1
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Schnitzler GR, Kang H, Fang S, Angom RS, Lee-Kim VS, Ma XR, Zhou R, Zeng T, Guo K, Taylor MS, Vellarikkal SK, Barry AE, Sias-Garcia O, Bloemendal A, Munson G, Guckelberger P, Nguyen TH, Bergman DT, Hinshaw S, Cheng N, Cleary B, Aragam K, Lander ES, Finucane HK, Mukhopadhyay D, Gupta RM, Engreitz JM. Convergence of coronary artery disease genes onto endothelial cell programs. Nature 2024; 626:799-807. [PMID: 38326615 PMCID: PMC10921916 DOI: 10.1038/s41586-024-07022-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/03/2024] [Indexed: 02/09/2024]
Abstract
Linking variants from genome-wide association studies (GWAS) to underlying mechanisms of disease remains a challenge1-3. For some diseases, a successful strategy has been to look for cases in which multiple GWAS loci contain genes that act in the same biological pathway1-6. However, our knowledge of which genes act in which pathways is incomplete, particularly for cell-type-specific pathways or understudied genes. Here we introduce a method to connect GWAS variants to functions. This method links variants to genes using epigenomics data, links genes to pathways de novo using Perturb-seq and integrates these data to identify convergence of GWAS loci onto pathways. We apply this approach to study the role of endothelial cells in genetic risk for coronary artery disease (CAD), and discover 43 CAD GWAS signals that converge on the cerebral cavernous malformation (CCM) signalling pathway. Two regulators of this pathway, CCM2 and TLNRD1, are each linked to a CAD risk variant, regulate other CAD risk genes and affect atheroprotective processes in endothelial cells. These results suggest a model whereby CAD risk is driven in part by the convergence of causal genes onto a particular transcriptional pathway in endothelial cells. They highlight shared genes between common and rare vascular diseases (CAD and CCM), and identify TLNRD1 as a new, previously uncharacterized member of the CCM signalling pathway. This approach will be widely useful for linking variants to functions for other common polygenic diseases.
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Affiliation(s)
- Gavin R Schnitzler
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- The Novo Nordisk Foundation Center for Genomic Mechanisms of Disease, Broad Institute, Cambridge, MA, USA
- Divisions of Genetics and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Helen Kang
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Basic Science and Engineering Initiative, Stanford Children's Health, Betty Irene Moore Children's Heart Center, Stanford, CA, USA
| | - Shi Fang
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Divisions of Genetics and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ramcharan S Angom
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Vivian S Lee-Kim
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Divisions of Genetics and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - X Rosa Ma
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Basic Science and Engineering Initiative, Stanford Children's Health, Betty Irene Moore Children's Heart Center, Stanford, CA, USA
| | - Ronghao Zhou
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Basic Science and Engineering Initiative, Stanford Children's Health, Betty Irene Moore Children's Heart Center, Stanford, CA, USA
| | - Tony Zeng
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Basic Science and Engineering Initiative, Stanford Children's Health, Betty Irene Moore Children's Heart Center, Stanford, CA, USA
| | - Katherine Guo
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Basic Science and Engineering Initiative, Stanford Children's Health, Betty Irene Moore Children's Heart Center, Stanford, CA, USA
| | - Martin S Taylor
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shamsudheen K Vellarikkal
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Divisions of Genetics and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Aurelie E Barry
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Divisions of Genetics and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Oscar Sias-Garcia
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Divisions of Genetics and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alex Bloemendal
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- The Novo Nordisk Foundation Center for Genomic Mechanisms of Disease, Broad Institute, Cambridge, MA, USA
| | - Glen Munson
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Tung H Nguyen
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Drew T Bergman
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Stephen Hinshaw
- Department of Chemical and Systems Biology, ChEM-H, and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Nathan Cheng
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Brian Cleary
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Faculty of Computing and Data Sciences, Departments of Biology and Biomedical Engineering, Biological Design Center, and Program in Bioinformatics, Boston University, Boston, MA, USA
| | - Krishna Aragam
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Eric S Lander
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Biology, MIT, Cambridge, MA, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Hilary K Finucane
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Rajat M Gupta
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- The Novo Nordisk Foundation Center for Genomic Mechanisms of Disease, Broad Institute, Cambridge, MA, USA.
- Divisions of Genetics and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Jesse M Engreitz
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- The Novo Nordisk Foundation Center for Genomic Mechanisms of Disease, Broad Institute, Cambridge, MA, USA.
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.
- Basic Science and Engineering Initiative, Stanford Children's Health, Betty Irene Moore Children's Heart Center, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
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2
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Rasooly D, Peloso GM, Pereira AC, Dashti H, Giambartolomei C, Wheeler E, Aung N, Ferolito BR, Pietzner M, Farber-Eger EH, Wells QS, Kosik NM, Gaziano L, Posner DC, Bento AP, Hui Q, Liu C, Aragam K, Wang Z, Charest B, Huffman JE, Wilson PWF, Phillips LS, Whittaker J, Munroe PB, Petersen SE, Cho K, Leach AR, Magariños MP, Gaziano JM, Langenberg C, Sun YV, Joseph J, Casas JP. Genome-wide association analysis and Mendelian randomization proteomics identify drug targets for heart failure. Nat Commun 2023; 14:3826. [PMID: 37429843 PMCID: PMC10333277 DOI: 10.1038/s41467-023-39253-3] [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: 12/08/2022] [Accepted: 06/05/2023] [Indexed: 07/12/2023] Open
Abstract
We conduct a large-scale meta-analysis of heart failure genome-wide association studies (GWAS) consisting of over 90,000 heart failure cases and more than 1 million control individuals of European ancestry to uncover novel genetic determinants for heart failure. Using the GWAS results and blood protein quantitative loci, we perform Mendelian randomization and colocalization analyses on human proteins to provide putative causal evidence for the role of druggable proteins in the genesis of heart failure. We identify 39 genome-wide significant heart failure risk variants, of which 18 are previously unreported. Using a combination of Mendelian randomization proteomics and genetic cis-only colocalization analyses, we identify 10 additional putatively causal genes for heart failure. Findings from GWAS and Mendelian randomization-proteomics identify seven (CAMK2D, PRKD1, PRKD3, MAPK3, TNFSF12, APOC3 and NAE1) proteins as potential targets for interventions to be used in primary prevention of heart failure.
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Affiliation(s)
- Danielle Rasooly
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02130, USA.
