAL2). Eur J Prev Cardiol 2023; 30:61-69. [PMID: 36208182 DOI: 10.1093/eurjpc/zwac232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/20/2022] [Accepted: 10/05/2022] [Indexed: 01/14/2023]
Abstract
AIMS The 2021 European Society of Cardiology cardiovascular disease (CVD) prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding intensified preventive treatment options in adults with Type 2 diabetes, e.g. the DIAbetes Lifetime perspective model (DIAL model). The aim of this study was to update the DIAL model using contemporary and representative registry data (DIAL2) and to systematically calibrate the model for use in other European countries. METHODS AND RESULTS The DIAL2 model was derived in 467 856 people with Type 2 diabetes without a history of CVD from the Swedish National Diabetes Register, with a median follow-up of 7.3 years (interquartile range: 4.0-10.6 years) and comprising 63 824 CVD (including fatal CVD, non-fatal stroke and non-fatal myocardial infarction) events and 66 048 non-CVD mortality events. The model was systematically recalibrated to Europe's low- and moderate-risk regions using contemporary incidence data and mean risk factor distributions. The recalibrated DIAL2 model was externally validated in 218 267 individuals with Type 2 diabetes from the Scottish Care Information-Diabetes (SCID) and Clinical Practice Research Datalink (CPRD). In these individuals, 43 074 CVD events and 27 115 non-CVD fatal events were observed. The DIAL2 model discriminated well, with C-indices of 0.732 [95% confidence interval (CI) 0.726-0.739] in CPRD and 0.700 (95% CI 0.691-0.709) in SCID. CONCLUSION The recalibrated DIAL2 model provides a useful tool for the prediction of CVD-free life expectancy and lifetime CVD risk for people with Type 2 diabetes without previous CVD in the European low- and moderate-risk regions. These long-term individualized measures of CVD risk are well suited for shared decision-making in clinical practice as recommended by the 2021 CVD ESC prevention guidelines.
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Affiliation(s)
- Helena Bleken Østergaard
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Stephanie H Read
- Usher Institute, University of Edinburgh, Craigour House, 450 Old Dalkeith Rd, Edinburgh EH16 4SS, UK
- On behalf of the Scottish Diabetes Research Network epidemiology group, Diabetes Support Unit, Level 8, Ninewells Hospital, DundeeDD1 9SY, UK
| | - Owen Taylor
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Lisa Pennells
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Carmen Petitjean
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Zhe Xu
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Fanchao Shi
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | | | - William Herrington
- Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Angela Wood
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Blå stråket 5 B Wallenberglab, SU41345 Göteborg, Sweden
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, 126 University Place, G12 8TA Glasgow, UK
| | - Sarah Wild
- Usher Institute, University of Edinburgh, Craigour House, 450 Old Dalkeith Rd, Edinburgh EH16 4SS, UK
- On behalf of the Scottish Diabetes Research Network epidemiology group, Diabetes Support Unit, Level 8, Ninewells Hospital, DundeeDD1 9SY, UK
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
- Health Data Science Centre, Human Technopole, V.le Rita Levi-Montalcini, 1, 20157 Milano MI, Italy
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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22
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Jefferson E, Cole C, Mumtaz S, Cox S, Giles TC, Adejumo S, Urwin E, Lea D, Macdonald C, Best J, Masood E, Milligan G, Johnston J, Horban S, Birced I, Hall C, Jackson AS, Collins C, Rising S, Dodsley C, Hampton J, Hadfield A, Santos R, Tarr S, Panagi V, Lavagna J, Jackson T, Chuter A, Beggs J, Martinez-Queipo M, Ward H, von Ziegenweidt J, Burns F, Martin J, Sebire N, Morris C, Bradley D, Baxter R, Ahonen-Bishopp A, Smith P, Shoemark A, Valdes AM, Ollivere B, Manisty C, Eyre D, Gallant S, Joy G, McAuley A, Connell D, Northstone K, Jeffery K, Di Angelantonio E, McMahon A, Walker M, Semple MG, Sims JM, Lawrence E, Davies B, Baillie JK, Tang M, Leeming G, Power L, Breeze T, Murray D, Orton C, Pierce I, Hall I, Ladhani S, Gillson N, Whitaker M, Shallcross L, Seymour D, Varma S, Reilly G, Morris A, Hopkins S, Sheikh A, Quinlan P. A Hybrid Architecture (CO-CONNECT) to Facilitate Rapid Discovery and Access to Data Across the United Kingdom in Response to the COVID-19 Pandemic: Development Study. J Med Internet Res 2022; 24:e40035. [PMID: 36322788 PMCID: PMC9822177 DOI: 10.2196/40035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND COVID-19 data have been generated across the United Kingdom as a by-product of clinical care and public health provision, as well as numerous bespoke and repurposed research endeavors. Analysis of these data has underpinned the United Kingdom's response to the pandemic, and informed public health policies and clinical guidelines. However, these data are held by different organizations, and this fragmented landscape has presented challenges for public health agencies and researchers as they struggle to find relevant data to access and interrogate the data they need to inform the pandemic response at pace. OBJECTIVE We aimed to transform UK COVID-19 diagnostic data sets to be findable, accessible, interoperable, and reusable (FAIR). METHODS A federated infrastructure model (COVID - Curated and Open Analysis and Research Platform [CO-CONNECT]) was rapidly built to enable the automated and reproducible mapping of health data partners' pseudonymized data to the Observational Medical Outcomes Partnership Common Data Model without the need for any data to leave the data controllers' secure environments, and to support federated cohort discovery queries and meta-analysis. RESULTS A total of 56 data sets from 19 organizations are being connected to the federated network. The data include research cohorts and COVID-19 data collected through routine health care provision linked to longitudinal health care records and demographics. The infrastructure is live, supporting aggregate-level querying of data across the United Kingdom. CONCLUSIONS CO-CONNECT was developed by a multidisciplinary team. It enables rapid COVID-19 data discovery and instantaneous meta-analysis across data sources, and it is researching streamlined data extraction for use in a Trusted Research Environment for research and public health analysis. CO-CONNECT has the potential to make UK health data more interconnected and better able to answer national-level research questions while maintaining patient confidentiality and local governance procedures.
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Affiliation(s)
- Emily Jefferson
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Christian Cole
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Shahzad Mumtaz
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Samuel Cox
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | | | - Sam Adejumo
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Esmond Urwin
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Daniel Lea
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Calum Macdonald
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joseph Best
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Erum Masood
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Gordon Milligan
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Jenny Johnston
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Scott Horban
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ipek Birced
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Christopher Hall
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Aaron S Jackson
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Clare Collins
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Sam Rising
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte Dodsley
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Jill Hampton
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Andrew Hadfield
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Roberto Santos
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Simon Tarr
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Vasiliki Panagi
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Joseph Lavagna
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Tracy Jackson
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Antony Chuter
- Lay Partnership in Healthcare Research, Lindfield, United Kingdom
| | - Jillian Beggs
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Helen Ward
- School of Public Health, Imperial College London, London, United Kingdom
| | - Julie von Ziegenweidt
- Department of Haemotology, University of Cambridge, Cambridge, United Kingdom
- National Institute for Healthcare Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Frances Burns
- Centre for Public Health, Belfast Institute of Clinical Science, Queens University Belfast, Belfast, United Kingdom
| | - Joanne Martin
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Neil Sebire
- Institute of Child Health, Great Ormond Street Hospital, London, United Kingdom
| | | | - Declan Bradley
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Belfast, United Kingdom
- Public Health Agency, Belfast, United Kingdom
| | - Rob Baxter
- EPCC, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Amelia Shoemark
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ana M Valdes
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Benjamin Ollivere
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte Manisty
- Institute of Cardiovascular Sciences, University of College London, London, United Kingdom
| | - David Eyre
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Stephanie Gallant
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - George Joy
- Barts Heart Centre, London, United Kingdom
| | - Andrew McAuley
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - David Connell
- School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Kate Northstone
- Population Health Sciences, Avon Longitudinal Study of Parents and Children, Bristol, United Kingdom
| | - Katie Jeffery
- Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus, University of Cambridge, Cambridge, United Kingdom
- Health Data Science Research Centre, Human Technopole, Milan, Italy
| | - Amy McMahon
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
| | - Mat Walker
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
| | - Malcolm Gracie Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infections, University of Liverpool, Liverpool, United Kingdom
- Respiratory Department, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | | | - Bethan Davies
- School of Public Health, Imperial College London, London, United Kingdom
| | - John Kenneth Baillie
- Outbreak Data Analysis Platform, University of Edinburgh, Edinburgh, United Kingdom
| | - Ming Tang
- NHS England, Worcestershire, United Kingdom
| | - Gary Leeming
- Civic Data Cooperative, Digital Innovation Facility, University of Liverpool, Liverpool, United Kingdom
| | - Linda Power
- Public Health England, London, United Kingdom
| | - Thomas Breeze
- Avon Longitudinal Study of Parents and Children, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Duncan Murray
- University of Birmingham, Birmingham, United Kingdom
- University Hospital Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Chris Orton
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Iain Pierce
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Ian Hall
- Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England Colindale, London, United Kingdom
| | | | - Matthew Whitaker
- School of Public Health, Imperial College London, London, United Kingdom
| | | | | | | | | | | | | | - Aziz Sheikh
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip Quinlan
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
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23
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Lopez-Jimenez F, Almahmeed W, Bays H, Cuevas A, Di Angelantonio E, le Roux CW, Sattar N, Sun MC, Wittert G, Pinto FJ, Wilding JPH. Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation. Eur J Prev Cardiol 2022; 29:2218-2237. [PMID: 36007112 DOI: 10.1093/eurjpc/zwac187] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
The ongoing obesity epidemic represents a global public health crisis that contributes to poor health outcomes, reduced quality of life, and >2.8 million deaths each year. Obesity is relapsing, progressive, and heterogeneous. It is considered a chronic disease by the World Obesity Federation (WOF) and a chronic condition by the World Heart Federation (WHF). People living with overweight/obesity are at greater risk for cardiovascular (CV) morbidity and mortality. Increased adiposity (body fat), particularly visceral/abdominal fat, is linked to CV risk and CV disease (CVD) via multiple direct and indirect pathophysiological mechanisms. The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy. Evidence indicates that intentional weight loss (particularly when substantial) lowers CVD risk among people with overweight/obesity. Long-term weight loss and maintenance require ongoing commitment from both the individual and those responsible for their care. This position paper, developed by the WOF and the WHF, aims to improve understanding of the direct and indirect links between overweight/obesity and CVD, the key controversies in this area and evidence relating to cardiometabolic outcomes with available weight management options. Finally, an action plan for clinicians provides recommendations to help in identifying and addressing the risks of obesity-related CVD (recognizing resource and support variances between countries).
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Affiliation(s)
| | - Wael Almahmeed
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Harold Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
| | - Ada Cuevas
- Center for Advanced Metabolic Medicine and Nutrition (CAMMYN), School of Medicine University Finis Terrae, Santiago, Chile
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marie Chan Sun
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Mauritius, Mauritius
| | - Gary Wittert
- Freemasons Centre for Male Health and Wellbeing, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Office of the President, World Heart Federation, Geneva, Switzerland
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Clinical Sciences Centre, Aintree University Hospital, Liverpool, UK
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24
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Khera AV, Wang M, Chaffin M, Emdin CA, Samani NJ, Schunkert H, Watkins H, McPherson R, Elosua R, Boerwinkle E, Ardissino D, Butterworth AS, Di Angelantonio E, Naheed A, Danesh J, Chowdhury R, Krumholz HM, Sheu WHH, Rich SS, Rotter JI, Chen YDI, Gabriel S, Lander ES, Saleheen D, Kathiresan S. Gene Sequencing Identifies Perturbation in Nitric Oxide Signaling as a Nonlipid Molecular Subtype of Coronary Artery Disease. Circ Genom Precis Med 2022; 15:e003598. [PMID: 36215124 PMCID: PMC9771961 DOI: 10.1161/circgen.121.003598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND A key goal of precision medicine is to disaggregate common, complex diseases into discrete molecular subtypes. Rare coding variants in the low-density lipoprotein receptor gene (LDLR) are identified in 1% to 2% of coronary artery disease (CAD) patients, defining a molecular subtype with risk driven by hypercholesterolemia. METHODS To search for additional subtypes, we compared the frequency of rare, predicted loss-of-function and damaging missense variants aggregated within a given gene in 41 081 CAD cases versus 217 115 controls. RESULTS Rare variants in LDLR were most strongly associated with CAD, present in 1% of cases and associated with 4.4-fold increased CAD risk. A second subtype was characterized by variants in endothelial nitric oxide synthase gene (NOS3), a key enzyme regulating vascular tone, endothelial function, and platelet aggregation. A rare predicted loss-of-function or damaging missense variants in NOS3 was present in 0.6% of cases and associated with 2.42-fold increased risk of CAD (95% CI, 1.80-3.26; P=5.50×10-9). These variants were associated with higher systolic blood pressure (+3.25 mm Hg; [95% CI, 1.86-4.65]; P=5.00×10-6) and increased risk of hypertension (adjusted odds ratio 1.31; [95% CI, 1.14-1.51]; P=2.00×10-4) but not circulating cholesterol concentrations, suggesting that, beyond lipid pathways, nitric oxide synthesis is a key nonlipid driver of CAD risk. CONCLUSIONS Beyond LDLR, we identified an additional nonlipid molecular subtype of CAD characterized by rare variants in the NOS3 gene.
