Dyslipidemia, inflammation, calcification, and adiposity in aortic stenosis: a genome-wide study

AIMS

Although highly heritable, the genetic etiology of calcific aortic stenosis (AS) remains incompletely understood. The aim of this study was to discover novel genetic contributors to AS and to integrate functional, expression, and cross-phenotype data to identify mechanisms of AS.

METHODS AND RESULTS

A genome-wide meta-analysis of 11.6 million variants in 10 cohorts involving 653 867 European ancestry participants (13 765 cases) was performed. Seventeen loci were associated with AS at P ≤ 5 × 10-8, of which 15 replicated in an independent cohort of 90 828 participants (7111 cases), including CELSR2-SORT1, NLRP6, and SMC2. A genetic risk score comprised of the index variants was associated with AS [odds ratio (OR) per standard deviation, 1.31; 95% confidence interval (CI), 1.26-1.35; P = 2.7 × 10-51] and aortic valve calcium (OR per standard deviation, 1.22; 95% CI, 1.08-1.37; P = 1.4 × 10-3), after adjustment for known risk factors. A phenome-wide association study indicated multiple associations with coronary artery disease, apolipoprotein B, and triglycerides. Mendelian randomization supported a causal role for apolipoprotein B-containing lipoprotein particles in AS (OR per g/L of apolipoprotein B, 3.85; 95% CI, 2.90-5.12; P = 2.1 × 10-20) and replicated previous findings of causality for lipoprotein(a) (OR per natural logarithm, 1.20; 95% CI, 1.17-1.23; P = 4.8 × 10-73) and body mass index (OR per kg/m2, 1.07; 95% CI, 1.05-1.9; P = 1.9 × 10-12). Colocalization analyses using the GTEx database identified a role for differential expression of the genes LPA, SORT1, ACTR2, NOTCH4, IL6R, and FADS.

CONCLUSION

Dyslipidemia, inflammation, calcification, and adiposity play important roles in the etiology of AS, implicating novel treatments and prevention strategies.

Cervical sonography in pregnant women with a prior cone biopsy or loop electrosurgical excision procedure

OBJECTIVES

To determine if pregnant women with a prior cone biopsy or loop electrosurgical excision procedure (LEEP) have a shorter midtrimester cervical length than do matched controls without a history of cervical surgery.

METHODS

Eighty-five pregnant women with a singleton gestation and previous cone biopsy or LEEP and 85 controls matched by age (± 5 years), race, gestational age (± 2 weeks), and number of prior vaginal deliveries underwent a single transvaginal cervical sonographic scan at 15-22 weeks' gestation. No patient had a cerclage in either group.

RESULTS

Mean cervical length was significantly shorter in the cone biopsy/LEEP group (3.3 vs. 3.9 cm, P < 0.001), with no significant difference in the proportion of cervical lengths less than 2.5 cm (5.9 vs. 2.4%). Gestational age at delivery was slightly but significantly lower in the cone biopsy/LEEP group (38.1 vs. 39.1 weeks, P = 0.005) than in the control group, with a higher proportion of women delivering late preterm and very preterm in the cone biopsy/LEEP group. However, no woman with a prior cone biopsy/LEEP experienced a midtrimester loss suggestive of cervical insufficiency, and no patient with a cervical length less than 2.5 cm delivered before 34 weeks' gestation.

CONCLUSIONS

Midtrimester cervical length in women with a previous cone biopsy or LEEP is significantly shorter than in those without prior cervical surgery. Based on the low frequency of a short cervix or midtrimester loss in women with prior excisional surgery, the routine use of midtrimester cervical sonography in such women is not supported.