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA.
| | - Gina M Peloso
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave Crosstown Centre, Boston, MA, 02118, USA
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo, Av Dr Eneas de Carvalho Aguiar 54, São Paulo, 5403000, Brazil
- Genetics Department, Harvard Medical School, Harvard University, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - Hesam Dashti
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02130, USA
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA, 02142, USA
| | - Claudia Giambartolomei
- Health Data Science Centre, Human Technopole, V.le Rita Levi-Montalcini, 1, Milan, 20157, Italy
- Central RNA Lab, Non-coding RNAs and RNA-based Therapeutics, Istituto Italiano di Tecnologia, Via Morego 30, 16163, Genova, Italy
| | - Eleanor Wheeler
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Addenbrookes Hospital, IMS, Box 285, Cambridge, CB2 0QQ, UK
| | - Nay Aung
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Brian R Ferolito
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
| | - Maik Pietzner
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Addenbrookes Hospital, IMS, Box 285, Cambridge, CB2 0QQ, UK
- Computational Medicine, Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Kapelle Ufer 2, Berlin, 10117, Germany
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
| | - Eric H Farber-Eger
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn Stanton Wells
- Vanderbilt University Med. Ctr., Departments of Medicine (Cardiology), Biomedical Informatics, and Pharmacology, Nashville, TN, USA
| | - Nicole M Kosik
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
| | - Liam Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Daniel C Posner
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
| | - A Patrícia Bento
- Department of Chemical Biology, European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, CB10 1SD, UK
| | - Qin Hui
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
- Atlanta VA Health Care System, 1670 Clairmont Road, Decatur, GA, 30033, USA
| | - Chang Liu
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Krishna Aragam
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
- Broad Institute of MIT and Harvard, 415 Main St., Cambridge, MA, 02142, USA
- Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Zeyuan Wang
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
| | - Jennifer E Huffman
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
| | - Peter W F Wilson
- Atlanta VA Health Care System, 1670 Clairmont Road, Decatur, GA, 30033, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1639 Pierce Dr NE, Atlanta, GA, 30322, USA
| | - Lawrence S Phillips
- Atlanta VA Health Care System, 1670 Clairmont Road, Decatur, GA, 30033, USA
- Division of Endocrinology, Emory University, 101 Woodruff Circle, WMRB 1027, Atlanta, GA, 30322, USA
| | - John Whittaker
- MRC Biostatistics Unit, University of Cambridge, Cambridge, CB2 0SR, United Kingdom
| | - Patricia B Munroe
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- National Institute for Health Research, Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 68Q, UK
| | - Kelly Cho
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02130, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
| | - Andrew R Leach
- Department of Chemical Biology, European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, CB10 1SD, UK
| | - María Paula Magariños
- Department of Chemical Biology, European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, CB10 1SD, UK
| | - John Michael Gaziano
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02130, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Addenbrookes Hospital, IMS, Box 285, Cambridge, CB2 0QQ, UK
- Computational Medicine, Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Kapelle Ufer 2, Berlin, 10117, Germany
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK
| | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
- Atlanta VA Health Care System, 1670 Clairmont Road, Decatur, GA, 30033, USA
- Department of Biomedical Informatics, Emory University School of Medicine, 1639 Pierce Dr NE, Atlanta, GA, 30332, USA
| | - Jacob Joseph
- Cardiology Section, VA Providence Healthcare System, 830 Chalkstone Avenue, Providence, RI, 02908, USA.
- Department of Medicine, Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, USA.
| | - Juan P Casas
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02130, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150. S. Huntington Ave, Boston, MA, 02130, USA
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3
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Joseph J, Liu C, Hui Q, Aragam K, Wang Z, Charest B, Huffman JE, Keaton JM, Edwards TL, Demissie S, Djousse L, Casas JP, Gaziano JM, Cho K, Wilson PWF, Phillips LS, O’Donnell CJ, Sun YV. Genetic architecture of heart failure with preserved versus reduced ejection fraction. Nat Commun 2022; 13:7753. [PMID: 36517512 PMCID: PMC9751124 DOI: 10.1038/s41467-022-35323-0] [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: 02/17/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Pharmacologic clinical trials for heart failure with preserved ejection fraction have been largely unsuccessful as compared to those for heart failure with reduced ejection fraction. Whether differences in the genetic underpinnings of these major heart failure subtypes may provide insights into the disparate outcomes of clinical trials remains unknown. We utilize a large, uniformly phenotyped, single cohort of heart failure sub-classified into heart failure with reduced and with preserved ejection fractions based on current clinical definitions, to conduct detailed genetic analyses of the two heart failure sub-types. We find different genetic architectures and distinct genetic association profiles between heart failure with reduced and with preserved ejection fraction suggesting differences in underlying pathobiology. The modest genetic discovery for heart failure with preserved ejection fraction (one locus) compared to heart failure with reduced ejection fraction (13 loci) despite comparable sample sizes indicates that clinically defined heart failure with preserved ejection fraction likely represents the amalgamation of several, distinct pathobiological entities. Development of consensus sub-phenotyping of heart failure with preserved ejection fraction is paramount to better dissect the underlying genetic signals and contributors to this highly prevalent condition.
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Affiliation(s)
- Jacob Joseph
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA ,Cardiology Section (111A), VA Providence Healthcare System, 830 Chalkstone Avenue, Providence, RI 02908 USA
| | - Chang Liu
- grid.189967.80000 0001 0941 6502Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Qin Hui
- grid.189967.80000 0001 0941 6502Emory University Rollins School of Public Health, Atlanta, GA USA ,grid.484294.7Atlanta VA Health Care System, Decatur, GA USA
| | - Krishna Aragam
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA ,grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA ,grid.66859.340000 0004 0546 1623Broad Institute of Harvard and MIT, Cambridge, MA USA
| | - Zeyuan Wang
- grid.189967.80000 0001 0941 6502Emory University Rollins School of Public Health, Atlanta, GA USA ,grid.484294.7Atlanta VA Health Care System, Decatur, GA USA
| | - Brian Charest
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA
| | - Jennifer E. Huffman
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA
| | - Jacob M. Keaton
- grid.94365.3d0000 0001 2297 5165Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD USA ,grid.412807.80000 0004 1936 9916Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Todd L. Edwards
- grid.412807.80000 0004 1936 9916Division of Epidemiology, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN USA
| | - Serkalem Demissie
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA ,grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA
| | - Luc Djousse
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Juan P. Casas
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - J. Michael Gaziano
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kelly Cho
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Peter W. F. Wilson
- grid.484294.7Atlanta VA Health Care System, Decatur, GA USA ,grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, GA USA
| | - Lawrence S. Phillips
- grid.484294.7Atlanta VA Health Care System, Decatur, GA USA ,grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, GA USA
| | | | - Christopher J. O’Donnell
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Yan V. Sun
- grid.189967.80000 0001 0941 6502Emory University Rollins School of Public Health, Atlanta, GA USA ,grid.484294.7Atlanta VA Health Care System, Decatur, GA USA
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4
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Maamari DJ, Brockman DG, Aragam K, Pelletier RC, Folkerts E, Neben CL, Okumura S, Hull LE, Philippakis AA, Natarajan P, Ellinor PT, Ng K, Zhou AY, Khera AV, Fahed AC. Clinical Implementation of Combined Monogenic and Polygenic Risk Disclosure for Coronary Artery Disease. JACC: Advances 2022; 1. [PMID: 36147540 PMCID: PMC9491373 DOI: 10.1016/j.jacadv.2022.100068] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND State-of-the-art genetic risk interpretation for a common complex disease such as coronary artery disease (CAD) requires assessment for both monogenic variants—such as those related to familial hypercholesterolemia—as well as the cumulative impact of many common variants, as quantified by a polygenic score. OBJECTIVES The objective of the study was to describe a combined monogenic and polygenic CAD risk assessment program and examine its impact on patient understanding and changes to clinical management. METHODS Study participants attended an initial visit in a preventive genomics clinic and a disclosure visit to discuss results and recommendations, primarily via telemedicine. Digital postdisclosure surveys and chart review evaluated the impact of disclosure. RESULTS There were 60 participants (mean age 51 years, 37% women, 72% with no known CAD), including 30 (50%) referred by their cardiologists and 30 (50%) self-referred. Two (3%) participants had a monogenic variant pathogenic for familial hypercholesterolemia, and 19 (32%) had a high polygenic score in the top quintile of the population distribution. In a postdisclosure survey, both the genetic test report (in 80% of participants) and the discussion with the clinician (in 89% of participants) were ranked as very or extremely helpful in understanding the result. Of the 42 participants without CAD, 17 or 40% had a change in management, including statin initiation, statin intensification, or coronary imaging. CONCLUSIONS Combined monogenic and polygenic assessments for CAD risk provided by preventive genomics clinics are beneficial for patients and result in changes in management in a significant portion of patients.