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Affiliation(s)
- Amit V. Khera
- Program in Medical & Population Genetics, Broad Inst of MIT & Harvard, Cambridge, MA
- Ctr for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Dept of Medicine, Harvard Medical School, Boston, MA
- Cardiology Division, Dept of Medicine, Massachusetts General Hospital, Boston, MA
| | - Minxian Wang
- Ctr for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Program in Medical & Population Genetics, Broad Inst of MIT & Harvard, Cambridge, MA
- CAS Key Laboratory of Genome Sciences & Information, Beijing Inst of Genomics, Chinese Academy of Sciences & China National Ctr for Bioinformation, Beijing, China
| | - Mark Chaffin
- Program in Medical & Population Genetics, Broad Inst of MIT & Harvard, Cambridge, MA
| | - Connor A. Emdin
- Ctr for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Dept of Medicine, Harvard Medical School, Boston, MA
- Program in Medical & Population Genetics, Broad Inst of MIT & Harvard, Cambridge, MA
| | - Nilesh J. Samani
- Dept of Cardiovascular Sciences, Univ of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Ctr, Glenfield Hospital, Leicester, UK
| | - Heribert Schunkert
- Dept of Cardiology, German Heart Ctr Munich, Technical Univ of Munich, Munich, Germany
- DZHK (German Ctr for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Dept of Medicine, Univ of Oxford, Headington, UK
- Wellcome Trust Ctr for Human Genetics, Univ of Oxford, Oxford, UK
| | - Ruth McPherson
- Inst for Cardiogenetics, Univ of Lübeck, Lübeck, Schleswig-Holstein, Germany
- German Research Ctr for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel & Univ Heart Center Lübeck (J.E.), Berlin, Brandenburg, Germany
- Depts of Medicine & Biochemistry, Univ of Ottawa Heart Inst, Ottawa, ON, Canada
| | - Roberto Elosua
- Cardiovascular Epidemiology & Genetics, Hospital del Mar Research Inst, Barcelona, Spain
- CIBER Enfermedades Cardiovasculares, Barcelona, Spain
- Facultat de Medicina, Universitat de Vic-Central de Cataluña, Barcelona, Spain
| | - Eric Boerwinkle
- Ctr for Human Genetics & Dept. of Epidemiology, Univ of Texas Health Science Ctr School of Public Health, Houston, TX
| | - Diego Ardissino
- Cardiology, Azienda Ospedaliero-Universitaria di Parma, Univ of Parma, Parma, Italy
- Associazione per lo Studio Della Trombosi in Cardiologia, Pavia, Italy
| | - Adam S. Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Dept of Public Health & Primary Care, Univ of Cambridge, Cambridge, UK
- National Inst for Health Research Blood & Transplant Research Unit in Donor Health & Genomics, Univ of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus & Univ of Cambridge, Cambridge, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Dept of Public Health & Primary Care, Univ of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus & Univ of Cambridge, Cambridge, UK
- NIHR Blood & Transplant Research Unit in Donor Health & Genomics, Univ of Cambridge, Cambridge, UK
- BHF Ctr of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, Univ of Cambridge, Cambridge, UK
- Health Data Science Research Ctr, Human Technopole, Milan, Italy
| | - Aliya Naheed
- Initiative for Noncommunicable Bangladesh, Diseases, Health Systems & Population Studies Division, International Ctr for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Dept of Public Health & Primary Care, Univ of Cambridge, Cambridge, UK
- National Inst for Health Research Blood & Transplant Research Unit in Donor Health & Genomics, Univ of Cambridge, Cambridge, UK
- British Heart Foundation Ctr of Research Excellence, Univ of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus & Univ of Cambridge, Cambridge, UK
- Dept of Human Genetics, Wellcome Sanger Inst, Hinxton, UK
| | - Rajiv Chowdhury
- British Heart Foundation Cardiovascular Epidemiology Unit, Dept of Public Health & Primary Care, Univ of Cambridge, Cambridge, UK
- Centre for Non-Communicable Disease Research, Dhaka, Bangladesh
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Dept of Medicine, Yale Univ, New Haven, CT
- Ctr for Outcomes Research & Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Wayne H-H Sheu
- Cardiovascular Research Ctr, Dept of Medicine, National Yang Ming Univ School of Medicine, Taipei, Taiwan
| | - Stephen S. Rich
- Ctr for Public Health Genomics, Univ of Virginia, Charlottesville, VA
| | - Jerome I. Rotter
- The Inst for Translational Genomics & Population Sciences, Dept of Pediatrics, The Lundquist Inst for Biomedical Innovation at Harbor-UCLA Medical Ctr, Torrance, CA
| | - Yii-der Ida Chen
- The Inst for Translational Genomics & Population Sciences, Dept of Pediatrics, The Lundquist Inst for Biomedical Innovation at Harbor-UCLA Medical Ctr, Torrance, CA
| | - Stacey Gabriel
- Program in Medical & Population Genetics, Broad Inst of MIT & Harvard, Cambridge, MA
| | - Eric S. Lander
- Program in Medical & Population Genetics, Broad Inst of MIT & Harvard, Cambridge, MA
- Dept of Biology, MIT, Cambridge, MA
- Dept of Systems Biology, Harvard Medical School, Boston, MA
| | - Danish Saleheen
- Dept of Medicine, Columbia Univ, New York, NY
- Ctr for Non-Communicable Diseases, Karachi, Sindh, Pakistan
| | - Sekar Kathiresan
- Ctr for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Dept of Medicine, Harvard Medical School, Boston, MA
- Cardiology Division, Dept of Medicine, Massachusetts General Hospital, Boston, MA
- Verve Therapeutics, Cambridge, MA
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25
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Foguet C, Xu Y, Ritchie SC, Lambert SA, Persyn E, Nath AP, Davenport EE, Roberts DJ, Paul DS, Di Angelantonio E, Danesh J, Butterworth AS, Yau C, Inouye M. Genetically personalised organ-specific metabolic models in health and disease. Nat Commun 2022; 13:7356. [PMID: 36446790 PMCID: PMC9708841 DOI: 10.1038/s41467-022-35017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
Understanding how genetic variants influence disease risk and complex traits (variant-to-function) is one of the major challenges in human genetics. Here we present a model-driven framework to leverage human genome-scale metabolic networks to define how genetic variants affect biochemical reaction fluxes across major human tissues, including skeletal muscle, adipose, liver, brain and heart. As proof of concept, we build personalised organ-specific metabolic flux models for 524,615 individuals of the INTERVAL and UK Biobank cohorts and perform a fluxome-wide association study (FWAS) to identify 4312 associations between personalised flux values and the concentration of metabolites in blood. Furthermore, we apply FWAS to identify 92 metabolic fluxes associated with the risk of developing coronary artery disease, many of which are linked to processes previously described to play in role in the disease. Our work demonstrates that genetically personalised metabolic models can elucidate the downstream effects of genetic variants on biochemical reactions involved in common human diseases.
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Affiliation(s)
- Carles Foguet
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK.
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
| | - Yu Xu
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Scott C Ritchie
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Samuel A Lambert
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Elodie Persyn
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Artika P Nath
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - David J Roberts
- BRC Haematology Theme, Radcliffe Department of Medicine, and NHSBT-Oxford, John Radcliffe Hospital, Oxford, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - Dirk S Paul
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
| | - Emanuele Di Angelantonio
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - John Danesh
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Wellcome Sanger Institute, Hinxton, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Adam S Butterworth
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, OX3 9DU, UK
- Health Data Research UK, Gibbs Building, 215 Euston Road, London, NW1 2BE, UK
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK.
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK.
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- The Alan Turing Institute, London, UK.
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26
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Gaziano L, Sun L, Arnold M, Bell S, Cho K, Kaptoge SK, Song RJ, Burgess S, Posner DC, Mosconi K, Robinson-Cohen C, Mason AM, Bolton TR, Tao R, Allara E, Schubert P, Chen L, Staley JR, Staplin N, Altay S, Amiano P, Arndt V, Ärnlöv J, Barr EL, Björkelund C, Boer JM, Brenner H, Casiglia E, Chiodini P, Cooper JA, Coresh J, Cushman M, Dankner R, Davidson KW, de Jongh RT, Donfrancesco C, Engström G, Freisling H, de la Cámara AG, Gudnason V, Hankey GJ, Hansson PO, Heath AK, Hoorn EJ, Imano H, Jassal SK, Kaaks R, Katzke V, Kauhanen J, Kiechl S, Koenig W, Kronmal RA, Kyrø C, Lawlor DA, Ljungberg B, MacDonald C, Masala G, Meisinger C, Melander O, Moreno Iribas C, Ninomiya T, Nitsch D, Nordestgaard BG, Onland-Moret C, Palmieri L, Petrova D, Garcia JRQ, Rosengren A, Sacerdote C, Sakurai M, Santiuste C, Schulze MB, Sieri S, Sundström J, Tikhonoff V, Tjønneland A, Tong T, Tumino R, Tzoulaki I, van der Schouw YT, Monique Verschuren W, Völzke H, Wallace RB, Wannamethee SG, Weiderpass E, Willeit P, Woodward M, Yamagishi K, Zamora-Ros R, Akwo EA, Pyarajan S, Gagnon DR, Tsao PS, Muralidhar S, Edwards TL, Damrauer SM, Joseph J, Pennells L, Wilson PW, Harrison S, Gaziano TA, Inouye M, Baigent C, Casas JP, Langenberg C, Wareham N, Riboli E, Gaziano J, Danesh J, Hung AM, Butterworth AS, Wood AM, Di Angelantonio E. Mild-to-Moderate Kidney Dysfunction and Cardiovascular Disease: Observational and Mendelian Randomization Analyses. Circulation 2022; 146:1507-1517. [PMID: 36314129 PMCID: PMC9662821 DOI: 10.1161/circulationaha.122.060700] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/18/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke. METHODS Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition-Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million person-years of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25 917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank. RESULTS There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eGFR values <60 or >105 mL·min-1·1.73 m-2, compared with those with eGFR between 60 and 105 mL·min-1·1.73 m-2. Mendelian randomization analyses for CHD showed an association among participants with eGFR <60 mL·min-1·1.73 m-2, with a 14% (95% CI, 3%-27%) higher CHD risk per 5 mL·min-1·1.73 m-2 lower genetically predicted eGFR, but not for those with eGFR >105 mL·min-1·1.73 m-2. Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin A1c, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD. CONCLUSIONS In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function.
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Affiliation(s)
- Liam Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Luanluan Sun
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | | | - Steven Bell
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Stroke Research Group, Department of Clinical Neurosciences (S. Bell), University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
| | - Kelly Cho
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Stephen K. Kaptoge
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Rebecca J. Song
- Department of Epidemiology, Boston University School of Public Health, MA (R.J.S.)
| | - Stephen Burgess
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Medical Research Council Biostatistics Unit (A.M.M., S. Burgess), University of Cambridge, UK
| | - Daniel C. Posner
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
| | - Katja Mosconi
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Cassianne Robinson-Cohen
- Division of Nephrology, Department of Medicine (C.R.-C., E.A.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Amy M. Mason
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Medical Research Council Biostatistics Unit (A.M.M., S. Burgess), University of Cambridge, UK
| | - Thomas R. Bolton
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
| | - Ran Tao
- Department of Biostatistics (R. Tao), Vanderbilt University Medical Center, Nashville, TN
| | - Elias Allara
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
| | - Petra Schubert
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
| | - Lingyan Chen
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - James R. Staley
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Natalie Staplin
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (N.S., C.B.), Nuffield Department of Population Health, University of Oxford, UK
| | - Servet Altay
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey (S.A.)
| | - Pilar Amiano
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastián, Spain (P.A.)
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain (P.A.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research (V.A.), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johan Ärnlöv
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Medical Research Council Biostatistics Unit (A.M.M., S. Burgess), University of Cambridge, UK
- Stroke Research Group, Department of Clinical Neurosciences (S. Bell), University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- MRC Epidemiology Unit, School of Clinical Medicine (C.L., N.W.), University of Cambridge, UK
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Division of Cardiovascular Medicine (J.J., T.A.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, MA (R.J.S.)
- Division of Nephrology, Department of Medicine (C.R.-C., E.A.A.), Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics (R. Tao), Vanderbilt University Medical Center, Nashville, TN
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (N.S., C.B.), Nuffield Department of Population Health, University of Oxford, UK
- Cancer Epidemiology Unit (T.T.), Nuffield Department of Population Health, University of Oxford, UK
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey (S.A.)
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastián, Spain (P.A.)
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain (P.A.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- Division of Clinical Epidemiology and Aging Research (V.A.), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden (J.A., H.B.)
- School of Health and Social Studies, Dalarna University, Falun, Sweden (J.A.)
- Wellbeing & Preventable Chronic Diseases (WPCD) Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia (E.L.M.B.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.L.M.B., M.I.)
- Institute of Medicine, School of Public Health and Community Medicine (C.B.), Sahlgrenska Academy, University of Gothenburg, Sweden
- Institute of Medicine, Department of Molecular and Clinical Medicine (P.-O.H., A.R.), Sahlgrenska Academy, University of Gothenburg, Sweden
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B., W.M.M.V.)
- Network Aging Research (NAR), Heidelberg University, Germany (H.B.)
- Studium Patavinum (E.C.), University of Padua, Italy
- Department of Medicine (V.T.), University of Padua, Italy
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania ‘Luigi Vanvitelli’, Caserta, Italy (P.C.)
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, UK (J.A.C.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
- Larner College of Medicine, The University of Vermont, Burlington (M.C.)
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel (R.D.)
- School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel (R.D.)
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, NY (R.D., K.W.D.)
- Amsterdam University Medical Centers, VUMC, the Netherlands (R.T.d.J.)
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy (C.D., L. Palmer)
- Department of Clinical Sciences, Malmö, Lund University, Sweden (G.E., O.M.)
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France (H.F., E.W.)
- 12 Octubre Hospital Research Institute, Madrid, Spain (A.G.d,l,C.)
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland and Icelandic Heart Association, Kopavogur, Iceland (V.G.)
- Medical School Faculty of Health & Medical Sciences, The University of Western Australia, Perth, WA, Australia (G.J.H.)
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden (P.-O.H., A.R.)
- School of Public Health (A.K.H., I.T., E.R.), Imperial College London, UK
- The George Institute for Global Health (M.W.), Imperial College London, UK
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, the Netherlands (E.J.H.)
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan (H.I.)
- University of Eastern Finland (UEF), Kuopio, Finland (J.K.)
- Department of Neurology & Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria (S.K.)
- Clinical Epidemiology Team, Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria (S.K., P.W.)
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany (W.K.)
- Deutsches Herzzentrum München, Technische Universität München, Germany (W.K.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance (W.K.)
- School of Public Health, University of Washington, Seattle (R.A.K.)
- Danish Cancer Society Research Center, Copenhagen, Denmark (C.K., A.T.)
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK (D.A.L.)
- Population Health Science, Bristol Medical School, UK (D.A.L.)
- Department of Surgical and Perioperative sciences, Urology and Andrology, Umeå University, Sweden (B.L.)
- University Paris-Saclay, UVSQ, Inserm, Villejuif, France (C. MacDonald)
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy (G.M.)
- Helmholtz Zentrum München, Munich, Germany (C. Meisinger)
- Navarra Public Health Institute, IdiSNA, Pamplona, Spain (C.M.I.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain (C.M.I.)
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (T.N.)
- London School of Hygiene & Tropical Medicine, UK (D.N.)
- Herlev and Gentofte Hospital (B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Frederiksberg Hospital B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences (B.G.N.), University of Copenhagen, Denmark
- Department of Public Health (A.T.), University of Copenhagen, Denmark
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain (D.P.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain (D.P.)
- Consejería de Sanidad del Principado de Asturias Oviedo, Asturias, Spain (J.R.Q.G.)
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy (C. Sacerdote)
- Department of Social and Environmental Medicine, Kanazawa Medical University, Uchinada, Japan (M.S.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Spain (C. Santiuste)
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.B.S.)
- German Center for Diabetes Research (DZD), Neuherberg, Germany (M.B.S.)
- Institute of Nutritional Science, University of Potsdam, Germany (M.B.S.)
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy (S.S.)
- Department of Medical Sciences, Uppsala University, Sweden (J.S.)
- Hyblean Association for Epidemiological Reserach AIRE - ONLUS, Ragusa, Italy (R.T.)
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung SHIP/ Klinisch-Epidemiologische Forschung, Germany (H.V.)
- College of Public Health, University of Iowa (R.B.W.)
- University College London, UK (S.G.W.)
- The George Institute for Global Health, Camperdown, NSW, Australia (M.W.)
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Japan (K.Y.)
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat (Barcelona), Spain (R.Z.-R.)
- Center for Data and Computational Sciences, VA Boston Healthcare System, Boston, MA (S.P.)
- Department of Biostatistics, Boston University School of Public Health, MA (D.R.G.)
- VA Pal Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto Health Care System, CA (P.S.T.)
- Medicine (Cardiovascular Medicine), Stanford University of School of Medicine, CA (P.S.T.)
- Office of Research and Development, Veterans Health Administration, Washington, DC (S.M.)
- Department of Veterans Affairs, Tennessee Valley Health Care System, Vanderbilt University, Nashville (T.L.E.)
- Medicine/Epidemiology, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (T.L.E.)
- Department of Surgery, Corporal Michael Crescenz VA Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
- Internal Medicine, VA Atlanta Healthcare System, Decatur, GA (P.W.F.W.)
- Emory University School of Medicine (Cardiology), Emory University, Atlanta, GA (P.W.F.W.)
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (T.A.G.)
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- The Alan Turing Institute, London, UK (M.I.)
