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Bick AG, Akwo E, Robinson-Cohen C, Lee K, Lynch J, Assimes TL, DuVall S, Edwards T, Fang H, Freiberg SM, Giri A, Huffman JE, Huang J, Hull L, Kember RL, Klarin D, Lee JS, Levin M, Miller DR, Natarajan P, Saleheen D, Shao Q, Sun YV, Tang H, Wilson O, Chang KM, Cho K, Concato J, Gaziano JM, Kathiresan S, O'Donnell CJ, Rader DJ, Tsao PS, Wilson PW, Hung AM, Damrauer SM. Association of APOL1 Risk Alleles With Cardiovascular Disease in Blacks in the Million Veteran Program. Circulation 2019; 140:1031-1040. [PMID: 31337231 DOI: 10.1161/circulationaha.118.036589] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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] [Indexed: 01/27/2023]
Abstract
BACKGROUND Approximately 13% of black individuals carry 2 copies of the apolipoprotein L1 (APOL1) risk alleles G1 or G2, which are associated with 1.5- to 2.5-fold increased risk of chronic kidney disease. There have been conflicting reports as to whether an association exists between APOL1 risk alleles and cardiovascular disease (CVD) that is independent of the effects of APOL1 on kidney disease. We sought to test the association of APOL1 G1/G2 alleles with coronary artery disease, peripheral artery disease, and stroke among black individuals in the Million Veteran Program. METHODS We performed a time-to-event analysis of retrospective electronic health record data using Cox proportional hazard and competing-risks Fine and Gray subdistribution hazard models. The primary exposure was APOL1 risk allele status. The primary outcome was incident coronary artery disease among individuals without chronic kidney disease during the 12.5-year follow-up period. We separately analyzed the cross-sectional association of APOL1 risk allele status with lipid traits and 115 cardiovascular diseases using phenome-wide association. RESULTS Among 30 903 black Million Veteran Program participants, 3941 (13%) carried the 2 APOL1 risk allele high-risk genotype. Individuals with normal kidney function at baseline with 2 risk alleles had slightly higher risk of developing coronary artery disease compared with those with no risk alleles (hazard ratio, 1.11 [95% CI, 1.01-1.21]; P=0.039). Similarly, modest associations were identified with incident stroke (hazard ratio, 1.20 [95% CI, 1.05-1.36; P=0.007) and peripheral artery disease (hazard ratio, 1.15 [95% CI, 1.01-1.29l; P=0.031). When both cardiovascular and renal outcomes were modeled, APOL1 was strongly associated with incident renal disease, whereas no significant association with the CVD end points could be detected. Cardiovascular phenome-wide association analyses did not identify additional significant associations with CVD subsets. CONCLUSIONS APOL1 risk variants display a modest association with CVD, and this association is likely mediated by the known APOL1 association with chronic kidney disease.
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Affiliation(s)
- Alexander G Bick
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.)
| | - Elvis Akwo
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Cassianne Robinson-Cohen
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Kyung Lee
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.)
| | - Julie Lynch
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.).,University of Massachusetts College of Nursing & Health Sciences, Boston (J.L.).,VA Informatics and Computing Infrastructure, Salt Lake City, UT (J.L., S.D.)
| | - Themistocles L Assimes
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Scott DuVall
- VA Informatics and Computing Infrastructure, Salt Lake City, UT (J.L., S.D.)
| | - Todd Edwards
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Huaying Fang
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - S Matthew Freiberg
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Ayush Giri
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Jennifer E Huffman
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.)
| | - Jie Huang
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.)
| | - Leland Hull
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.)
| | - Rachel L Kember
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Derek Klarin
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.)
| | - Jennifer S Lee
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Michael Levin
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Donald R Miller
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.).,Boston University, MA (D.R.M.)
| | - Pradeep Natarajan
- Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.)
| | - Danish Saleheen
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Qing Shao
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.)
| | - Yan V Sun
- Atlanta VA Medical Center, GA (Y.V.S., P.W.W.).,Emory University, Atlanta, GA (Y.V.S., P.W.W.)
| | - Hua Tang
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Otis Wilson
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.)
| | - Kyong-Mi Chang
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Kelly Cho
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.)
| | - John Concato
- VA Connecticut HealthCare System, New Haven (J.C.)
| | - J Michael Gaziano
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Harvard Medical School, Boston, MA (J.M.G., S.K., C.J.O.)
| | - Sekar Kathiresan
- Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.).,Harvard Medical School, Boston, MA (J.M.G., S.K., C.J.O.)
| | - Christopher J O'Donnell
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Harvard Medical School, Boston, MA (J.M.G., S.K., C.J.O.)
| | - Daniel J Rader
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.)
| | - Philip S Tsao
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Peter W Wilson
- Atlanta VA Medical Center, GA (Y.V.S., P.W.W.).,Emory University, Atlanta, GA (Y.V.S., P.W.W.)
| | - Adriana M Hung
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Scott M Damrauer
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
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