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Affiliation(s)
- Dimitri J. Maamari
- Center for Genomic Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Deanna G. Brockman
- Center for Genomic Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Krishna Aragam
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Renée C. Pelletier
- Center for Genomic Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Emma Folkerts
- Center for Genomic Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Leland E. Hull
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anthony A. Philippakis
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Pradeep Natarajan
- Center for Genomic Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Patrick T. Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Kenney Ng
- Center for Computational Health, IBM Research, Cambridge, Massachusetts, USA
| | | | - Amit V. Khera
- Center for Genomic Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Verve Therapeutics, Cambridge, Massachusetts, USA
| | - Akl C. Fahed
- Center for Genomic Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
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5
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Blumenthal DM, Maddox TM, Aragam K, Sacks CA, Virani SS, Wasfy JH. Predictors of PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibitor Prescriptions for Secondary Prevention of Clinical Atherosclerotic Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2021; 14:e007237. [PMID: 34404223 DOI: 10.1161/circoutcomes.120.007237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
BACKGROUND Little is known about patterns of PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitor) use among patients with established clinical atherosclerotic cardiovascular disease. This study's objective was to describe PCSK9i prescribing patterns among patients with atherosclerotic cardiovascular disease. METHODS We used a national outpatient clinic registry linked to zip-code level on household income from the US Census to assess characteristics of patients with atherosclerotic cardiovascular disease and LDL-C (low-density lipoprotein cholesterol) <190 mg/dL between September 1, 2015, and September 30, 2019, who did and did not receive PCSK9i prescriptions and practice-level and temporal variation in PCSK9i prescriptions. We assessed predictors of PCSK9i prescription with a multivariable mixed effects regression model which included patient covariates as fixed effects and the cardiology practice as a random effect. Adjusted practice-level variation in PCSK9i prescribing was evaluated with median odds ratio (OR). RESULTS Of 2 148 100 patients meeting study inclusion criteria, 27 249 (1.3%) received PCSK9i prescriptions. Receiving a PCSK9i prescription was associated with White race (versus non-White: OR, 1.78 [95% CI, 1.55-1.83]); high estimated household income (versus low income: OR, 1.18 [95% CI, 1.08-1.29]), and urban or suburban (versus rural) practice location (urban: OR, 1.47 [95% CI, 1.32-1.64]; suburban: OR, 1.25 [95% CI, 1.13-1.39]). Hispanics had lower odds of receiving PCSK9i prescriptions (OR, 0.66 [95% CI, 0.57-0.76]). The adjusted median odds ratio was 2.68 (95% CI, 2.46-2.94), consistent with clinically significant practice-level variation in PCSK9i prescriptions. No differences in quarterly PCSK9i prescription rates were observed before and after price reductions for evolocumab and alirocumab initiated during the fourth quarter of 2018 and first quarter of 2019, respectively. CONCLUSIONS This study highlights racial, socioeconomic, geographic, and practice-level variations in early PCSK9i prescriptions which persist despite adjustment for clinical and demographic factors. After adjustment, 2 randomly selected practices would differ in likelihood of PCSK9i prescription by a factor of >2.
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Affiliation(s)
- Daniel M Blumenthal
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA (D.M.B., K.A., J.H.W.).,Harvard Medical School, Boston, MA (D.M.B., K.A., C.A.S., J.H.W.)
| | - Thomas M Maddox
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO (T.M.M.).,Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, MO (T.M.M.)
| | - Krishna Aragam
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA (D.M.B., K.A., J.H.W.).,Harvard Medical School, Boston, MA (D.M.B., K.A., C.A.S., J.H.W.).,Broad Institute, Cambridge, MA (K.A.)
| | - Chana A Sacks
- Harvard Medical School, Boston, MA (D.M.B., K.A., C.A.S., J.H.W.).,Division of General Internal Medicine and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (C.A.S.)
| | - Salim S Virani
- Department of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX (S.S.V.)
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA (D.M.B., K.A., J.H.W.).,Harvard Medical School, Boston, MA (D.M.B., K.A., C.A.S., J.H.W.)
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6
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Biddinger KJ, Emdin C, Haas ME, Wang M, Hindy G, Ellinor PT, Kathiresan S, Khera AV, Aragam K. Abstract 056: Alcohol Increases Risk Of Cardiovascular Disease At All Levels Of Intake. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Genetic analyses have suggested a causal association between alcohol intake and cardiovascular diseases, questioning the purported cardioprotective effects of modest intake. Though traditional approaches to genetic epidemiology are limited in ability to assess association shapes, we hypothesized that any alcohol may increase risk of cardiovascular disease. In 371,463 participants from the UK Biobank, we first examined for confounding in epidemiological associations between alcohol intake and cardiovascular diseases. Next, using traditional and non-linear genetic approaches (Mendelian randomization), we assessed for causal links of alcohol consumption with several cardiovascular diseases and evaluated the shapes of all causal associations identified. Study participants consumed 9.2 (SD, 10.6) standard drinks per week on average; 121,708 (32.8%) and 27,667 (7.5%) subjects had hypertension and CAD, respectively. Modest consumers of alcohol demonstrated healthier lifestyles - such as lower BMI and greater physical activity - than abstainers, and adjustment for lifestyle factors attenuated the observed benefits of light alcohol intake. Traditional and non-linear Mendelian randomization demonstrated consistently risk-increasing and quadratic associations between alcohol consumption and both clinical and subclinical cardiovascular disease, with exponential increases in risk across levels of drinking; relative to abstainers, consumption of 7, 14, 21, and 28 drinks per week conferred 1.2, 1.7, 3.4, and 8.9-fold odds of hypertension and 1.2, 2.3, 6.2, and 25.9-fold odds of CAD, respectively (both models p<0.001). In conclusion, coincident, favorable lifestyle factors may mediate the observational benefits of modest alcohol intake. All amounts of alcohol intake increase cardiovascular risk, but marked absolute and relative risk differences exist across levels of intake, which should inform public health recommendations around habitual alcohol consumption.