- Computational Medicine, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (C.L.)
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK (J.D.)
- Division of Nephrology & Hypertension, Department of Medicine, Tennessee Valley Health Care System and Vanderbilt University Medical Center, Nashville (A.M.H.)
- Cambridge Centre for AI in Medicine, UK (A.M.W.)
- Health Data Science Centre, Human Technopole, Milan, Italy (E.D.A.)
| | - Elizabeth L.M. Barr
- Wellbeing & Preventable Chronic Diseases (WPCD) Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia (E.L.M.B.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.L.M.B., M.I.)
| | - Cecilia Björkelund
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (N.S., C.B.), Nuffield Department of Population Health, University of Oxford, UK
| | - Jolanda M.A. Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B., W.M.M.V.)
| | - Hermann Brenner
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden (J.A., H.B.)
- Network Aging Research (NAR), Heidelberg University, Germany (H.B.)
| | | | - Paolo Chiodini
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania ‘Luigi Vanvitelli’, Caserta, Italy (P.C.)
| | - Jackie A. Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, UK (J.A.C.)
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Mary Cushman
- Larner College of Medicine, The University of Vermont, Burlington (M.C.)
| | - Rachel Dankner
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel (R.D.)
- School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel (R.D.)
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, NY (R.D., K.W.D.)
| | - Karina W. Davidson
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, NY (R.D., K.W.D.)
| | | | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy (C.D., L. Palmer)
| | - Gunnar Engström
- Department of Clinical Sciences, Malmö, Lund University, Sweden (G.E., O.M.)
| | - Heinz Freisling
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France (H.F., E.W.)
| | - Agustín Gómez de la Cámara
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- 12 Octubre Hospital Research Institute, Madrid, Spain (A.G.d,l,C.)
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland and Icelandic Heart Association, Kopavogur, Iceland (V.G.)
| | - Graeme J. Hankey
- Medical School Faculty of Health & Medical Sciences, The University of Western Australia, Perth, WA, Australia (G.J.H.)
| | - Per-Olof Hansson
- Institute of Medicine, Department of Molecular and Clinical Medicine (P.-O.H., A.R.), Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden (P.-O.H., A.R.)
| | - Alicia K. Heath
- School of Public Health (A.K.H., I.T., E.R.), Imperial College London, UK
| | - Ewout J. Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, the Netherlands (E.J.H.)
| | - Hironori Imano
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan (H.I.)
| | - Simerjot K. Jassal
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Verena Katzke
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jussi Kauhanen
- University of Eastern Finland (UEF), Kuopio, Finland (J.K.)
| | - Stefan Kiechl
- Department of Neurology & Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria (S.K.)
- Clinical Epidemiology Team, Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria (S.K., P.W.)
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany (W.K.)
- Deutsches Herzzentrum München, Technische Universität München, Germany (W.K.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance (W.K.)
| | | | - Cecilie Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark (C.K., A.T.)
| | - Deborah A. Lawlor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK (D.A.L.)
- Population Health Science, Bristol Medical School, UK (D.A.L.)
| | - Börje Ljungberg
- Department of Surgical and Perioperative sciences, Urology and Andrology, Umeå University, Sweden (B.L.)
| | - Conor MacDonald
- University Paris-Saclay, UVSQ, Inserm, Villejuif, France (C. MacDonald)
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy (G.M.)
| | | | - Olle Melander
- Department of Clinical Sciences, Malmö, Lund University, Sweden (G.E., O.M.)
| | - Conchi Moreno Iribas
- Navarra Public Health Institute, IdiSNA, Pamplona, Spain (C.M.I.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain (C.M.I.)
| | - Toshiharu Ninomiya
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (T.N.)
| | | | - Børge G. Nordestgaard
- Herlev and Gentofte Hospital (B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Frederiksberg Hospital B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences (B.G.N.), University of Copenhagen, Denmark
| | - Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
| | - Luigi Palmieri
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Medical Research Council Biostatistics Unit (A.M.M., S. Burgess), University of Cambridge, UK
- Stroke Research Group, Department of Clinical Neurosciences (S. Bell), University of Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- MRC Epidemiology Unit, School of Clinical Medicine (C.L., N.W.), University of Cambridge, UK
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Division of Cardiovascular Medicine (J.J., T.A.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, MA (R.J.S.)
- Division of Nephrology, Department of Medicine (C.R.-C., E.A.A.), Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics (R. Tao), Vanderbilt University Medical Center, Nashville, TN
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit (N.S., C.B.), Nuffield Department of Population Health, University of Oxford, UK
- Cancer Epidemiology Unit (T.T.), Nuffield Department of Population Health, University of Oxford, UK
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey (S.A.)
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastián, Spain (P.A.)
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain (P.A.)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- Division of Clinical Epidemiology and Aging Research (V.A.), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Cancer Epidemiology (S.K.J., R.K., V.K.), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden (J.A., H.B.)
- School of Health and Social Studies, Dalarna University, Falun, Sweden (J.A.)
- Wellbeing & Preventable Chronic Diseases (WPCD) Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia (E.L.M.B.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.L.M.B., M.I.)
- Institute of Medicine, School of Public Health and Community Medicine (C.B.), Sahlgrenska Academy, University of Gothenburg, Sweden
- Institute of Medicine, Department of Molecular and Clinical Medicine (P.-O.H., A.R.), Sahlgrenska Academy, University of Gothenburg, Sweden
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B., W.M.M.V.)
- Network Aging Research (NAR), Heidelberg University, Germany (H.B.)
- Studium Patavinum (E.C.), University of Padua, Italy
- Department of Medicine (V.T.), University of Padua, Italy
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania ‘Luigi Vanvitelli’, Caserta, Italy (P.C.)
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, UK (J.A.C.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
- Larner College of Medicine, The University of Vermont, Burlington (M.C.)
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel (R.D.)
- School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel (R.D.)
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, NY (R.D., K.W.D.)
- Amsterdam University Medical Centers, VUMC, the Netherlands (R.T.d.J.)
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy (C.D., L. Palmer)
- Department of Clinical Sciences, Malmö, Lund University, Sweden (G.E., O.M.)
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France (H.F., E.W.)
- 12 Octubre Hospital Research Institute, Madrid, Spain (A.G.d,l,C.)
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland and Icelandic Heart Association, Kopavogur, Iceland (V.G.)
- Medical School Faculty of Health & Medical Sciences, The University of Western Australia, Perth, WA, Australia (G.J.H.)
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden (P.-O.H., A.R.)
- School of Public Health (A.K.H., I.T., E.R.), Imperial College London, UK
- The George Institute for Global Health (M.W.), Imperial College London, UK
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, the Netherlands (E.J.H.)
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Japan (H.I.)
- University of Eastern Finland (UEF), Kuopio, Finland (J.K.)
- Department of Neurology & Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria (S.K.)
- Clinical Epidemiology Team, Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria (S.K., P.W.)
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany (W.K.)
- Deutsches Herzzentrum München, Technische Universität München, Germany (W.K.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance (W.K.)
- School of Public Health, University of Washington, Seattle (R.A.K.)
- Danish Cancer Society Research Center, Copenhagen, Denmark (C.K., A.T.)
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK (D.A.L.)
- Population Health Science, Bristol Medical School, UK (D.A.L.)
- Department of Surgical and Perioperative sciences, Urology and Andrology, Umeå University, Sweden (B.L.)
- University Paris-Saclay, UVSQ, Inserm, Villejuif, France (C. MacDonald)
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy (G.M.)
- Helmholtz Zentrum München, Munich, Germany (C. Meisinger)
- Navarra Public Health Institute, IdiSNA, Pamplona, Spain (C.M.I.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain (C.M.I.)
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (T.N.)
- London School of Hygiene & Tropical Medicine, UK (D.N.)
- Herlev and Gentofte Hospital (B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Frederiksberg Hospital B.G.N.), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences (B.G.N.), University of Copenhagen, Denmark
- Department of Public Health (A.T.), University of Copenhagen, Denmark
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain (D.P.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain (D.P.)
- Consejería de Sanidad del Principado de Asturias Oviedo, Asturias, Spain (J.R.Q.G.)
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy (C. Sacerdote)
- Department of Social and Environmental Medicine, Kanazawa Medical University, Uchinada, Japan (M.S.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Spain (C. Santiuste)
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.B.S.)
- German Center for Diabetes Research (DZD), Neuherberg, Germany (M.B.S.)
- Institute of Nutritional Science, University of Potsdam, Germany (M.B.S.)
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy (S.S.)
- Department of Medical Sciences, Uppsala University, Sweden (J.S.)
- Hyblean Association for Epidemiological Reserach AIRE - ONLUS, Ragusa, Italy (R.T.)
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung SHIP/ Klinisch-Epidemiologische Forschung, Germany (H.V.)
- College of Public Health, University of Iowa (R.B.W.)
- University College London, UK (S.G.W.)
- The George Institute for Global Health, Camperdown, NSW, Australia (M.W.)
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Japan (K.Y.)
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat (Barcelona), Spain (R.Z.-R.)
- Center for Data and Computational Sciences, VA Boston Healthcare System, Boston, MA (S.P.)
- Department of Biostatistics, Boston University School of Public Health, MA (D.R.G.)
- VA Pal Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto Health Care System, CA (P.S.T.)
- Medicine (Cardiovascular Medicine), Stanford University of School of Medicine, CA (P.S.T.)
- Office of Research and Development, Veterans Health Administration, Washington, DC (S.M.)
- Department of Veterans Affairs, Tennessee Valley Health Care System, Vanderbilt University, Nashville (T.L.E.)
- Medicine/Epidemiology, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (T.L.E.)
- Department of Surgery, Corporal Michael Crescenz VA Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
- Internal Medicine, VA Atlanta Healthcare System, Decatur, GA (P.W.F.W.)
- Emory University School of Medicine (Cardiology), Emory University, Atlanta, GA (P.W.F.W.)
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (T.A.G.)
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- The Alan Turing Institute, London, UK (M.I.)
- Computational Medicine, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (C.L.)
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK (J.D.)
- Division of Nephrology & Hypertension, Department of Medicine, Tennessee Valley Health Care System and Vanderbilt University Medical Center, Nashville (A.M.H.)
- Cambridge Centre for AI in Medicine, UK (A.M.W.)
- Health Data Science Centre, Human Technopole, Milan, Italy (E.D.A.)
| | - Dafina Petrova
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain (D.P.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain (D.P.)
| | | | - Annika Rosengren
- Institute of Medicine, Department of Molecular and Clinical Medicine (P.-O.H., A.R.), Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden (P.-O.H., A.R.)
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy (C. Sacerdote)
| | - Masaru Sakurai
- Department of Social and Environmental Medicine, Kanazawa Medical University, Uchinada, Japan (M.S.)
| | - Carmen Santiuste
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain (P.A., A.G.d.l.C., D.P., C. Santiuste)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Spain (C. Santiuste)
| | - Matthias B. Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (M.B.S.)
- German Center for Diabetes Research (DZD), Neuherberg, Germany (M.B.S.)
- Institute of Nutritional Science, University of Potsdam, Germany (M.B.S.)
| | - Sabina Sieri
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy (S.S.)
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Sweden (J.S.)
| | | | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark (C.K., A.T.)
- Department of Public Health (A.T.), University of Copenhagen, Denmark
| | - Tammy Tong
- Cancer Epidemiology Unit (T.T.), Nuffield Department of Population Health, University of Oxford, UK
| | - Rosario Tumino
- Hyblean Association for Epidemiological Reserach AIRE - ONLUS, Ragusa, Italy (R.T.)
| | - Ioanna Tzoulaki
- School of Public Health (A.K.H., I.T., E.R.), Imperial College London, UK
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
| | - W.M. Monique Verschuren
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (J.M.A.B., W.M.M.V.)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (C.O.-M., Y.T.v.d.S., W.M.M.V.)
| | - Henry Völzke
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung SHIP/ Klinisch-Epidemiologische Forschung, Germany (H.V.)
| | | | | | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France (H.F., E.W.)
| | - Peter Willeit
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Clinical Epidemiology Team, Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria (S.K., P.W.)
| | - Mark Woodward
- The George Institute for Global Health, Camperdown, NSW, Australia (M.W.)
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Japan (K.Y.)
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat (Barcelona), Spain (R.Z.-R.)
| | - Elvis A. Akwo
- Division of Nephrology, Department of Medicine (C.R.-C., E.A.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Saiju Pyarajan
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Data and Computational Sciences, VA Boston Healthcare System, Boston, MA (S.P.)
| | - David R. Gagnon
- Department of Biostatistics, Boston University School of Public Health, MA (D.R.G.)
| | - Philip S. Tsao
- VA Pal Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto Health Care System, CA (P.S.T.)
- Medicine (Cardiovascular Medicine), Stanford University of School of Medicine, CA (P.S.T.)
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, DC (S.M.)
| | - Todd L. Edwards
- Department of Veterans Affairs, Tennessee Valley Health Care System, Vanderbilt University, Nashville (T.L.E.)
- Medicine/Epidemiology, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (T.L.E.)
| | - Scott M. Damrauer
- Department of Surgery, Corporal Michael Crescenz VA Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
| | - Jacob Joseph
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- Division of Cardiovascular Medicine (J.J., T.A.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Lisa Pennells
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Peter W.F. Wilson
- Internal Medicine, VA Atlanta Healthcare System, Decatur, GA (P.W.F.W.)
- Emory University School of Medicine (Cardiology), Emory University, Atlanta, GA (P.W.F.W.)
| | - Seamus Harrison
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Thomas A. Gaziano
- Division of Cardiovascular Medicine (J.J., T.A.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (T.A.G.)
| | - Michael Inouye
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.L.M.B., M.I.)
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- The Alan Turing Institute, London, UK (M.I.)
| | - Colin Baigent
- Institute of Medicine, School of Public Health and Community Medicine (C.B.), Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Claudia Langenberg
- MRC Epidemiology Unit, School of Clinical Medicine (C.L., N.W.), University of Cambridge, UK
- Computational Medicine, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (C.L.)
| | - Nick Wareham
- MRC Epidemiology Unit, School of Clinical Medicine (C.L., N.W.), University of Cambridge, UK
| | - Elio Riboli
- The George Institute for Global Health (M.W.), Imperial College London, UK
| | - J.Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA (L.G., K.C., R.J.S., D.C.P., P.S., J.J., J.P.C., J.M.G.)
- Division of Aging (K.C., S.P., J.P.C. J.M.G.), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - John Danesh
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK (J.D.)
| | - Adriana M. Hung
- Division of Nephrology & Hypertension, Department of Medicine, Tennessee Valley Health Care System and Vanderbilt University Medical Center, Nashville (A.M.H.)
| | - Adam S. Butterworth
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
| | - Angela M. Wood
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Cambridge Centre for AI in Medicine, UK (A.M.W.)
| | - Emanuele Di Angelantonio
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care (L.G., L.S., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., T.R.B., E.A., L.C., J.R.S., P.W., L. Pennells, S.H., M.I., J.D., A.S.B., A.M.W., E.D.A.)
- BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital (A.M.M., S. Burgess, J.D., A.M.W., A.S.B., E.D.A.)
- Heart and Lung Research Institute, University of Cambridge, Cambridge UK (L.G., S. Bell, S.K.K., S. Burgess, K.M., A.M.M., E.A., L. Pennells, M.I., J.D., A.S.B., A.M.W., E.D.A.)
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (S. Bell, T.R.B., E.A., J.D., A.S.B., A.M.W., E.D.A.), University of Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, UK (M.I., J.D., A.S.B., A.M.W., E.D.A.)