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Affiliation(s)
| | | | | | - Minxian Wang
- Broad Institute of MIT and Harvard, Cambridge, MA
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7
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Abohashem S, Osborne M, Abbasi T, Zureigat H, Dar T, Ghoneem A, Etiwy M, Aragam K, Elmariah S, Khera A, Tawakol A. POLYGENIC RISK SCORE FOR CORONARY ARTERY DISEASE ASSOCIATES WITH INCIDENCE OF CALCIFIC AORTIC STENOSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Guindo-Martínez M, Amela R, Bonàs-Guarch S, Puiggròs M, Salvoro C, Miguel-Escalada I, Carey CE, Cole JB, Rüeger S, Atkinson E, Leong A, Sanchez F, Ramon-Cortes C, Ejarque J, Palmer DS, Kurki M, Aragam K, Florez JC, Badia RM, Mercader JM, Torrents D. The impact of non-additive genetic associations on age-related complex diseases. Nat Commun 2021; 12:2436. [PMID: 33893285 PMCID: PMC8065056 DOI: 10.1038/s41467-021-21952-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 05/11/2020] [Accepted: 02/09/2021] [Indexed: 01/19/2023] Open
Abstract
Genome-wide association studies (GWAS) are not fully comprehensive, as current strategies typically test only the additive model, exclude the X chromosome, and use only one reference panel for genotype imputation. We implement an extensive GWAS strategy, GUIDANCE, which improves genotype imputation by using multiple reference panels and includes the analysis of the X chromosome and non-additive models to test for association. We apply this methodology to 62,281 subjects across 22 age-related diseases and identify 94 genome-wide associated loci, including 26 previously unreported. Moreover, we observe that 27.7% of the 94 loci are missed if we use standard imputation strategies with a single reference panel, such as HRC, and only test the additive model. Among the new findings, we identify three novel low-frequency recessive variants with odds ratios larger than 4, which need at least a three-fold larger sample size to be detected under the additive model. This study highlights the benefits of applying innovative strategies to better uncover the genetic architecture of complex diseases.
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Affiliation(s)
| | - Ramon Amela
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Silvia Bonàs-Guarch
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
- Regulatory Genomics and Diabetes, Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain
| | | | | | - Irene Miguel-Escalada
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
- Regulatory Genomics and Diabetes, Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Madrid, Spain
| | - Caitlin E Carey
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joanne B Cole
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA, USA
| | - Sina Rüeger
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Elizabeth Atkinson
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Aaron Leong
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Jorge Ejarque
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Duncan S Palmer
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- GENOMICS plc, Oxford, UK
| | - Mitja Kurki
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Krishna Aragam
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jose C Florez
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Rosa M Badia
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Josep M Mercader
- Barcelona Supercomputing Center (BSC), Barcelona, Spain.
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - David Torrents
- Barcelona Supercomputing Center (BSC), Barcelona, Spain.
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.
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9
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Natarajan P, Pampana A, Graham SE, Ruotsalainen SE, Perry JA, de Vries PS, Broome JG, Pirruccello JP, Honigberg MC, Aragam K, Wolford B, Brody JA, Antonacci-Fulton L, Arden M, Aslibekyan S, Assimes TL, Ballantyne CM, Bielak LF, Bis JC, Cade BE, Do R, Doddapaneni H, Emery LS, Hung YJ, Irvin MR, Khan AT, Lange L, Lee J, Lemaitre RN, Martin LW, Metcalf G, Montasser ME, Moon JY, Muzny D, O'Connell JR, Palmer ND, Peralta JM, Peyser PA, Stilp AM, Tsai M, Wang FF, Weeks DE, Yanek LR, Wilson JG, Abecasis G, Arnett DK, Becker LC, Blangero J, Boerwinkle E, Bowden DW, Chang YC, Chen YDI, Choi WJ, Correa A, Curran JE, Daly MJ, Dutcher SK, Ellinor PT, Fornage M, Freedman BI, Gabriel S, Germer S, Gibbs RA, He J, Hveem K, Jarvik GP, Kaplan RC, Kardia SLR, Kenny E, Kim RW, Kooperberg C, Laurie CC, Lee S, Lloyd-Jones DM, Loos RJF, Lubitz SA, Mathias RA, Martinez KAV, McGarvey ST, Mitchell BD, Nickerson DA, North KE, Palotie A, Park CJ, Psaty BM, Rao DC, Redline S, Reiner AP, Seo D, Seo JS, Smith AV, Tracy RP, Vasan RS, Kathiresan S, Cupples LA, Rotter JI, Morrison AC, Rich SS, Ripatti S, Willer C, Peloso GM. Chromosome Xq23 is associated with lower atherogenic lipid concentrations and favorable cardiometabolic indices. Nat Commun 2021; 12:2182. [PMID: 33846329 PMCID: PMC8042019 DOI: 10.1038/s41467-021-22339-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 08/28/2020] [Accepted: 03/02/2021] [Indexed: 02/01/2023] Open
Abstract
Autosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10-72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10-4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10-5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids.
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Affiliation(s)
- Pradeep Natarajan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Akhil Pampana
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Sarah E Graham
- Department of Internal Medicine: Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Sanni E Ruotsalainen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - James A Perry
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition and Program for Personalized and Genomic Medicine, Baltimore, MD, USA
| | - Paul S de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jai G Broome
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - James P Pirruccello
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael C Honigberg
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Krishna Aragam
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Brooke Wolford
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lucinda Antonacci-Fulton
- The McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
- Department of Genetics, Washington University in St. Louis, St. Louis, MO, USA
| | - Moscati Arden
- The Charles Bronfman Institute for Personalized Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Stella Aslibekyan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Themistocles L Assimes
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
- Houston Methodist Debakey Heart and Vascular Center, Houston, TX, USA
| | - Lawrence F Bielak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Brian E Cade
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Harsha Doddapaneni
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Leslie S Emery
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Yi-Jen Hung
- Division of Endocrine and Metabolism, Tri-Service General Hospital Songshan branch, Taipei, Taiwan
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alyna T Khan
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Leslie Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jiwon Lee
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lisa W Martin
- Division of Cardiology, George Washington University School of Medicine and Healthcare Sciences, Washington, DC, USA
| | - Ginger Metcalf
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - May E Montasser
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition and Program for Personalized and Genomic Medicine, Baltimore, MD, USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donna Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey R O'Connell
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition and Program for Personalized and Genomic Medicine, Baltimore, MD, USA
| | - Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Juan M Peralta
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
| | - Patricia A Peyser
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Adrienne M Stilp
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Michael Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Fei Fei Wang
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Daniel E Weeks
- Departments of Human Genetics and Biostatistics, University of Pittsburgh, Pittsburgh, Pittsburgh, PA, USA
| | - Lisa R Yanek
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James G Wilson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Goncalo Abecasis
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Donna K Arnett
- Deans office, School of Public Health, University of Kentucky, Lexington, KY, USA
| | - Lewis C Becker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Blangero
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Donald W Bowden
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Yi-Cheng Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yii-Der I Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Won Jung Choi
- Psomagen. Inc. (formerly Macrogen USA), Rockville, MD, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Joanne E Curran
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
| | - Mark J Daly
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan K Dutcher
- The McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
- Department of Genetics, Washington University in St. Louis, St. Louis, MO, USA
| | - Patrick T Ellinor
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Cardiac Arrhythmia Service and Cardiovascular Research Center Massachusetts General Hospital, Boston, MA, USA
| | - Myriam Fornage
- Institute of Molecular Medicine, the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-, Salem, NC, USA
| | - Stacey Gabriel
- Genomics Platform, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | - Richard A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, and Tulane University Translational Science Institute, Tulane University, New Orleans, LA, USA
| | - Kristian Hveem
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
- K. G. Jebsen Center for Genetic Epidemiology, Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington, Seattle, WA, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Eimear Kenny
- The Charles Bronfman Institute for Personalized Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan W Kim
- Psomagen. Inc. (formerly Macrogen USA), Rockville, MD, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Cathy C Laurie
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Seonwook Lee
- Psomagen. Inc. (formerly Macrogen USA), Rockville, MD, USA
| | - Don M Lloyd-Jones
- Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, USA
- The Mindich Child Health and Development Institute, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven A Lubitz
- Cardiac Arrhythmia Service and Cardiovascular Research Center Massachusetts General Hospital, Boston, MA, USA
| | - Rasika A Mathias
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Stephen T McGarvey
- Department of Epidemiology and International Health Institute, Brown University, Providence, RI, USA
| | - Braxton D Mitchell
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition and Program for Personalized and Genomic Medicine, Baltimore, MD, USA
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - Deborah A Nickerson
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- University of Washington Center for Mendelian Genomics, Seattle, WA, USA
| | - Kari E North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aarno Palotie
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cheol Joo Park
- Psomagen. Inc. (formerly Macrogen USA), Rockville, MD, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Departments of Epidemiology and Health Services, University of Washington, Seattle, WA, USA
| | - D C Rao
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daekwan Seo
- Psomagen. Inc. (formerly Macrogen USA), Rockville, MD, USA
| | - Jeong-Sun Seo
- Psomagen. Inc. (formerly Macrogen USA), Rockville, MD, USA
| | - Albert V Smith
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- The Icelandic Heart Association, Kopavogur, Iceland
| | - Russell P Tracy
- Departments of Pathology & Laboratory Medicine and Biochemistry, Larrner College of Medicine, University of Vermont, Colchester, VT, USA
| | - Ramachandran S Vasan
- Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- NHLBI Framingham Heart Study, Framingham, MA, USA
| | - Sekar Kathiresan
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Verve Therapeutics, Cambridge, MA, USA
| | - L Adrienne Cupples
- NHLBI Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Samuli Ripatti
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Cristen Willer
- Department of Internal Medicine: Cardiology, University of Michigan, Ann Arbor, MI, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
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10
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Emdin CA, Haas ME, Khera AV, Aragam K, Chaffin M, Klarin D, Hindy G, Jiang L, Wei WQ, Feng Q, Karjalainen J, Havulinna A, Kiiskinen T, Bick A, Ardissino D, Wilson JG, Schunkert H, McPherson R, Watkins H, Elosua R, Bown MJ, Samani NJ, Baber U, Erdmann J, Gupta N, Danesh J, Saleheen D, Chang KM, Vujkovic M, Voight B, Damrauer S, Lynch J, Kaplan D, Serper M, Tsao P, Program MV, Mercader J, Hanis C, Daly M, Denny J, Gabriel S, Kathiresan S. Correction: A missense variant in Mitochondrial Amidoxime Reducing Component 1 gene and protection against liver disease. PLoS Genet 2021; 17:e1009503. [PMID: 33822779 PMCID: PMC8023447 DOI: 10.1371/journal.pgen.1009503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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11
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Finneran P, Pampana A, Khetarpal SA, Trinder M, Patel AP, Paruchuri K, Aragam K, Peloso GM, Natarajan P. Lipoprotein(a) and Coronary Artery Disease Risk Without a Family History of Heart Disease. J Am Heart Assoc 2021; 10:e017470. [PMID: 33631942 PMCID: PMC8174293 DOI: 10.1161/jaha.120.017470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Phoebe Finneran
- Cardiovascular Research Center and Center for Genomic Medicine Massachusetts General Hospital Boston MA
| | - Akhil Pampana
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative Broad Institute of Harvard and MIT Cambridge MA
| | - Sumeet A Khetarpal
- Cardiovascular Research Center and Center for Genomic Medicine Massachusetts General Hospital Boston MA.,Program in Medical and Population Genetics and Cardiovascular Disease Initiative Broad Institute of Harvard and MIT Cambridge MA.,Department of Medicine Harvard Medical School Boston MA
| | - Mark Trinder
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative Broad Institute of Harvard and MIT Cambridge MA.,Centre for Heart Lung Innovation The University of British Columbia Vancouver British Columbia Canada
| | - Aniruddh P Patel
- Cardiovascular Research Center and Center for Genomic Medicine Massachusetts General Hospital Boston MA.,Program in Medical and Population Genetics and Cardiovascular Disease Initiative Broad Institute of Harvard and MIT Cambridge MA.,Department of Medicine Harvard Medical School Boston MA
| | - Kaavya Paruchuri
- Cardiovascular Research Center and Center for Genomic Medicine Massachusetts General Hospital Boston MA.,Program in Medical and Population Genetics and Cardiovascular Disease Initiative Broad Institute of Harvard and MIT Cambridge MA.,Department of Medicine Harvard Medical School Boston MA
| | - Krishna Aragam
- Cardiovascular Research Center and Center for Genomic Medicine Massachusetts General Hospital Boston MA.,Program in Medical and Population Genetics and Cardiovascular Disease Initiative Broad Institute of Harvard and MIT Cambridge MA.,Department of Medicine Harvard Medical School Boston MA
| | - Gina M Peloso
- Department of Biostatistics Boston University School of Public Health Boston MA
| | - Pradeep Natarajan
- Cardiovascular Research Center and Center for Genomic Medicine Massachusetts General Hospital Boston MA.,Program in Medical and Population Genetics and Cardiovascular Disease Initiative Broad Institute of Harvard and MIT Cambridge MA.,Department of Medicine Harvard Medical School Boston MA
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12
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Trinder M, Uddin M, Finneran P, Aragam K, Natarajan P. Clinical utility of LPA genetic characterization for primary prevention of atherosclerotic cardiovascular disease. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Honigberg MC, Pirruccello JP, Aragam K, Sarma AA, Scott NS, Wood MJ, Natarajan P. Menopausal age and left ventricular remodeling by cardiac magnetic resonance imaging among 14,550 women. Am Heart J 2020; 229:138-143. [PMID: 32827459 DOI: 10.1016/j.ahj.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/06/2020] [Indexed: 11/25/2022]
Abstract
The present study included 14,550 postmenopausal female participants in the UK Biobank who completed cardiac magnetic resonance imaging. Earlier age at menopause was significantly and independently associated with smaller left ventricular end-diastolic volume and smaller stroke volume, a pattern suggesting acceleration of previously described age-related left ventricular remodeling. These findings may have implications for understanding mechanisms of heart failure, specifically heart failure with preserved ejection fraction, among women with early menopause.