- Health Data Science Centre, Human Technopole, Milan, Italy (E.D.A.)
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27
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Surendran P, Stewart ID, Au Yeung VPW, Pietzner M, Raffler J, Wörheide MA, Li C, Smith RF, Wittemans LBL, Bomba L, Menni C, Zierer J, Rossi N, Sheridan PA, Watkins NA, Mangino M, Hysi PG, Di Angelantonio E, Falchi M, Spector TD, Soranzo N, Michelotti GA, Arlt W, Lotta LA, Denaxas S, Hemingway H, Gamazon ER, Howson JMM, Wood AM, Danesh J, Wareham NJ, Kastenmüller G, Fauman EB, Suhre K, Butterworth AS, Langenberg C. Rare and common genetic determinants of metabolic individuality and their effects on human health. Nat Med 2022; 28:2321-2332. [PMID: 36357675 PMCID: PMC9671801 DOI: 10.1038/s41591-022-02046-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 09/16/2022] [Indexed: 11/12/2022]
Abstract
Garrod's concept of 'chemical individuality' has contributed to comprehension of the molecular origins of human diseases. Untargeted high-throughput metabolomic technologies provide an in-depth snapshot of human metabolism at scale. We studied the genetic architecture of the human plasma metabolome using 913 metabolites assayed in 19,994 individuals and identified 2,599 variant-metabolite associations (P < 1.25 × 10-11) within 330 genomic regions, with rare variants (minor allele frequency ≤ 1%) explaining 9.4% of associations. Jointly modeling metabolites in each region, we identified 423 regional, co-regulated, variant-metabolite clusters called genetically influenced metabotypes. We assigned causal genes for 62.4% of these genetically influenced metabotypes, providing new insights into fundamental metabolite physiology and clinical relevance, including metabolite-guided discovery of potential adverse drug effects (DPYD and SRD5A2). We show strong enrichment of inborn errors of metabolism-causing genes, with examples of metabolite associations and clinical phenotypes of non-pathogenic variant carriers matching characteristics of the inborn errors of metabolism. Systematic, phenotypic follow-up of metabolite-specific genetic scores revealed multiple potential etiological relationships.
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Affiliation(s)
- Praveen Surendran
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Hinxton, UK
- Rutherford Fund Fellow, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | - Maik Pietzner
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Raffler
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- Digital Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Maria A Wörheide
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Chen Li
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Rebecca F Smith
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Laura B L Wittemans
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Big Data Institute, University of Oxford, Oxford, UK
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Lorenzo Bomba
- Department of Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Open Targets, Wellcome Genome Campus, Hinxton, UK
| | - Cristina Menni
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Jonas Zierer
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Niccolò Rossi
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | | | | | - Massimo Mangino
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' Foundation Trust, London, UK
| | - Pirro G Hysi
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- Health Data Science Research Centre, Human Technopole, Milan, Italy
| | - Mario Falchi
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Tim D Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Nicole Soranzo
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Open Targets, Wellcome Genome Campus, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
| | | | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Luca A Lotta
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - Eric R Gamazon
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Clare Hall & MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Joanna M M Howson
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Genetics, Novo Nordisk Research Centre Oxford, Oxford, UK
| | - Angela M Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Hinxton, UK
- Department of Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Nicholas J Wareham
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Hinxton, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Gabi Kastenmüller
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Eric B Fauman
- Internal Medicine Research Unit, Pfizer Worldwide Research, Development and Medical, Cambridge, MA, USA
| | - Karsten Suhre
- Department of Biophysics and Physiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Hinxton, UK.
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK.
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK.
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28
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Graham IM, Di Angelantonio E, Huculeci R, Di Angelantonio E, De Bacquer D, Ference B, Halle M, Huculeci R, McEvoy J, Timmis A, Vardas P, Visseren F. New Way to "SCORE" Risk: Updates on the ESC Scoring System and Incorporation into ESC Cardiovascular Prevention Guidelines. Curr Cardiol Rep 2022; 24:1679-1684. [PMID: 36441402 DOI: 10.1007/s11886-022-01790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Prior European Society of Cardiology (ESC) guidelines endorsed the SCORE 10-year cardiovascular disease (CVD) risk calculator to inform the total risk approach to CVD prevention, including the use of preventive interventions like lipid lowering therapies. However, SCORE was released in 2003, did not allow for estimation of fatal and non-fatal CVD events, and was limited to adults aged 40 to 70 years. The ESC's Cardiovascular Risk Collaboration (CRC) was tasked with updating SCORE (SCORE2) and with extending the upper age range of adults eligible for risk estimation (SCORE2-OP). This review summarises these two deliverables. RECENT FINDINGS Published in 2021, these updated risk scores allow for estimation of 10 year total (fatal + non-fatal) risks of a first atherosclerotic cardiovascular event in adults (SCORE2) and older persons (SCORE2-OP), calibrated for use in four European risk regions. The models account for competing risk of non-CVD death. These were extensively validated with excellent calibration and C-statistics ranging from 0.67 to 0.81. SCORE2 and SCORE2-OP have informed the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. In addition to endorsing these two updated risk calculators, these guidelines have, for the first time, recommended the use of age-related risk categories. This change was motivated to prevent overreliance on age when making CVD prevention decisions.
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Affiliation(s)
- Ian M Graham
- Cardiovascular Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.,Health Data Science Centre, Human Technopole, Milan, Italy.,Clinical Epidemiology, University of Cambridge, Cambridge, England
| | - Radu Huculeci
- ESC European Heart Health Institute (EHHI), Brussels, Belgium
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29
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Chen L, Peters JE, Prins B, Persyn E, Traylor M, Surendran P, Karthikeyan S, Yonova-Doing E, Di Angelantonio E, Roberts DJ, Watkins NA, Ouwehand WH, Danesh J, Lewis CM, Bronson PG, Markus HS, Burgess S, Butterworth AS, Howson JMM. Systematic Mendelian randomization using the human plasma proteome to discover potential therapeutic targets for stroke. Nat Commun 2022; 13:6143. [PMID: 36253349 PMCID: PMC9576777 DOI: 10.1038/s41467-022-33675-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 09/28/2022] [Indexed: 02/02/2023] Open
Abstract
Stroke is the second leading cause of death with substantial unmet therapeutic needs. To identify potential stroke therapeutic targets, we estimate the causal effects of 308 plasma proteins on stroke outcomes in a two-sample Mendelian randomization framework and assess mediation effects by stroke risk factors. We find associations between genetically predicted plasma levels of six proteins and stroke (P ≤ 1.62 × 10-4). The genetic associations with stroke colocalize (Posterior Probability >0.7) with the genetic associations of four proteins (TFPI, TMPRSS5, CD6, CD40). Mendelian randomization supports atrial fibrillation, body mass index, smoking, blood pressure, white matter hyperintensities and type 2 diabetes as stroke risk factors (P ≤ 0.0071). Body mass index, white matter hyperintensity and atrial fibrillation appear to mediate the TFPI, IL6RA, TMPRSS5 associations with stroke. Furthermore, thirty-six proteins are associated with one or more of these risk factors using Mendelian randomization. Our results highlight causal pathways and potential therapeutic targets for stroke.
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Affiliation(s)
- Lingyan Chen
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Genetics, Novo Nordisk Research Centre Oxford, Oxford, UK
| | - James E Peters
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK
| | - Bram Prins
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Elodie Persyn
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Medical and Molecular Genetics, King's College London, London, UK
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matthew Traylor
- Department of Genetics, Novo Nordisk Research Centre Oxford, Oxford, UK
- Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Praveen Surendran
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Rutherford Fund Fellow, Department of Public Health and Primary Care, University of Cambridge, CB1 8RN, Cambridge, UK
| | - Savita Karthikeyan
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ekaterina Yonova-Doing
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Genetics, Novo Nordisk Research Centre Oxford, Oxford, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Health Data Science Research Centre, Human Technopole, Milan, Italy
| | - David J Roberts
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant-Oxford Centre, Level 2, John Radcliffe Hospital, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Nicholas A Watkins
- NHS Blood and Transplant, Cambridge Biomedical Campus, Long Road, Cambridge, UK
| | - Willem H Ouwehand
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, Cambridge Biomedical Campus, Long Road, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
- Wellcome Sanger Institute, Hinxton, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Cathryn M Lewis
- Department of Medical and Molecular Genetics, King's College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | | | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Stephen Burgess
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Joanna M M Howson
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Department of Genetics, Novo Nordisk Research Centre Oxford, Oxford, UK.
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Knight R, Walker V, Ip S, Cooper JA, Bolton T, Keene S, Denholm R, Akbari A, Abbasizanjani H, Torabi F, Omigie E, Hollings S, North TL, Toms R, Jiang X, Angelantonio ED, Denaxas S, Thygesen JH, Tomlinson C, Bray B, Smith CJ, Barber M, Khunti K, Davey Smith G, Chaturvedi N, Sudlow C, Whiteley WN, Wood AM, Sterne JA. Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales. Circulation 2022; 146:892-906. [PMID: 36121907 PMCID: PMC9484653 DOI: 10.1161/circulationaha.122.060785] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear. METHODS We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history. RESULTS Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0-22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21-1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3-35.2) in week 1 to 1.80 (95% CI, 1.50-2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses. CONCLUSIONS High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.
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Affiliation(s)
- Rochelle Knight
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
- NIHR Applied Research Collaboration West, Bristol, UK (R.K.)
- MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.)
| | - Venexia Walker
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.)
| | - Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Centre for Cancer Genetic Epidemiology (S.I.), University of Cambridge, UK
| | - Jennifer A. Cooper
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
| | - Thomas Bolton
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
- British Heart Foundation Data Science Centre (T.B., C.S.), London
| | - Spencer Keene
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
| | - Rachel Denholm
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
- Health Data Research UK South-West, Bristol (R.D., J.A.C.S.)
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.)
| | - Hoda Abbasizanjani
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.)
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.)
| | - Efosa Omigie
- National Health Service Digital, Leeds, UK (E.O., S.H.)
| | - Sam Hollings
- National Health Service Digital, Leeds, UK (E.O., S.H.)
| | - Teri-Louise North
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
| | - Renin Toms
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- School of Health Sciences, Cardiff Metropolitan University, UK (R.T.)
| | - Xiyun Jiang
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
- British Heart Foundation Centre of Research Excellence (E.D.A., A.M.W.), University of Cambridge, UK
- Wellcome Genome Campus, Health Data Research UK Cambridge (E.D.A., A.M.W.)
| | - Spiros Denaxas
- Health Data Research UK (S.D.), London
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK
- University College London Hospitals Biomedical Research Centre (C.T., S.D.), University College London, UK
- BHF Accelerator, London, UK (S.D.)
| | - Johan H. Thygesen
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK
| | - Christopher Tomlinson
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK
- UK Research and Innovation Centre for Doctoral Training in AI-Enabled Healthcare Systems (C.T.), University College London, UK
- University College London Hospitals Biomedical Research Centre (C.T., S.D.), University College London, UK
| | - Ben Bray
- School of Population Health and Environmental Sciences, King’s College London, UK (B.B.)
| | - Craig J. Smith
- Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Northern Care Alliance National Health Service Foundation Trust, Salford Royal Hospital, UK (C.J.S.)
- Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, UK (C.J.S.)
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, UK (K.K.)
| | - George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.)
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science (N.C.), University College London, UK
| | - Cathie Sudlow
- British Heart Foundation Data Science Centre (T.B., C.S.), London
| | - William N. Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, UK (W.N.W.)
- Nuffield Department of Population Health, University of Oxford, UK (W.N.W.)
| | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK
- British Heart Foundation Centre of Research Excellence (E.D.A., A.M.W.), University of Cambridge, UK
- Wellcome Genome Campus, Health Data Research UK Cambridge (E.D.A., A.M.W.)
- NIHR Cambridge Biomedical Research Centre, UK (A.M.W.)
- Cambridge Centre for AI in Medicine, UK (A.M.W.)
| | - Jonathan A.C. Sterne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.)
- NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.)
- Health Data Research UK South-West, Bristol (R.D., J.A.C.S.)