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14
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Honigberg MC, Chaffin M, Aragam K, Bhatt DL, Wood MJ, Sarma AA, Scott NS, Peloso GM, Natarajan P. Genetic Variation in Cardiometabolic Traits and Medication Targets and the Risk of Hypertensive Disorders of Pregnancy. Circulation 2020; 142:711-713. [PMID: 32804569 DOI: 10.1161/circulationaha.120.047936] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 11/16/2022]
Affiliation(s)
- Michael C Honigberg
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., M.C., K.A., P.N.)
- Cardiovascular Research Center and Center for Genomic Medicine (M.C.H., K.A., P.N.), Massachusetts General Hospital, Boston
| | - Mark Chaffin
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., M.C., K.A., P.N.)
| | - Krishna Aragam
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Malissa J Wood
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Corrigan Women's Heart Health Program (M.C.H., M.J.W., A.A.S., N.S.S.), Massachusetts General Hospital, Boston
| | - Amy A Sarma
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Corrigan Women's Heart Health Program (M.C.H., M.J.W., A.A.S., N.S.S.), Massachusetts General Hospital, Boston
| | - Nandita S Scott
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Corrigan Women's Heart Health Program (M.C.H., M.J.W., A.A.S., N.S.S.), Massachusetts General Hospital, Boston
| | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, MA (G.M.P.)
| | - Pradeep Natarajan
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Cardiovascular Research Center and Center for Genomic Medicine (M.C.H., K.A., P.N.), Massachusetts General Hospital, Boston
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15
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Emdin CA, Haas ME, Khera AV, Aragam K, Chaffin M, Klarin D, Hindy G, Jiang L, Wei WQ, Feng Q, Karjalainen J, Havulinna A, Kiiskinen T, Bick A, Ardissino D, Wilson JG, Schunkert H, McPherson R, Watkins H, Elosua R, Bown MJ, Samani NJ, Baber U, Erdmann J, Gupta N, Danesh J, Saleheen D, Chang KM, Vujkovic M, Voight B, Damrauer S, Lynch J, Kaplan D, Serper M, Tsao P, Mercader J, Hanis C, Daly M, Denny J, Gabriel S, Kathiresan S. A missense variant in Mitochondrial Amidoxime Reducing Component 1 gene and protection against liver disease. PLoS Genet 2020; 16:e1008629. [PMID: 32282858 PMCID: PMC7200007 DOI: 10.1371/journal.pgen.1008629] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [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: 10/02/2019] [Revised: 05/05/2020] [Accepted: 01/24/2020] [Indexed: 12/15/2022] Open
Abstract
Analyzing 12,361 all-cause cirrhosis cases and 790,095 controls from eight cohorts, we identify a common missense variant in the Mitochondrial Amidoxime Reducing Component 1 gene (MARC1 p.A165T) that associates with protection from all-cause cirrhosis (OR 0.91, p = 2.3*10−11). This same variant also associates with lower levels of hepatic fat on computed tomographic imaging and lower odds of physician-diagnosed fatty liver as well as lower blood levels of alanine transaminase (-0.025 SD, 3.7*10−43), alkaline phosphatase (-0.025 SD, 1.2*10−37), total cholesterol (-0.030 SD, p = 1.9*10−36) and LDL cholesterol (-0.027 SD, p = 5.1*10−30) levels. We identified a series of additional MARC1 alleles (low-frequency missense p.M187K and rare protein-truncating p.R200Ter) that also associated with lower cholesterol levels, liver enzyme levels and reduced risk of cirrhosis (0 cirrhosis cases for 238 R200Ter carriers versus 17,046 cases of cirrhosis among 759,027 non-carriers, p = 0.04) suggesting that deficiency of the MARC1 enzyme may lower blood cholesterol levels and protect against cirrhosis. Cirrhosis is a leading cause of death worldwide. However, the genetic underpinnings of cirrhosis remain poorly understood. In this study, we analyze twelve thousand individuals with cirrhosis and identify a common missense variant in a gene called MARC1 that protects against cirrhosis. Carriers of this missense variant also have lower blood cholesterol levels, lower liver enzyme levels and reduced liver fat. We identify an additional two low-frequency coding variants in MARC1 that are also associated with lower cholesterol levels, lower liver enzyme levels and protection from cirrhosis. Finally, we identify an individual homozygous for a predicted loss-of-function variant in MARC1 who exhibits very low blood LDL cholesterol levels. These genetic findings suggest that MARC1 deficiency may lower blood cholesterol levels and protect against cirrhosis, pointing to MARC1 as a potential therapeutic target for liver disease.