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Pathak GA, Karjalainen J, Stevens C, Neale BM, Daly M, Ganna A, Andrews SJ, Kanai M, Cordioli M, Polimanti R, Harerimana N, Pirinen M, Liao RG, Chwialkowska K, Trankiem A, Balaconis MK, Nguyen H, Solomonson M, Veerapen K, Wolford B, Roberts G, Park D, Ball CA, Coignet M, McCurdy S, Knight S, Partha R, Rhead B, Zhang M, Berkowitz N, Gaddis M, Noto K, Ruiz L, Pavlovic M, Hong EL, Rand K, Girshick A, Guturu H, Baltzell AH, Niemi MEK, Rahmouni S, Guntz J, Beguin Y, Cordioli M, Pigazzini S, Nkambule L, Georges M, Moutschen M, Misset B, Darcis G, Guiot J, Azarzar S, Gofflot S, Claassen S, Malaise O, Huynen P, Meuris C, Thys M, Jacques J, Léonard P, Frippiat F, Giot JB, Sauvage AS, Frenckell CV, Belhaj Y, Lambermont B, Nakanishi T, Morrison DR, Mooser V, Richards JB, Butler-Laporte G, Forgetta V, Li R, Ghosh B, Laurent L, Belisle A, Henry D, Abdullah T, Adeleye O, Mamlouk N, Kimchi N, Afrasiabi Z, Rezk N, Vulesevic B, Bouab M, Guzman C, Petitjean L, Tselios C, Xue X, Afilalo J, Afilalo M, Oliveira M, Brenner B, Brassard N, Durand M, Schurr E, Lepage P, Ragoussis J, Auld D, Chassé M, Kaufmann DE, Lathrop GM, Adra D, Hayward C, Glessner JT, Shaw DM, Campbell A, Morris M, Hakonarson H, Porteous DJ, Below J, Richmond A, Chang X, Polikowski H, Lauren PE, Chen HH, Wanying Z, Fawns-Ritchie C, North K, McCormick JB, Chang X, Glessner JR, Hakonarson H, Gignoux CR, Wicks SJ, Crooks K, Barnes KC, Daya M, Shortt J, Rafaels N, Chavan S, Timmers PRHJ, Wilson JF, Tenesa A, Kerr SM, D’Mellow K, Shahin D, El-Sherbiny YM, von Hohenstaufen KA, Sobh A, Eltoukhy MM, Nkambul L, Elhadidy TA, Abd Elghafar MS, El-Jawhari JJ, Mohamed AAS, Elnagdy MH, Samir A, Abdel-Aziz M, Khafaga WT, El-Lawaty WM, Torky MS, El-shanshory MR, Yassen AM, Hegazy MAF, Okasha K, Eid MA, Moahmed HS, Medina-Gomez C, Ikram MA, Uitterlinden AG, Mägi R, Milani L, Metspalu A, Laisk T, Läll K, Lepamets M, Esko T, Reimann E, Naaber P, Laane E, Pesukova J, Peterson P, Kisand K, Tabri J, Allos R, Hensen K, Starkopf J, Ringmets I, Tamm A, Kallaste A, Alavere H, Metsalu K, Puusepp M, Batini C, Tobin MD, Venn LD, Lee PH, Shrine N, Williams AT, Guyatt AL, John C, Packer RJ, Ali A, Free RC, Wang X, Wain LV, Hollox EJ, Bee CE, Adams EL, Palotie A, Ripatti S, Ruotsalainen S, Kristiansson K, Koskelainen S, Perola M, Donner K, Kivinen K, Palotie A, Kaunisto M, Rivolta C, Bochud PY, Bibert S, Boillat N, Nussle SG, Albrich W, Quinodoz M, Kamdar D, Suh N, Neofytos D, Erard V, Voide C, Bochud PY, Rivolta C, Bibert S, Quinodoz M, Kamdar D, Neofytos D, Erard V, Voide C, Friolet R, Vollenweider P, Pagani JL, Oddo M, zu Bentrup FM, Conen A, Clerc O, Marchetti O, Guillet A, Guyat-Jacques C, Foucras S, Rime M, Chassot J, Jaquet M, Viollet RM, Lannepoudenx Y, Portopena L, Bochud PY, Vollenweider P, Pagani JL, Desgranges F, Filippidis P, Guéry B, Haefliger D, Kampouri EE, Manuel O, Munting A, Papadimitriou-Olivgeris M, Regina J, Rochat-Stettler L, Suttels V, Tadini E, Tschopp J, Van Singer M, Viala B, Boillat-Blanco N, Brahier T, Hügli O, Meuwly JY, Pantet O, Gonseth Nussle S, Bochud M, D’Acremont V, Estoppey Younes S, Albrich WC, Suh N, Cerny A, O’Mahony L, von Mering C, Bochud PY, Frischknecht M, Kleger GR, Filipovic M, Kahlert CR, Wozniak H, Negro TR, Pugin J, Bouras K, Knapp C, Egger T, Perret A, Montillier P, di Bartolomeo C, Barda B, de Cid R, Carreras A, Moreno V, Kogevinas M, Galván-Femenía I, Blay N, Farré X, Sumoy L, Cortés B, Mercader JM, Guindo-Martinez M, Torrents D, Garcia-Aymerich J, Castaño-Vinyals G, Dobaño C, Gori M, Renieri A, Mari F, Mondelli MU, Castelli F, Vaghi M, Rusconi S, Montagnani F, Bargagli E, Franchi F, Mazzei MA, Cantarini L, Tacconi D, Feri M, Scala R, Spargi G, Nencioni C, Bandini M, Caldarelli GP, Canaccini A, Ognibene A, D’Arminio Monforte A, Girardis M, Antinori A, Francisci D, Schiaroli E, Scotton PG, Panese S, Scaggiante R, Monica MD, Capasso M, Fiorentino G, Castori M, Aucella F, Biagio AD, Masucci L, Valente S, Mandalà M, Zucchi P, Giannattasio F, Coviello DA, Mussini C, Tavecchia L, Crotti L, Rizzi M, Rovere MTL, Sarzi-Braga S, Bussotti M, Ravaglia S, Artuso R, Perrella A, Romani D, Bergomi P, Catena E, Vincenti A, Ferri C, Grassi D, Pessina G, Tumbarello M, Pietro MD, Sabrina R, Luchi S, Furini S, Dei S, Benetti E, Picchiotti N, Sanarico M, Ceri S, Pinoli P, Raimondi F, Biscarini F, Stella A, Zguro K, Capitani K, Nkambule L, Tanfoni M, Fallerini C, Daga S, Baldassarri M, Fava F, Frullanti E, Valentino F, Doddato G, Giliberti A, Tita R, Amitrano S, Bruttini M, Croci S, Meloni I, Mencarelli MA, Rizzo CL, Pinto AM, Beligni G, Tommasi A, Sarno LD, Palmieri M, Carriero ML, Alaverdian D, Busani S, Bruno R, Vecchia M, Belli MA, Mantovani S, Ludovisi S, Quiros-Roldan E, Antoni MD, Zanella I, Siano M, Emiliozzi A, Fabbiani M, Rossetti B, Bergantini L, D’Alessandro M, Cameli P, Bennett D, Anedda F, Marcantonio S, Scolletta S, Guerrini S, Conticini E, Frediani B, Spertilli C, Donati A, Guidelli L, Corridi M, Croci L, Piacentini P, Desanctis E, Cappelli S, Verzuri A, Anemoli V, Pancrazzi A, Lorubbio M, Miraglia FG, Venturelli S, Cossarizza A, Vergori A, Gabrieli A, Riva A, Paciosi F, Andretta F, Gatti F, Parisi SG, Baratti S, Piscopo C, Russo R, Andolfo I, Iolascon A, Carella M, Merla G, Squeo GM, Raggi P, Marciano C, Perna R, Bassetti M, Sanguinetti M, Giorli A, Salerni L, Parravicini P, Menatti E, Trotta T, Coiro G, Lena F, Martinelli E, Mancarella S, Gabbi C, Maggiolo F, Ripamonti D, Bachetti T, Suardi C, Parati G, Bottà G, Domenico PD, Rancan I, Bianchi F, Colombo R, Barbieri C, Acquilini D, Andreucci E, Segala FV, Tiseo G, Falcone M, Lista M, Poscente M, Vivo OD, Petrocelli P, Guarnaccia A, Baroni S, Hayward C, Porteous DJ, Fawns-Ritchie C, Richmond A, Campbell A, van Heel DA, Hunt KA, Trembath RC, Huang QQ, Martin HC, Mason D, Trivedi B, Wright J, Finer S, Akhtar S, Anwar M, Arciero E, Ashraf S, Breen G, Chung R, Curtis CJ, Chowdhury M, Colligan G, Deloukas P, Durham C, Finer S, Griffiths C, Huang QQ, Hurles M, Hunt KA, Hussain S, Islam K, Khan A, Khan A, Lavery C, Lee SH, Lerner R, MacArthur D, MacLaughlin B, Martin H, Mason D, Miah S, Newman B, Safa N, Tahmasebi F, Trembath RC, Trivedi B, van Heel DA, Wright J, Griffiths CJ, Smith AV, Boughton AP, Li KW, LeFaive J, Annis A, Niavarani A, Aliannejad R, Sharififard B, Amirsavadkouhi A, Naderpour Z, Tadi HA, Aleagha AE, Ahmadi S, Moghaddam SBM, Adamsara A, Saeedi M, Abdollahi H, Hosseini A, Chariyavilaskul P, Jantarabenjakul W, Hirankarn N, Chamnanphon M, Suttichet TB, Shotelersuk V, Pongpanich M, Phokaew C, Chetruengchai W, Putchareon O, Torvorapanit P, Puthanakit T, Suchartlikitwong P, Nilaratanakul V, Sodsai P, Brumpton BM, Hveem K, Willer C, Wolford B, Zhou W, Rogne T, Solligard E, Åsvold BO, Franke L, Boezen M, Deelen P, Claringbould A, Lopera E, Warmerdam R, Vonk JM, van Blokland I, Lanting P, Ori APS, Feng YCA, Mercader J, Weiss ST, Karlson EW, Smoller JW, Murphy SN, Meigs JB, Woolley AE, Green RC, Perez EF, Wolford B, Zöllner S, Wang J, Beck A, Sloofman LG, Ascolillo S, Sebra RP, Collins BL, Levy T, Buxbaum JD, Sealfon SC, Jordan DM, Thompson RC, Gettler K, Chaudhary K, Belbin GM, Preuss M, Hoggart C, Choi S, Underwood SJ, Salib I, Britvan B, Keller K, Tang L, Peruggia M, Hiester LL, Niblo K, Aksentijevich A, Labkowsky A, Karp A, Zlatopolsky M, Zyndorf M, Charney AW, Beckmann ND, Schadt EE, Abul-Husn NS, Cho JH, Itan Y, Kenny EE, Loos RJF, Nadkarni GN, Do R, O’Reilly P, Huckins LM, Ferreira MAR, Abecasis GR, Leader JB, Cantor MN, Justice AE, Carey DJ, Chittoor G, Josyula NS, Kosmicki JA, Horowitz JE, Baras A, Gass MC, Yadav A, Mirshahi T, Hottenga JJ, Bartels M, de geus EEJC, Nivard MMG, Verma A, Ritchie MD, Rader D, Li B, Verma SS, Lucas A, Bradford Y, Abedalthagafi M, Alaamery M, Alshareef A, Sawaji M, Massadeh S, AlMalik A, Alqahtani S, Baraka D, Harthi FA, Alsolm E, Safieh LA, Alowayn AM, Alqubaishi F, Mutairi AA, Mangul S, Almutairi M, Aljawini N, Albesher N, Arabi YM, Mahmoud ES, Khattab AK, Halawani RT, Alahmadey ZZ, Albakri JK, Felemban WA, Suliman BA, Hasanato R, Al-Awdah L, Alghamdi J, AlZahrani D, AlJohani S, Al-Afghani H, AlDhawi N, AlBardis H, Alkwai S, Alswailm M, Almalki F, Albeladi M, Almohammed I, Barhoush E, Albader A, Alotaibi S, Alghamdi B, Jung J, fawzy MS, Alrashed M, Zeberg H, Nkambul L, Frithiof R, Hultström M, Lipcsey M, Tardif N, Rooyackers O, Grip J, Maricic T, Helgeland Ø, Magnus P, Trogstad LIS, Lee Y, Harris JR, Mangino M, Spector TD, Emma D, Moutsianas L, Caulfield MJ, Scott RH, Kousathanas A, Pasko D, Walker S, Stuckey A, Odhams CA, Rhodes D, Fowler T, Rendon A, Chan G, Arumugam P, Karczewski KJ, Martin AR, Wilson DJ, Spencer CCA, Crook DW, Wyllie DH, O’Connell AM, Atkinson EG, Kanai M, Tsuo K, Baya N, Turley P, Gupta R, Walters RK, Palmer DS, Sarma G, Solomonson M, Cheng N, Lu W, Churchhouse C, Goldstein JI, King D, Zhou W, Seed C, Daly MJ, Neale BM, Finucane H, Bryant S, Satterstrom FK, Band G, Earle SG, Lin SK, Arning N, Koelling N, Armstrong J, Rudkin JK, Callier S, Bryant S, Cusick C, Soranzo N, Zhao JH, Danesh J, Angelantonio ED, Butterworth AS, Sun YV, Huffman JE, Cho K, O’Donnell CJ, Tsao P, Gaziano JM, Peloso G, Ho YL, Smieszek SP, Polymeropoulos C, Polymeropoulos V, Polymeropoulos MH, Przychodzen BP, Fernandez-Cadenas I, Planas AM, Perez-Tur J, Llucià-Carol L, Cullell N, Muiño E, Cárcel-Márquez J, DeDiego ML, Iglesias LL, Soriano A, Rico V, Agüero D, Bedini JL, Lozano F, Domingo C, Robles V, Ruiz-Jaén F, Márquez L, Gomez J, Coto E, Albaiceta GM, García-Clemente M, Dalmau D, Arranz MJ, Dietl B, Serra-Llovich A, Soler P, Colobrán R, Martín-Nalda A, Martínez AP, Bernardo D, Rojo S, Fiz-López A, Arribas E, de la Cal-Sabater P, Segura T, González-Villa E, Serrano-Heras G, Martí-Fàbregas J, Jiménez-Xarrié E, de Felipe Mimbrera A, Masjuan J, García-Madrona S, Domínguez-Mayoral A, Villalonga JM, Menéndez-Valladares P, Chasman DI, Sesso HD, Manson JE, Buring JE, Ridker PM, Franco G, Davis L, Lee S, Priest J, Sankaran VG, van Heel D, Biesecker L, Kerchberger VE, Baillie JK. A first update on mapping the human genetic architecture of COVID-19. Nature 2022; 608:E1-E10. [PMID: 35922517 PMCID: PMC9352569 DOI: 10.1038/s41586-022-04826-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/29/2022] [Indexed: 01/04/2023]
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Xu Z, Arnold M, Sun L, Stevens D, Chung R, Ip S, Barrett J, Kaptoge S, Pennells L, Di Angelantonio E, Wood AM. Incremental value of risk factor variability for cardiovascular risk prediction in individuals with type 2 diabetes: results from UK primary care electronic health records. Int J Epidemiol 2022; 51:1813-1823. [PMID: 35776101 PMCID: PMC9749723 DOI: 10.1093/ije/dyac140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/17/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) risk prediction models for individuals with type 2 diabetes are important tools to guide intensification of interventions for CVD prevention. We aimed to assess the added value of incorporating risk factors variability in CVD risk prediction for people with type 2 diabetes. METHODS We used electronic health records (EHRs) data from 83 910 adults with type 2 diabetes but without pre-existing CVD from the UK Clinical Practice Research Datalink for 2004-2017. Using a landmark-modelling approach, we developed and validated sex-specific Cox models, incorporating conventional predictors and trajectories plus variability of systolic blood pressure (SBP), total and high-density lipoprotein (HDL) cholesterol, and glycated haemoglobin (HbA1c). Such models were compared against simpler models using single last observed values or means. RESULTS The standard deviations (SDs) of SBP, HDL cholesterol and HbA1c were associated with higher CVD risk (P < 0.05). Models incorporating trajectories and variability of continuous predictors demonstrated improvement in risk discrimination (C-index = 0.659, 95% CI: 0.654-0.663) as compared with using last observed values (C-index = 0.651, 95% CI: 0.646-0.656) or means (C-index = 0.650, 95% CI: 0.645-0.655). Inclusion of SDs of SBP yielded the greatest improvement in discrimination (C-index increase = 0.005, 95% CI: 0.004-0.007) in comparison to incorporating SDs of total cholesterol (C-index increase = 0.002, 95% CI: 0.000-0.003), HbA1c (C-index increase = 0.002, 95% CI: 0.000-0.003) or HDL cholesterol (C-index increase= 0.003, 95% CI: 0.002-0.005). CONCLUSION Incorporating variability of predictors from EHRs provides a modest improvement in CVD risk discrimination for individuals with type 2 diabetes. Given that repeat measures are readily available in EHRs especially for regularly monitored patients with diabetes, this improvement could easily be achieved.
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Affiliation(s)
- Zhe Xu
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matthew Arnold
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Luanluan Sun
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - David Stevens
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ryan Chung
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jessica Barrett
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Stephen Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Angela M Wood
- Corresponding author. Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, CB1 8RN, UK. E-mail:
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Bomba L, Walter K, Guo Q, Surendran P, Kundu K, Nongmaithem S, Karim MA, Stewart ID, Langenberg C, Danesh J, Di Angelantonio E, Roberts DJ, Ouwehand WH, Dunham I, Butterworth AS, Soranzo N. Whole-exome sequencing identifies rare genetic variants associated with human plasma metabolites. Am J Hum Genet 2022; 109:1038-1054. [PMID: 35568032 PMCID: PMC9247822 DOI: 10.1016/j.ajhg.2022.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/13/2022] [Indexed: 12/11/2022] Open
Abstract
Metabolite levels measured in the human population are endophenotypes for biological processes. We combined sequencing data for 3,924 (whole-exome sequencing, WES, discovery) and 2,805 (whole-genome sequencing, WGS, replication) donors from a prospective cohort of blood donors in England. We used multiple approaches to select and aggregate rare genetic variants (minor allele frequency [MAF] < 0.1%) in protein-coding regions and tested their associations with 995 metabolites measured in plasma by using ultra-high-performance liquid chromatography-tandem mass spectrometry. We identified 40 novel associations implicating rare coding variants (27 genes and 38 metabolites), of which 28 (15 genes and 28 metabolites) were replicated. We developed algorithms to prioritize putative driver variants at each locus and used mediation and Mendelian randomization analyses to test directionality at associations of metabolite and protein levels at the ACY1 locus. Overall, 66% of reported associations implicate gene targets of approved drugs or bioactive drug-like compounds, contributing to drug targets' validating efforts.
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Affiliation(s)
- Lorenzo Bomba
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK; Open Targets, Wellcome Genome Campus, Hinxton CB10 1SD, UK
| | - Klaudia Walter
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Qi Guo
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
| | - Praveen Surendran
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Puddicombe Way, Cambridge CB2 0AW, UK
| | - Kousik Kundu
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Puddicombe Way, Cambridge CB2 0AW, UK
| | - Suraj Nongmaithem
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Mohd Anisul Karim
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK; Open Targets, Wellcome Genome Campus, Hinxton CB10 1SD, UK
| | - Isobel D Stewart
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0SL, UK
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0SL, UK; Computational Medicine, Berlin Institute of Health at Charité - Utniversitätsmedizin Berlin, Berlin 10117, Germany
| | - John Danesh
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK; British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB2 0QQ, UK; National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK; Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB2 0QQ, UK; National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK; Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK; Human Technopole, Palazzo Italia, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy
| | - David J Roberts
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK; NHS Blood and Transplant-Oxford Centre, Level 2, John Radcliffe Hospital, Oxford OX3 9BQ, UK; Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9BQ, UK
| | - Willem H Ouwehand
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Puddicombe Way, Cambridge CB2 0AW, UK
| | | | - Ian Dunham
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK; Open Targets, Wellcome Genome Campus, Hinxton CB10 1SD, UK; European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton CB10 1SD, UK
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB2 0QQ, UK; National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK; Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
| | - Nicole Soranzo
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK; Open Targets, Wellcome Genome Campus, Hinxton CB10 1SD, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Puddicombe Way, Cambridge CB2 0AW, UK; British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB2 0QQ, UK; National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK; Human Technopole, Palazzo Italia, Viale Rita Levi-Montalcini 1, 20157 Milan, Italy.
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. [2021 ESC Guidelines on cardiovascular disease prevention in clinical practice]. G Ital Cardiol (Rome) 2022; 23:e3-e115. [PMID: 35708476 DOI: 10.1714/3808.37926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Bountziouka V, Nelson CP, Codd V, Wang Q, Musicha C, Allara E, Kaptoge S, Di Angelantonio E, Butterworth AS, Thompson JR, Curtis EM, Wood AM, Danesh JN, Harvey NC, Cooper C, Samani NJ. Association of shorter leucocyte telomere length with risk of frailty. J Cachexia Sarcopenia Muscle 2022; 13:1741-1751. [PMID: 35297226 PMCID: PMC9178164 DOI: 10.1002/jcsm.12971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/24/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Frailty is a multidimensional syndrome of decline that affects multiple systems and predisposes to adverse health outcomes. Although chronological age is the major risk factor, inter-individual variation in risk is not fully understood. Leucocyte telomere length (LTL), a proposed marker of biological age, has been associated with risk of many diseases. We sought to determine whether LTL is associated with risk of frailty. METHODS We utilized cross-sectional data from 441 781 UK Biobank participants (aged 40-69 years), with complete data on frailty indicators and LTL. Frailty was defined as the presence of at least three of five indicators: weaker grip strength, slower walking pace, weight loss in the past year, lower physical activity, and exhaustion in the past 2 weeks. LTL was measured using a validated qPCR method and reported as a ratio of the telomere repeat number (T) to a single-copy gene (S) (T/S ratio). Association of LTL with frailty was evaluated using adjusted (chronological age, sex, deprivation, smoking, alcohol intake, body mass index, and multimorbidity) multinomial and ordinal regression models, and results are presented as relative risk (RRR) or odds ratios (OR), respectively, alongside the 95% confidence interval (CI). Mendelian randomization (MR), using 131 genetic variants associated with LTL, was used to assess if the association of LTL with frailty was causal. RESULTS Frail participants (4.6%) were older (median age difference (95% CI): 3 (2.5; 3.5) years, P = 2.73 × 10-33 ), more likely to be female (61%, P = 1.97 × 10-129 ), and had shorter LTL (-0.13SD vs. 0.03SD, P = 5.43 × 10-111 ) than non-frail. In adjusted analyses, both age and LTL were associated with frailty (RRR = 1.03 (95% CI: 1.02; 1.04) per year of older chronological age, P = 3.99 × 10-12 ; 1.10 (1.08; 1.11) per SD shorter LTL, P = 1.46 × 10-30 ). Within each age group (40-49, 50-59, 60-69 years), the prevalence of frailty was about 33% higher in participants with shorter (-2SD) versus longer telomeres (+2SD). MR analysis showed an association of LTL with frailty that was directionally consistent with the observational association, but not statistically significant (MR-Median: OR (95% CI): 1.08 (0.98; 1.19) per SD shorter LTL, P = 0.13). CONCLUSIONS Inter-individual variation in LTL is associated with the risk of frailty independently of chronological age and other risk factors. Our findings provide evidence for an additional biological determinant of frailty.
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Affiliation(s)
- Vasiliki Bountziouka
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Christopher P. Nelson
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Veryan Codd
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Qingning Wang
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Crispin Musicha
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Elias Allara
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of CambridgeCambridgeUK
| | - Stephen Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
| | - Adam S. Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
| | | | | | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
| | - John N. Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of CambridgeCambridgeUK
- Wellcome Sanger Institute, Wellcome Genome CampusCambridgeHinxtonUK
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Nilesh J. Samani
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
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Hageman SHJ, McKay AJ, Ueda P, Gunn LH, Jernberg T, Hagström E, Bhatt DL, Steg PG, Läll K, Mägi R, Gynnild MN, Ellekjær H, Saltvedt I, Tuñón J, Mahíllo I, Aceña Á, Kaminski K, Chlabicz M, Sawicka E, Tillman T, McEvoy JW, Di Angelantonio E, Graham I, De Bacquer D, Ray KK, Dorresteijn JAN, Visseren FLJ. Estimation of recurrent atherosclerotic cardiovascular event risk in patients with established cardiovascular disease: the updated SMART2 algorithm. Eur Heart J 2022; 43:1715-1727. [PMID: 35165703 PMCID: PMC9312860 DOI: 10.1093/eurheartj/ehac056] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/30/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
AIMS The 10-year risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events in patients with established ASCVD can be estimated with the Secondary Manifestations of ARTerial disease (SMART) risk score, and may help refine clinical management. To broaden generalizability across regions, we updated the existing tool (SMART2 risk score) and recalibrated it with regional incidence rates and assessed its performance in external populations. METHODS AND RESULTS Individuals with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysms were included from the Utrecht Cardiovascular Cohort-SMART cohort [n = 8355; 1706 ASCVD events during a median follow-up of 8.2 years (interquartile range 4.2-12.5)] to derive a 10-year risk prediction model for recurrent ASCVD events (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular mortality) using a Fine and Gray competing risk-adjusted model. The model was recalibrated to four regions across Europe, and to Asia (excluding Japan), Japan, Australia, North America, and Latin America using contemporary cohort data from each target region. External validation used data from seven cohorts [Clinical Practice Research Datalink, SWEDEHEART, the international REduction of Atherothrombosis for Continued Health (REACH) Registry, Estonian Biobank, Spanish Biomarkers in Acute Coronary Syndrome and Biomarkers in Acute Myocardial Infarction (BACS/BAMI), the Norwegian COgnitive Impairment After STroke, and Bialystok PLUS/Polaspire] and included 369 044 individuals with established ASCVD of whom 62 807 experienced an ASCVD event. C-statistics ranged from 0.605 [95% confidence interval (CI) 0.547-0.664] in BACS/BAMI to 0.772 (95% CI 0.659-0.886) in REACH Europe high-risk region. The clinical utility of the model was demonstrated across a range of clinically relevant treatment thresholds for intensified treatment options. CONCLUSION The SMART2 risk score provides an updated, validated tool for the prediction of recurrent ASCVD events in patients with established ASCVD across European and non-European populations. The use of this tool could allow for a more personalized approach to secondary prevention based upon quantitative rather than qualitative estimates of residual risk.
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Affiliation(s)
- Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Ailsa J McKay
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Peter Ueda
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Laura H Gunn
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Public Health Sciences and School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Ph. Gabriel Steg
- French Alliance for Cardiovascular Trials, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, INSERM Unité, 1148 Paris, France
| | - Kristi Läll
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Mari Nordbø Gynnild
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
- Department of Stroke, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
- Department of Stroke, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU—Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatrics, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - José Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Autónoma University, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Ignacio Mahíllo
- Department of Epidemiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Autónoma University, Madrid, Spain
| | - Karol Kaminski
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Białystok, Poland
| | - Malgorzata Chlabicz
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Białystok, Poland
- Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Emilia Sawicka
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Białystok, Poland
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Taavi Tillman
- Centre for Non-Communicable Disease, Institute for Global Health, University College London, London, UK
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
- Galway Campus, National University of Ireland Galway, Galway, Ireland
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ian Graham
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
- Corresponding author. Tel: +31 88 7555161, Fax: +31 30 2523741,
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Angelantonio ED, Franco OH, Halvorsen S, Richard Hobbs FD, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Rev Esp Cardiol (Engl Ed) 2022; 75:429. [PMID: 35525570 DOI: 10.1016/j.rec.2022.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Bountziouka V, Musicha C, Allara E, Kaptoge S, Wang Q, Angelantonio ED, Butterworth AS, Thompson JR, Danesh JN, Wood AM, Nelson CP, Codd V, Samani NJ. Modifiable traits, healthy behaviours, and leukocyte telomere length: a population-based study in UK Biobank. Lancet Healthy Longev 2022; 3:e321-e331. [PMID: 35685390 PMCID: PMC9068584 DOI: 10.1016/s2666-7568(22)00072-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Telomere length is associated with risk of several age-related diseases and cancers. We aimed to investigate the extent to which telomere length might be modifiable through lifestyle and behaviour, and whether such modification has any clinical consequences. Methods In this population-based study, we included participants from UK Biobank who had leukocyte telomere length (LTL) measurement, ethnicity, and white blood cell count data. We investigated associations of LTL with 117 potentially modifiable traits, as well as two indices of healthy behaviours incorporating between them smoking, physical activity, diet, maintenance of a healthy bodyweight, and alcohol intake, using both available and imputed data. To help interpretation, associations were summarised as the number of equivalent years of age-related change in LTL by dividing the trait β coefficients with the age β coefficient. We used mendelian randomisation to test causality of selected associations. We investigated whether the associations of LTL with 22 diseases were modified by the number of healthy behaviours and the extent to which the associations of more healthy behaviours with greater life expectancy and lower risk of coronary artery disease might be mediated through LTL. Findings 422 797 participants were available for the analysis (227 620 [53·8%] were women and 400 036 [94·6%] were White). 71 traits showed significant (p<4·27 × 10-4) associations with LTL but most were modest, equivalent to less than 1 year of age-related change in LTL. In multivariable analyses of 17 traits with stronger associations (equivalent to ≥2 years of age-related change in LTL), oily fish intake, educational attainment, and general health status retained a significant association of this magnitude, with walking pace and current smoking being additionally significant at this level of association in the imputed models. Mendelian randomisation analysis suggested that educational attainment and smoking behaviour causally affect LTL. Both indices of healthy behaviour were positively and linearly associated with LTL, with those with the most healthy behaviours having longer LTL equivalent to about 3·5 years of age-related change in LTL than those with the least heathy behaviours (p<0·001). However, healthy behaviours explained less than 0·2% of the total variation in LTL and did not significantly modify the association of LTL with risk of any of the diseases studied. Neither the association of more healthy behaviours on greater life expectancy or lower risk of coronary artery disease were substantially mediated through LTL. Interpretation Although several potentially modifiable traits and healthy behaviours have a quantifiable association with LTL, at least some of which are likely to be causal, these effects are not of a sufficient magnitude to substantially alter the association between LTL and various diseases or life expectancy. Attempts to change telomere length through lifestyle or behavioural changes might not confer substantial clinical benefit. Funding UK Medical Research Council, UK Biotechnology and Biological Sciences Research Council, and British Heart Foundation.
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Affiliation(s)
- Vasiliki Bountziouka
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Crispin Musicha
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Elias Allara
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, National Institute for Health Research Blood Transplant Research Unit in Donor Health and Genomics, and British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
| | - Stephen Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, National Institute for Health Research Blood Transplant Research Unit in Donor Health and Genomics, and British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
| | - Qingning Wang
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, National Institute for Health Research Blood Transplant Research Unit in Donor Health and Genomics, and British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, University of Cambridge, Cambridge, UK
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, National Institute for Health Research Blood Transplant Research Unit in Donor Health and Genomics, and British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, University of Cambridge, Cambridge, UK
| | - John R Thompson
- Department of Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - John N Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, National Institute for Health Research Blood Transplant Research Unit in Donor Health and Genomics, and British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, University of Cambridge, Cambridge, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Angela M Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, National Institute for Health Research Blood Transplant Research Unit in Donor Health and Genomics, and British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, University of Cambridge, Cambridge, UK
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Veryan Codd
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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Eysenbach G, Noh MFM, Ismail SR, van Daalen KR, Kamaruddin PSNM, Zulkiply SH, Azizul NH, Khalid NM, Ali A, Idris IM, Mei YS, Abdullah SR, Faridus N, Yusof NAM, Yusoff NNFM, Jamal R, Rahim AAA, Ghapar AKA, Radhakrishnan AK, Fong AYY, Ismail O, Krishinan S, Lee CY, Bang LH, Mageswaren E, Mahendran K, Amin NHM, Muthusamy G, Jin AOH, Ramli AW, Ross NT, Ruhani AI, Yahya M, Yusoff Y, Abidin SKZ, Amado L, Bolton T, Weston S, Crawte J, Ovenden N, Michielsen A, Monower MM, Mahiyuddin WRW, Wood A, Di Angelantonio E, Sulaiman NS, Danesh J, Butterworth AS. Investigating Genetic and Other Determinants of First-Onset Myocardial Infarction in Malaysia: Protocol for the Malaysian Acute Vascular Events Risk Study. JMIR Res Protoc 2022; 11:e31885. [PMID: 35142634 PMCID: PMC8874931 DOI: 10.2196/31885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the burden of premature myocardial infarction (MI) is high in Malaysia, direct evidence on the determinants of MI in this multi-ethnic population remains sparse. OBJECTIVE The Malaysian Acute Vascular Events Risk (MAVERIK) study is a retrospective case-control study established to investigate the genomic, lipid-related, and other determinants of acute MI in Malaysia. In this paper, we report the study protocol and early results. METHODS By June 2019, we had enrolled approximately 2500 patients with their first MI and 2500 controls without cardiovascular disease, who were frequency-matched by age, sex, and ethnicity, from 17 hospitals in Malaysia. For each participant, serum and whole blood have been collected and stored. Clinical, demographic, and behavioral information has been obtained using a 200-item questionnaire. RESULTS Tobacco consumption, a history of diabetes, hypertension, markers of visceral adiposity, indicators of lower socioeconomic status, and a family history of coronary disease were more prevalent in cases than in controls. Adjusted (age and sex) logistic regression models for traditional risk factors indicated that current smoking (odds ratio [OR] 4.11, 95% CI 3.56-4.75; P<.001), previous smoking (OR 1.34, 95% CI 1.12-1.60; P=.001), a history of high blood pressure (OR 2.13, 95% CI 1.86-2.44; P<.001), a history of diabetes mellitus (OR 2.72, 95% CI 2.34-3.17; P<.001), a family history of coronary heart disease (OR 1.28, 95% CI 1.07-1.55; P=.009), and obesity (BMI >30 kg/m2; OR 1.19, 95% CI 1.05-1.34; P=.009) were associated with MI in age- and sex-adjusted models. CONCLUSIONS The MAVERIK study can serve as a useful platform to investigate genetic and other risk factors for MI in an understudied Southeast Asian population. It should help to hasten the discovery of disease-causing pathways and inform regionally appropriate strategies that optimize public health action. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/31885.