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Affiliation(s)
- Connor A. Emdin
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Mary E. Haas
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Amit V. Khera
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Krishna Aragam
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Mark Chaffin
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Derek Klarin
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - George Hindy
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Lan Jiang
- Departments of Biomedical Informatics, Vanderbilt University, Vanderbilt, Tennessee, United States of America
- Departments of Medicine, Vanderbilt University, Vanderbilt, Tennessee, United States of America
| | - Wei-Qi Wei
- Departments of Biomedical Informatics, Vanderbilt University, Vanderbilt, Tennessee, United States of America
| | - Qiping Feng
- Departments of Medicine, Vanderbilt University, Vanderbilt, Tennessee, United States of America
| | - Juha Karjalainen
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FI, Helsinki, Finland
| | - Aki Havulinna
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FI, Helsinki, Finland
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FI, Helsinki, Finland
| | - Alexander Bick
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero–Universitaria di Parma, Parma, Italy
- Associazione per lo Studio Della Trombosi in Cardiologia, Pavia, Italy
| | - James G. Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung, München, Germany
| | - Ruth McPherson
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
- Facultat de Medicina, Universitat de Vic-Central de Cataluña, Vic, Spain
| | - Matthew J. Bown
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Lübeck, Germany
| | - Namrata Gupta
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - John Danesh
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
- National Institute of Health Research Blood and Transplant; Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Danish Saleheen
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Non-Communicable Diseases, Karachi, Pakistan
| | - Kyong-Mi Chang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Marijana Vujkovic
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ben Voight
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Scott Damrauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Julie Lynch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - David Kaplan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Marina Serper
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Philip Tsao
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
| | | | - Josep Mercader
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Craig Hanis
- Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Mark Daly
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FI, Helsinki, Finland
| | - Joshua Denny
- Departments of Biomedical Informatics, Vanderbilt University, Vanderbilt, Tennessee, United States of America
- Departments of Medicine, Vanderbilt University, Vanderbilt, Tennessee, United States of America
| | - Stacey Gabriel
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
| | - Sekar Kathiresan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Verve Therapeutics, Boston, Massachusetts, United States of America
- * E-mail:
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Finneran P, Pampana A, Khetarpal S, Aragam K, Natarajan P. LIPOPROTEIN(A) CONFERS INCIDENT CORONARY ARTERY DISEASE RISK AMONG 243,474 INDIVIDUALS WITHOUT A FAMILY HISTORY OF HEART DISEASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Zekavat SM, Aragam K, Emdin C, Khera AV, Klarin D, Zhao H, Natarajan P. Genetic Association of Finger Photoplethysmography-Derived Arterial Stiffness Index With Blood Pressure and Coronary Artery Disease. Arterioscler Thromb Vasc Biol 2020; 39:1253-1261. [PMID: 31070453 DOI: 10.1161/atvbaha.119.312626] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective- Arterial stiffness index (ASI) is independently associated with blood pressure (BP) and coronary artery disease (CAD) epidemiologically. However, it is unknown whether these associations represent causal relationships. Here, we assess whether genetic predisposition to increased ASI is associated with elevated BP and CAD risk. Approach and Results- We first performed a large-scale epidemiological association of finger photoplethysmography-derived ASI in the UK Biobank, finding significant associations with systolic BP (β=0.55 mm Hg; [95% CI, 0.45-0.65]; P=5.77×10-24; N=137 858), diastolic BP (β=1.05 mm Hg; [95% CI, 0.99-1.11]; P=7.27×10-272; N=137 862), and incident CAD (hazard ratio, 1.08; [95% CI, 1.04-1.11]; P=1.5×10-6; N=3692 cases, 126 615 controls) in multivariable models. We then performed an ASI genome-wide association study analysis in 131 686 participants from the UK Biobank. Across participants not in the ASI genome-wide association study, a 6-variant ASI polygenic risk score was calculated. Each SD increase in genetic ASI was associated with systolic BP (β=4.63 mm Hg; [95% CI, 2.1-7.2]; P=3.37×10-4; N=208 897), and diastolic BP (β=2.61 mm Hg; [95% CI, 1.2-4.0]; P=2.85×10-4; N=208 897); however, no association was observed with incident CAD (hazard ratio, 1.12; [95% CI, 0.55-2.3]; P=0.75; N=223 061; 7534 cases). The lack of CAD association observed was replicated among 184 305 participants (60 810 cases) from the CARDIOGRAMplusC4D (Coronary Artery Disease Genetics Consortium; odds ratio, 0.56; [95% CI, 0.26-1.24]; P=0.15). Conclusions- Our data support the conclusion that finger photoplethysmography-derived ASI is an independent, genetically causal risk factor for BP, but do not support the notion that ASI is a suitable surrogate for CAD risk.
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Affiliation(s)
- Seyedeh M Zekavat
- From the Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., K.A., C.E., A.V.K., D.K., P.N.).,Yale School of Medicine, New Haven, CT (S.M.Z.).,Computational Biology and Bioinformatics Program, Yale University, New Haven, CT (S.M.Z., H.Z.).,Center for Genomic Medicine (S.M.Z., K.A., A.V.K., D.K., P.N.), Massachusetts General Hospital, Boston.,Cardiovascular Research Center (S.M.Z., K.A., P.N.), Massachusetts General Hospital, Boston
| | - Krishna Aragam
- From the Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., K.A., C.E., A.V.K., D.K., P.N.).,Center for Genomic Medicine (S.M.Z., K.A., A.V.K., D.K., P.N.), Massachusetts General Hospital, Boston.,Cardiovascular Research Center (S.M.Z., K.A., P.N.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (K.A., C.E., A.V.K., D.K., P.N.)
| | - Connor Emdin
- From the Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., K.A., C.E., A.V.K., D.K., P.N.).,Harvard Medical School, Boston, MA (K.A., C.E., A.V.K., D.K., P.N.)
| | - Amit V Khera
- From the Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., K.A., C.E., A.V.K., D.K., P.N.).,Center for Genomic Medicine (S.M.Z., K.A., A.V.K., D.K., P.N.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (K.A., C.E., A.V.K., D.K., P.N.)
| | - Derek Klarin
- From the Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., K.A., C.E., A.V.K., D.K., P.N.).,Center for Genomic Medicine (S.M.Z., K.A., A.V.K., D.K., P.N.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (K.A., C.E., A.V.K., D.K., P.N.)
| | - Hongyu Zhao
- Computational Biology and Bioinformatics Program, Yale University, New Haven, CT (S.M.Z., H.Z.).,Department of Biostatistics, Yale School of Public Health, New Haven, CT (H.Z.)
| | - Pradeep Natarajan
- From the Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., K.A., C.E., A.V.K., D.K., P.N.).,Center for Genomic Medicine (S.M.Z., K.A., A.V.K., D.K., P.N.), Massachusetts General Hospital, Boston.,Cardiovascular Research Center (S.M.Z., K.A., P.N.), Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, MA (K.A., C.E., A.V.K., D.K., P.N.)