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Affiliation(s)
| | - Mohd Fairulnizal Md Noh
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Sophia Rasheeqa Ismail
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Kim Robin van Daalen
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Siti Hafizah Zulkiply
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Nur Hayati Azizul
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Norhayati Mustafa Khalid
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Azizan Ali
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Izyan Mohd Idris
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Yong Shih Mei
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Shazana Rifham Abdullah
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Norfashihah Faridus
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Nur Azirah Md Yusof
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Nur Najwa Farahin M Yusoff
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Rahman Jamal
- UKM Medical Molecular Biological Institute, Kuala Lumpur, Malaysia
| | | | | | - Ammu Kutty Radhakrishnan
- Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Alan Yean Yip Fong
- Department of Cardiology, Sarawak Heart Centre, Kota Samarahan, Malaysia.,Clinical Research Centre, Institute for Clinical Research, Sarawak General Hospital, Kuching, Malaysia
| | - Omar Ismail
- Department of Cardiology, Hospital Pulau Pinang, Pulau Pinang, Malaysia
| | | | - Chuey Yan Lee
- Department of Cardiology, Hospital Sultanah Aminah, Johor, Malaysia
| | - Liew Houng Bang
- Department of Cardiology & Clinical Research Centre, Hospital Queen Elizabeth II, Sabah, Malaysia
| | - Eashwary Mageswaren
- Department of General Medicine, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
| | - Kauthaman Mahendran
- Department of General Medicine & Clinical Research Centre, Hospital Melaka, Melaka, Malaysia
| | - Nor Hanim Mohd Amin
- Department of General Medicine, Hospital Raja Permaisuri Bainun, Perak, Malaysia
| | | | - Aaron Ong Hean Jin
- Department of General Medicine, Hospital Tuanku Fauziah, Perlis, Malaysia
| | - Ahmad Wazi Ramli
- Department of Cardiology, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | - Noel Thomas Ross
- Department of General Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Mansor Yahya
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Yusniza Yusoff
- Department of General Medicine, Hospital Sungai Buloh, Selangor, Malaysia
| | | | - Laryssa Amado
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Thomas Bolton
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Sophie Weston
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jason Crawte
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Niko Ovenden
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Ank Michielsen
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Md Mostafa Monower
- National Heart Foundation Hospital & Research Institute, Mirpur, Dhaka, Bangladesh
| | - Wan Rozita Wan Mahiyuddin
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - Angela Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom.,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom.,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom.,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom.,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
| | - Nur Suffia Sulaiman
- Institute for Medical Research, National Institute of Health, Ministry of Health, Kuala Lumpur, Malaysia
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom.,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom.,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom.,Department of Human Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom.,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom.,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
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40
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Riveros-Mckay F, Roberts D, Di Angelantonio E, Yu B, Soranzo N, Danesh J, Selvin E, Butterworth AS, Barroso I. An Expanded Genome-Wide Association Study of Fructosamine Levels Identifies RCN3 as a Replicating Locus and Implicates FCGRT as the Effector Transcript. Diabetes 2022; 71:359-364. [PMID: 34753797 PMCID: PMC8914280 DOI: 10.2337/db21-0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022]
Abstract
Fructosamine is a measure of short-term glycemic control, which has been suggested as a useful complement to glycated hemoglobin (HbA1c) for the diagnosis and monitoring of diabetes. To date, a single genome-wide association study (GWAS) including 8,951 U.S. White and 2,712 U.S. Black individuals without a diabetes diagnosis has been published. Results in Whites and Blacks yielded different association loci, near RCN3 and CNTN5, respectively. In this study, we performed a GWAS on 20,731 European-ancestry blood donors and meta-analyzed our results with previous data from U.S. White participants from the Atherosclerosis Risk in Communities (ARIC) study (Nmeta = 29,685). We identified a novel association near GCK (rs3757840, βmeta = 0.0062; minor allele frequency [MAF] = 0.49; Pmeta = 3.66 × 10-8) and confirmed the association near RCN3 (rs113886122, βmeta = 0.0134; MAF = 0.17; Pmeta = 5.71 × 10-18). Colocalization analysis with whole-blood expression quantitative trait loci data suggested FCGRT as the effector transcript at the RCN3 locus. We further showed that fructosamine has low heritability (h2 = 7.7%), has no significant genetic correlation with HbA1c and other glycemic traits in individuals without a diabetes diagnosis (P > 0.05), but has evidence of shared genetic etiology with some anthropometric traits (Bonferroni-corrected P < 0.0012). Our results broaden knowledge of the genetic architecture of fructosamine and prioritize FCGRT for downstream functional studies at the established RCN3 locus.
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Affiliation(s)
| | - David Roberts
- Department of Public Health and Primary Care, The National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, U.K
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, U.K
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, U.K
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, The National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, U.K
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, U.K
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, U.K
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Nicole Soranzo
- Wellcome Sanger Institute, Cambridge, U.K
- Department of Public Health and Primary Care, The National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, U.K
- Department of Haematology, University of Cambridge, Cambridge, U.K
| | - John Danesh
- Wellcome Sanger Institute, Cambridge, U.K
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, U.K
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Adam S. Butterworth
- Department of Public Health and Primary Care, The National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, U.K
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, U.K
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Inês Barroso
- Wellcome Sanger Institute, Cambridge, U.K
- Exeter Centre of Excellence for Diabetes Research, University of Exeter Medical School, Exeter, U.K
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41
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Whiteley WN, Ip S, Cooper JA, Bolton T, Keene S, Walker V, Denholm R, Akbari A, Omigie E, Hollings S, Di Angelantonio E, Denaxas S, Wood A, Sterne JAC, Sudlow C. Association of COVID-19 vaccines ChAdOx1 and BNT162b2 with major venous, arterial, or thrombocytopenic events: A population-based cohort study of 46 million adults in England. PLoS Med 2022; 19:e1003926. [PMID: 35192597 PMCID: PMC8863280 DOI: 10.1371/journal.pmed.1003926] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Thromboses in unusual locations after the Coronavirus Disease 2019 (COVID-19) vaccine ChAdOx1-S have been reported, although their frequency with vaccines of different types is uncertain at a population level. The aim of this study was to estimate the population-level risks of hospitalised thrombocytopenia and major arterial and venous thromboses after COVID-19 vaccination. METHODS AND FINDINGS In this whole-population cohort study, we analysed linked electronic health records from adults living in England, from 8 December 2020 to 18 March 2021. We estimated incidence rates and hazard ratios (HRs) for major arterial, venous, and thrombocytopenic outcomes 1 to 28 and >28 days after first vaccination dose for ChAdOx1-S and BNT162b2 vaccines. Analyses were performed separately for ages <70 and ≥70 years and adjusted for age, age2, sex, ethnicity, and deprivation. We also prespecified adjustment for anticoagulant medication, combined oral contraceptive medication, hormone replacement therapy medication, history of pulmonary embolism or deep vein thrombosis, and history of coronavirus infection in analyses of venous thrombosis; and diabetes, hypertension, smoking, antiplatelet medication, blood pressure lowering medication, lipid lowering medication, anticoagulant medication, history of stroke, and history of myocardial infarction in analyses of arterial thromboses. We selected further covariates with backward selection. Of 46 million adults, 23 million (51%) were women; 39 million (84%) were <70; and 3.7 million (8.1%) Asian or Asian British, 1.6 million (3.5%) Black or Black British, 36 million (79%) White, 0.7 million (1.5%) mixed ethnicity, and 1.5 million (3.2%) were of another ethnicity. Approximately 21 million (46%) adults had their first vaccination between 8 December 2020 and 18 March 2021. The crude incidence rates (per 100,000 person-years) of all venous events were as follows: prevaccination, 140 [95% confidence interval (CI): 138 to 142]; ≤28 days post-ChAdOx1-S, 294 (281 to 307); >28 days post-ChAdOx1-S, 359 (338 to 382), ≤28 days post-BNT162b2-S, 241 (229 to 253); >28 days post-BNT162b2-S 277 (263 to 291). The crude incidence rates (per 100,000 person-years) of all arterial events were as follows: prevaccination, 546 (95% CI: 541 to 555); ≤28 days post-ChAdOx1-S, 1,211 (1,185 to 1,237); >28 days post-ChAdOx1-S, 1678 (1,630 to 1,726), ≤28 days post-BNT162b2-S, 1,242 (1,214 to 1,269); >28 days post-BNT162b2-S, 1,539 (1,507 to 1,572). Adjusted HRs (aHRs) 1 to 28 days after ChAdOx1-S, compared with unvaccinated rates, at ages <70 and ≥70 years, respectively, were 0.97 (95% CI: 0.90 to 1.05) and 0.58 (0.53 to 0.63) for venous thromboses, and 0.90 (0.86 to 0.95) and 0.76 (0.73 to 0.79) for arterial thromboses. Corresponding aHRs for BNT162b2 were 0.81 (0.74 to 0.88) and 0.57 (0.53 to 0.62) for venous thromboses, and 0.94 (0.90 to 0.99) and 0.72 (0.70 to 0.75) for arterial thromboses. aHRs for thrombotic events were higher at younger ages for venous thromboses after ChAdOx1-S, and for arterial thromboses after both vaccines. Rates of intracranial venous thrombosis (ICVT) and of thrombocytopenia in adults aged <70 years were higher 1 to 28 days after ChAdOx1-S (aHRs 2.27, 95% CI: 1.33 to 3.88 and 1.71, 1.35 to 2.16, respectively), but not after BNT162b2 (0.59, 0.24 to 1.45 and 1.00, 0.75 to 1.34) compared with unvaccinated. The corresponding absolute excess risks of ICVT 1 to 28 days after ChAdOx1-S were 0.9 to 3 per million, varying by age and sex. The main limitations of the study are as follows: (i) it relies on the accuracy of coded healthcare data to identify exposures, covariates, and outcomes; (ii) the use of primary reason for hospital admission to measure outcome, which improves the positive predictive value but may lead to an underestimation of incidence; and (iii) potential unmeasured confounding. CONCLUSIONS In this study, we observed increases in rates of ICVT and thrombocytopenia after ChAdOx1-S vaccination in adults aged <70 years that were small compared with its effect in reducing COVID-19 morbidity and mortality, although more precise estimates for adults aged <40 years are needed. For people aged ≥70 years, rates of arterial or venous thrombotic events were generally lower after either vaccine compared with unvaccinated, suggesting that either vaccine is suitable in this age group.
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Affiliation(s)
- William N. Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population Health University of Oxford, Oxford, United Kingdom
| | - Samantha Ip
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jennifer A. Cooper
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Thomas Bolton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- BHF Data Science Centre, Health Data Research UK, London, United Kingdom
| | - Spencer Keene
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Venexia Walker
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Rachel Denholm
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ashley Akbari
- Population Data Science, Health Data Research UK, Swansea University, Swansea, United Kingdom
| | | | | | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Spiros Denaxas
- BHF Data Science Centre, Health Data Research UK, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Angela Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan A. C. Sterne
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
- HDR UK South West, Bristol, United Kingdom
| | - Cathie Sudlow
- BHF Data Science Centre, Health Data Research UK, London, United Kingdom
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42
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Hageman S, Pennells L, Ojeda F, Kaptoge S, Dorresteijn J, Di Angelantonio E. SCORE2 models allow consideration of sex-specific cardiovascular disease risks by region. Eur Heart J 2022; 43:241-242. [PMID: 35080243 DOI: 10.1093/eurheartj/ehab761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Steven Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Netherlands
| | - Lisa Pennells
- Cardiovascular Epidemiology Unit, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | | | - Stephen Kaptoge
- Cardiovascular Epidemiology Unit, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
| | - Jannick Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Netherlands
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK
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43
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Xu Y, Vuckovic D, Ritchie SC, Akbari P, Jiang T, Grealey J, Butterworth AS, Ouwehand WH, Roberts DJ, Di Angelantonio E, Danesh J, Soranzo N, Inouye M. Machine learning optimized polygenic scores for blood cell traits identify sex-specific trajectories and genetic correlations with disease. Cell Genom 2022; 2:None. [PMID: 35072137 PMCID: PMC8758502 DOI: 10.1016/j.xgen.2021.100086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 08/24/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022]
Abstract
Genetic association studies for blood cell traits, which are key indicators of health and immune function, have identified several hundred associations and defined a complex polygenic architecture. Polygenic scores (PGSs) for blood cell traits have potential clinical utility in disease risk prediction and prevention, but designing PGS remains challenging and the optimal methods are unclear. To address this, we evaluated the relative performance of 6 methods to develop PGS for 26 blood cell traits, including a standard method of pruning and thresholding (P + T) and 5 learning methods: LDpred2, elastic net (EN), Bayesian ridge (BR), multilayer perceptron (MLP) and convolutional neural network (CNN). We evaluated these optimized PGSs on blood cell trait data from UK Biobank and INTERVAL. We find that PGSs designed using common machine learning methods EN and BR show improved prediction of blood cell traits and consistently outperform other methods. Our analyses suggest EN/BR as the top choices for PGS construction, showing improved performance for 25 blood cell traits in the external validation, with correlations with the directly measured traits increasing by 10%-23%. Ten PGSs showed significant statistical interaction with sex, and sex-specific PGS stratification showed that all of them had substantial variation in the trajectories of blood cell traits with age. Genetic correlations between the PGSs for blood cell traits and common human diseases identified well-known as well as new associations. We develop machine learning-optimized PGS for blood cell traits, demonstrate their relationships with sex, age, and disease, and make these publicly available as a resource.
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Affiliation(s)
- Yu Xu
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Dragana Vuckovic
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
| | - Scott C. Ritchie
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
| | - Parsa Akbari
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
| | - Tao Jiang
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Jason Grealey
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Department of Mathematics and Statistics, La Trobe University, Bundoora, VIC 3086, Australia
| | - Adam S. Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
| | - Willem H. Ouwehand
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- National Health Service (NHS) Blood and Transplant, Cambridge Biomedical Campus, Cambridge CB2 0PT, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0PT, UK
| | - David J. Roberts
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- National Health Service (NHS) Blood and Transplant, Cambridge Biomedical Campus, Cambridge CB2 0PT, UK
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- Health Data Science Research Centre, Human Technopole, Milan 20157, Italy
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
| | - Nicole Soranzo
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge CB1 8RN, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge CB10 1SA, UK
- The Alan Turing Institute, London NW1 2DB, UK
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Sadique Z, Willis S, Corte KD, Pennington M, Moore C, Kaptoge S, Angelantonio ED, Miflin G, Roberts DJ, Grieve R. Cost-effectiveness of alternative minimum recall intervals between whole blood donations. PLoS One 2022; 17:e0272854. [PMID: 35976959 PMCID: PMC9384981 DOI: 10.1371/journal.pone.0272854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The INTERVAL trial showed shorter inter-donation intervals could safely increase the frequency of whole-blood donation. We extended the INTERVAL trial to consider the relative cost-effectiveness of reduced inter-donation intervals. METHODS Our within-trial cost-effectiveness analysis (CEA) used data from 44,863 whole-blood donors randomly assigned to 12, 10 or 8 week (males), and 16, 14 or 12 week inter-donation intervals (females). The CEA analysed the number of whole-blood donations, deferrals including low- haemoglobin deferrals, and donors' health-related quality of life (QoL) to report costs and cost-effectiveness over two years. FINDINGS The mean number of blood donation visits over two years was higher for the reduced interval strategies, for males (7.76, 6.60 and 5.68 average donations in the 8-, 10- and 12- week arms) and for females (5.10, 4.60 and 4.01 donations in the 12-, 14- and 16- week arms). For males, the average rate of deferral for low haemoglobin per session attended, was 5.71% (8- week arm), 3.73% (10- week), and 2.55% (12- week), and for females the rates were: 7.92% (12-week), 6.63% (14- week), and 5.05% (16- week). Donors' QoL was similar across strategies, although self-reported symptoms were increased with shorter donation intervals. The shorter interval strategies increased average cost, with incremental cost-effectiveness ratios of £9.51 (95% CI 9.33 to 9.69) per additional whole-blood donation for the 8- versus 12- week interval for males, and £10.17 (95% CI 9.80 to 10.54) for the 12- versus 16- week interval arm for females. CONCLUSIONS Over two years, reducing the minimum donation interval could provide additional units of whole-blood at a small additional cost, including for those donor subgroups whose blood type is in relatively high demand. However, the significance of self-reported symptoms needs to be investigated further before these policies are expanded.
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Affiliation(s)
- Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Sarah Willis
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kaat De Corte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Pennington
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Health Services and Population Research, King’s College London, London, United Kingdom
| | - Carmel Moore
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- University of East Anglia, Norwich, United Kingdom
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Gail Miflin
- NHS Blood and Transplant, Liverpool, United Kingdom
| | - David J. Roberts
- Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- NHS Blood and Transplant, Liverpool, United Kingdom
- Radcliffe Department of Medicine and BRC Biomedical Centre–Haematology Theme, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Sofianopoulou E, Kaptoge SK, Afzal S, Jiang T, Gill D, Gundersen TE, Bolton TR, Allara E, Arnold MG, Mason AM, Chung R, Pennells LAM, Shi F, Sun L, Willeit P, Forouhi NG, Langenberg C, Sharp SJ, Panico S, Engström G, Melander O, Tong TYN, Perez-Cornago A, Norberg M, Johansson I, Katzke V, Srour B, José Sánchez M, Redondo-Sánchez D, Olsen A, Dahm CC, Overvad K, Brustad M, Skeie G, Moreno-Iribas C, Onland-Moret NC, van der Schouw YT, Tsilidis KK, Heath AK, Agnoli C, Krogh V, de Boer IH, Kobylecki CJ, Çolak Y, Zittermann A, Sundström J, Welsh P, Weiderpass E, Aglago EK, Ferrari P, Clarke R, Boutron MC, Severi G, MacDonald C, Providencia R, Masala G, Zamora Ros R, Boer J, Verschuren WMM, Cawthon P, Schierbeck LL, Cooper C, Schulze MB, Bergmann MM, Hannemann A, Kiechl S, Brenner H, van Schoor NM, Albertorio JR, Sacerdote C, Linneberg A, Kårhus LL, Huerta JM, Imaz L, Joergensen C, Ben-Shlomo Y, Lundqvist A, Gallacher J, Sattar N, Wood AM, Wareham NJ, Nordestgaard BG, Di Angelantonio E, Danesh J, Butterworth AS, Burgess S. Estimating dose-response relationships for vitamin D with coronary heart disease, stroke, and all-cause mortality: observational and Mendelian randomisation analyses. Lancet Diabetes Endocrinol 2021; 9:837-846. [PMID: 34717822 PMCID: PMC8600124 DOI: 10.1016/s2213-8587(21)00263-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Randomised trials of vitamin D supplementation for cardiovascular disease and all-cause mortality have generally reported null findings. However, generalisability of results to individuals with low vitamin D status is unclear. We aimed to characterise dose-response relationships between 25-hydroxyvitamin D (25[OH]D) concentrations and risk of coronary heart disease, stroke, and all-cause mortality in observational and Mendelian randomisation frameworks. METHODS Observational analyses were undertaken using data from 33 prospective studies comprising 500 962 individuals with no known history of coronary heart disease or stroke at baseline. Mendelian randomisation analyses were performed in four population-based cohort studies (UK Biobank, EPIC-CVD, and two Copenhagen population-based studies) comprising 386 406 middle-aged individuals of European ancestries, including 33 546 people who developed coronary heart disease, 18 166 people who had a stroke, and 27 885 people who died. Primary outcomes were coronary heart disease, defined as fatal ischaemic heart disease (International Classification of Diseases 10th revision code I20-I25) or non-fatal myocardial infarction (I21-I23); stroke, defined as any cerebrovascular disease (I60-I69); and all-cause mortality. FINDINGS Observational analyses suggested inverse associations between incident coronary heart disease, stroke, and all-cause mortality outcomes with 25(OH)D concentration at low 25(OH)D concentrations. In population-wide genetic analyses, there were no associations of genetically-predicted 25(OH)D with coronary heart disease, stroke, or all-cause mortality. However, for the participants with vitamin D deficiency (25[OH]D concentration <25 nmol/L), genetic analyses provided strong evidence for an inverse association with all-cause mortality (odds ratio [OR] per 10 nmol/L increase in genetically-predicted 25[OH]D concentration 0·69 [95% CI 0·59-0·80]; p<0·0001) and non-significant inverse associations for stroke (0·85 [0·70-1·02], p=0·09) and coronary heart disease (0·89 [0·76-1·04]; p=0·14). A finer stratification of participants found inverse associations between genetically-predicted 25(OH)D concentrations and all-cause mortality up to around 40 nmol/L. INTERPRETATION Stratified Mendelian randomisation analyses suggest a causal relationship between 25(OH)D concentrations and mortality for individuals with low vitamin D status. Our findings have implications for the design of vitamin D supplementation trials, and potential disease prevention strategies. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health Research, Health Data Research UK, Cancer Research UK, and International Agency for Research on Cancer.
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46
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Ritchie SC, Lambert SA, Arnold M, Teo SM, Lim S, Scepanovic P, Marten J, Zahid S, Chaffin M, Liu Y, Abraham G, Ouwehand WH, Roberts DJ, Watkins NA, Drew BG, Calkin AC, Di Angelantonio E, Soranzo N, Burgess S, Chapman M, Kathiresan S, Khera AV, Danesh J, Butterworth AS, Inouye M. Integrative analysis of the plasma proteome and polygenic risk of cardiometabolic diseases. Nat Metab 2021; 3:1476-1483. [PMID: 34750571 PMCID: PMC8574944 DOI: 10.1038/s42255-021-00478-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/14/2021] [Indexed: 01/13/2023]
Abstract
Cardiometabolic diseases are frequently polygenic in architecture, comprising a large number of risk alleles with small effects spread across the genome1-3. Polygenic scores (PGS) aggregate these into a metric representing an individual's genetic predisposition to disease. PGS have shown promise for early risk prediction4-7 and there is an open question as to whether PGS can also be used to understand disease biology8. Here, we demonstrate that cardiometabolic disease PGS can be used to elucidate the proteins underlying disease pathogenesis. In 3,087 healthy individuals, we found that PGS for coronary artery disease, type 2 diabetes, chronic kidney disease and ischaemic stroke are associated with the levels of 49 plasma proteins. Associations were polygenic in architecture, largely independent of cis and trans protein quantitative trait loci and present for proteins without quantitative trait loci. Over a follow-up of 7.7 years, 28 of these proteins associated with future myocardial infarction or type 2 diabetes events, 16 of which were mediators between polygenic risk and incident disease. Twelve of these were druggable targets with therapeutic potential. Our results demonstrate the potential for PGS to uncover causal disease biology and targets with therapeutic potential, including those that may be missed by approaches utilizing information at a single locus.
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Affiliation(s)
- Scott C Ritchie
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia.
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK.
| | - Samuel A Lambert
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Matthew Arnold
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Shu Mei Teo
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Sol Lim
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Petar Scepanovic
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Marten
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sohail Zahid
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mark Chaffin
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Yingying Liu
- Lipid Metabolism & Cardiometabolic Disease Laboratory, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Molecular Metabolism & Ageing Laboratory, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Gad Abraham
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Willem H Ouwehand
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - David J Roberts
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and John Radcliffe Hospital, Oxford, UK
| | - Nicholas A Watkins
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
| | - Brian G Drew
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Molecular Metabolism & Ageing Laboratory, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anna C Calkin
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Lipid Metabolism & Cardiometabolic Disease Laboratory, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- Centre for Health Data Science, Human Technopole, Milan, Italy
| | - Nicole Soranzo
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Stephen Burgess
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Michael Chapman
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | | | - Amit V Khera
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Cambridge Baker Systems Genomics Initiative, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia.
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK.
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK.
- Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia.
- The Alan Turing Institute, London, UK.
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Liu B, Mason AM, Sun L, Di Angelantonio E, Gill D, Burgess S. Genetically Predicted Type 2 Diabetes Mellitus Liability, Glycated Hemoglobin and Cardiovascular Diseases: A Wide-Angled Mendelian Randomization Study. Genes (Basel) 2021; 12:1644. [PMID: 34681038 PMCID: PMC8536164 DOI: 10.3390/genes12101644] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Aim: To investigate the causal effects of T2DM liability and glycated haemoglobin (HbA1c) levels on various cardiovascular disease outcomes, both in the general population and in non-diabetic individuals specifically. (2) Methods: We selected 243 variants as genetic instruments for T2DM liability and 536 variants for HbA1c. Linear Mendelian randomization analyses were performed to estimate the associations of genetically-predicted T2DM liability and HbA1c with 12 cardiovascular disease outcomes in 367,703 unrelated UK Biobank participants of European ancestries. We performed secondary analyses in participants without diabetes (HbA1c < 6.5% with no diagnosed diabetes), and in participants without diabetes or pre-diabetes (HbA1c < 5.7% with no diagnosed diabetes). (3) Results: Genetically-predicted T2DM liability was positively associated (p < 0.004, 0.05/12) with peripheral vascular disease, aortic valve stenosis, coronary artery disease, heart failure, ischaemic stroke, and any stroke. Genetically-predicted HbA1c was positively associated with coronary artery disease and any stroke. Mendelian randomization estimates generally shifted towards the null when excluding diabetic and pre-diabetic participants from analyses. (4) Conclusions: This genetic evidence supports causal effects of T2DM liability and HbA1c on a range of cardiovascular diseases, suggesting that improving glycaemic control could reduce cardiovascular risk in a general population, with greatest benefit in individuals with diabetes.
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Affiliation(s)
- Bowen Liu
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Amy M. Mason
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
| | - Luanluan Sun
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- Genetics Department, Novo Nordisk Research Centre Oxford, Old Road Campus, Oxford OX3 7FZ, UK
- Clinical Pharmacology and Therapeutics Section, Institute of Medical and Biomedical Education and Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
- Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (B.L.); (A.M.M.); (L.S.); (E.D.A.)
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge CB2 0SR, UK
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48
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Xu Z, Arnold M, Stevens D, Kaptoge S, Pennells L, Sweeting MJ, Barrett J, Di Angelantonio E, Wood AM. Prediction of Cardiovascular Disease Risk Accounting for Future Initiation of Statin Treatment. Am J Epidemiol 2021; 190:2000-2014. [PMID: 33595074 PMCID: PMC8485151 DOI: 10.1093/aje/kwab031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease (CVD) risk-prediction models are used to identify high-risk individuals and guide statin initiation. However, these models are usually derived from individuals who might initiate statins during follow-up. We present a simple approach to address statin initiation to predict “statin-naive” CVD risk. We analyzed primary care data (2004–2017) from the UK Clinical Practice Research Datalink for 1,678,727 individuals (aged 40–85 years) without CVD or statin treatment history at study entry. We derived age- and sex-specific prediction models including conventional risk factors and a time-dependent effect of statin initiation constrained to 25% risk reduction (from trial results). We compared predictive performance and measures of public-health impact (e.g., number needed to screen to prevent 1 event) against models ignoring statin initiation. During a median follow-up of 8.9 years, 103,163 individuals developed CVD. In models accounting for (versus ignoring) statin initiation, 10-year CVD risk predictions were slightly higher; predictive performance was moderately improved. However, few individuals were reclassified to a high-risk threshold, resulting in negligible improvements in number needed to screen to prevent 1 event. In conclusion, incorporating statin effects from trial results into risk-prediction models enables statin-naive CVD risk estimation and provides moderate gains in predictive ability but had a limited impact on treatment decision-making under current guidelines in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Angela M Wood
- Correspondence to Dr. Angela M. Wood, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, United Kingdom (e-mail: )
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49
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Goudswaard LJ, Bell JA, Hughes DA, Corbin LJ, Walter K, Davey Smith G, Soranzo N, Danesh J, Di Angelantonio E, Ouwehand WH, Watkins NA, Roberts DJ, Butterworth AS, Hers I, Timpson NJ. Effects of adiposity on the human plasma proteome: observational and Mendelian randomisation estimates. Int J Obes (Lond) 2021; 45:2221-2229. [PMID: 34226637 PMCID: PMC8455324 DOI: 10.1038/s41366-021-00896-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Variation in adiposity is associated with cardiometabolic disease outcomes, but mechanisms leading from this exposure to disease are unclear. This study aimed to estimate effects of body mass index (BMI) on an extensive set of circulating proteins. METHODS We used SomaLogic proteomic data from up to 2737 healthy participants from the INTERVAL study. Associations between self-reported BMI and 3622 unique plasma proteins were explored using linear regression. These were complemented by Mendelian randomisation (MR) analyses using a genetic risk score (GRS) comprised of 654 BMI-associated polymorphisms from a recent genome-wide association study (GWAS) of adult BMI. A disease enrichment analysis was performed using DAVID Bioinformatics 6.8 for proteins which were altered by BMI. RESULTS Observationally, BMI was associated with 1576 proteins (P < 1.4 × 10-5), with particularly strong evidence for a positive association with leptin and fatty acid-binding protein-4 (FABP4), and a negative association with sex hormone-binding globulin (SHBG). Observational estimates were likely confounded, but the GRS for BMI did not associate with measured confounders. MR analyses provided evidence for a causal relationship between BMI and eight proteins including leptin (0.63 standard deviation (SD) per SD BMI, 95% CI 0.48-0.79, P = 1.6 × 10-15), FABP4 (0.64 SD per SD BMI, 95% CI 0.46-0.83, P = 6.7 × 10-12) and SHBG (-0.45 SD per SD BMI, 95% CI -0.65 to -0.25, P = 1.4 × 10-5). There was agreement in the magnitude of observational and MR estimates (R2 = 0.33) and evidence that proteins most strongly altered by BMI were enriched for genes involved in cardiovascular disease. CONCLUSIONS This study provides evidence for a broad impact of adiposity on the human proteome. Proteins strongly altered by BMI include those involved in regulating appetite, sex hormones and inflammation; such proteins are also enriched for cardiovascular disease-related genes. Altogether, results help focus attention onto new proteomic signatures of obesity-related disease.
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Affiliation(s)
- Lucy J Goudswaard
- Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
- Bristol Heart Institute, Bristol, UK.
| | - Joshua A Bell
- Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David A Hughes
- Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura J Corbin
- Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - George Davey Smith
- Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicole Soranzo
- Wellcome Sanger Institute, Hinxton, UK
- Department of Haematology, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Danesh
- Wellcome Sanger Institute, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Emanuele Di Angelantonio
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Willem H Ouwehand
- Wellcome Sanger Institute, Hinxton, UK
- Department of Haematology, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
| | | | - David J Roberts
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant-Oxford Centre, Level 2, John Radcliffe Hospital, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Adam S Butterworth
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Ingeborg Hers
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
- Bristol Heart Institute, Bristol, UK
| | - Nicholas J Timpson
- Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2021; 29:5-115. [PMID: 34558602 DOI: 10.1093/eurjpc/zwab154] [Citation(s) in RCA: 181] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA).,International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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