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18
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Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, Januzzi JL, Scott NS, Natarajan P. Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease. JAMA 2019; 322:2411-2421. [PMID: 31738818 PMCID: PMC7231649 DOI: 10.1001/jama.2019.19191] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [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] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Recent guidelines endorse using history of menopause before age 40 years to refine atherosclerotic cardiovascular disease risk assessments among middle-aged women. Robust data on cardiovascular disease risk in this population are lacking. OBJECTIVE To examine the development of cardiovascular diseases and cardiovascular risk factors in women with natural and surgical menopause before age 40 years. DESIGN, SETTING, AND PARTICIPANTS Cohort study (UK Biobank), with adult residents of the United Kingdom recruited between 2006 and 2010. Of women who were 40 to 69 years old and postmenopausal at study enrollment, 144 260 were eligible for inclusion. Follow-up occurred through August 2016. EXPOSURES Natural premature menopause (menopause before age 40 without oophorectomy) and surgical premature menopause (bilateral oophorectomy before age 40). Postmenopausal women without premature menopause served as the reference group. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of incident coronary artery disease, heart failure, aortic stenosis, mitral regurgitation, atrial fibrillation, ischemic stroke, peripheral artery disease, and venous thromboembolism. Secondary outcomes included individual components of the primary outcome, incident hypertension, hyperlipidemia, and type 2 diabetes. RESULTS Of 144 260 postmenopausal women included (mean [SD] age at enrollment, 59.9 [5.4] years), 4904 (3.4%) had natural premature menopause and 644 (0.4%) had surgical premature menopause. Participants were followed up for a median of 7 years (interquartile range, 6.3-7.7). The primary outcome occurred in 5415 women (3.9%) with no premature menopause (incidence, 5.70/1000 woman-years), 292 women (6.0%) with natural premature menopause (incidence, 8.78/1000 woman-years) (difference vs no premature menopause, +3.08/1000 woman-years [95% CI, 2.06-4.10]; P < .001), and 49 women (7.6%) with surgical premature menopause (incidence, 11.27/1000 woman-years) (difference vs no premature menopause, +5.57/1000 woman-years [95% CI, 2.41-8.73]; P < .001). For the primary outcome, natural and surgical premature menopause were associated with hazard ratios of 1.36 (95% CI, 1.19-1.56; P < .001) and 1.87 (95% CI, 1.36-2.58; P < .001), respectively, after adjustment for conventional cardiovascular disease risk factors and use of menopausal hormone therapy. CONCLUSIONS AND RELEVANCE Natural and surgical premature menopause (before age 40 years) were associated with a small but statistically significant increased risk for a composite of cardiovascular diseases among postmenopausal women. Further research is needed to understand the mechanisms underlying these associations.
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Affiliation(s)
- Michael C. Honigberg
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
| | - Seyedeh Maryam Zekavat
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
- Yale University School of Medicine, New Haven,
Connecticut
| | - Krishna Aragam
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
| | - Phoebe Finneran
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
| | - Derek Klarin
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Division of Vascular Surgery and Endovascular
Therapy, University of Florida College of Medicine, Gainesville
| | - Deepak L. Bhatt
- Cardiovascular Division, Brigham and
Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - James L. Januzzi
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
| | - Nandita S. Scott
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
| | - Pradeep Natarajan
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
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19
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Honigberg MC, Zekavat SM, Aragam K, Klarin D, Bhatt DL, Scott NS, Peloso GM, Natarajan P. Long-Term Cardiovascular Risk in Women With Hypertension During Pregnancy. J Am Coll Cardiol 2019; 74:2743-2754. [PMID: 31727424 DOI: 10.1016/j.jacc.2019.09.052] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [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: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND History of a hypertensive disorder of pregnancy (HDP) among women may be useful to refine atherosclerotic cardiovascular disease risk assessments. However, future risk of diverse cardiovascular conditions in asymptomatic middle-aged women with prior HDP remains unknown. OBJECTIVES The purpose of this study was to examine the long-term incidence of diverse cardiovascular conditions among middle-aged women with and without prior HDP. METHODS Women in the prospective, observational UK Biobank age 40 to 69 years who reported ≥1 live birth were included. Noninvasive arterial stiffness measurement was performed in a subset of women. Cox models were fitted to associate HDP with incident cardiovascular diseases. Causal mediation analyses estimated the contribution of conventional risk factors to observed associations. RESULTS Of 220,024 women included, 2,808 (1.3%) had prior HDP. The mean age at baseline was 57.4 ± 7.8 years, and women were followed for median 7 years (interquartile range: 6.3 to 7.7 years). Women with HDP had elevated arterial stiffness indexes and greater prevalence of chronic hypertension compared with women without HDP. Overall, 7.0 versus 5.3 age-adjusted incident cardiovascular conditions occurred per 1,000 women-years for women with versus without prior HDP, respectively (p = 0.001). In analysis of time-to-first incident cardiovascular diagnosis, prior HDP was associated with a hazard ratio (HR) of 1.3 (95% CI: 1.04 to 1.60; p = 0.02). HDP was associated with greater incidence of CAD (HR: 1.8; 95% CI: 1.3 to 2.6; p < 0.001), heart failure (HR: 1.7; 95% CI: 1.04 to 2.60; p = 0.03), aortic stenosis (HR: 2.9; 95% CI: 1.5 to 5.4; p < 0.001), and mitral regurgitation (HR: 5.0; 95% CI: 1.5 to 17.1; p = 0.01). In causal mediation analyses, chronic hypertension explained 64% of HDP's association with CAD and 49% of HDP's association with heart failure. CONCLUSIONS Hypertensive disorders of pregnancy are associated with accelerated cardiovascular aging and more diverse cardiovascular conditions than previously appreciated, including valvular heart disease. Cardiovascular risk after HDP is largely but incompletely mediated by development of chronic hypertension.
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Affiliation(s)
- Michael C Honigberg
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Seyedeh Maryam Zekavat
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts; Yale University School of Medicine, New Haven, Connecticut
| | - Krishna Aragam
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Derek Klarin
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Deepak L Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nandita S Scott
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Pradeep Natarajan
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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20
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Klarin D, Busenkell E, Judy R, Lynch J, Levin M, Haessler J, Aragam K, Chaffin M, Haas M, Lindström S, Assimes TL, Huang J, Min Lee K, Shao Q, Huffman JE, Kabrhel C, Huang Y, Sun YV, Vujkovic M, Saleheen D, Miller DR, Reaven P, DuVall S, Boden WE, Pyarajan S, Reiner AP, Trégouët DA, Henke P, Kooperberg C, Gaziano JM, Concato J, Rader DJ, Cho K, Chang KM, Wilson PWF, Smith NL, O'Donnell CJ, Tsao PS, Kathiresan S, Obi A, Damrauer SM, Natarajan P. Genome-wide association analysis of venous thromboembolism identifies new risk loci and genetic overlap with arterial vascular disease. Nat Genet 2019; 51:1574-1579. [PMID: 31676865 PMCID: PMC6858581 DOI: 10.1038/s41588-019-0519-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [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: 03/05/2019] [Accepted: 09/24/2019] [Indexed: 12/22/2022]
Abstract
Venous thromboembolism is a significant cause of mortality1, yet its genetic determinants are incompletely defined. We performed a discovery genome-wide association study in the Million Veteran Program and UK Biobank, with testing of approximately 13 million DNA sequence variants for association with venous thromboembolism (26,066 cases and 624,053 controls) and meta-analyzed both studies, followed by independent replication with up to 17,672 venous thromboembolism cases and 167,295 controls. We identified 22 previously unknown loci, bringing the total number of venous thromboembolism-associated loci to 33, and subsequently fine-mapped these associations. We developed a genome-wide polygenic risk score for venous thromboembolism that identifies 5% of the population at an equivalent incident venous thromboembolism risk to carriers of the established factor V Leiden p.R506Q and prothrombin G20210A mutations. Our data provide mechanistic insights into the genetic epidemiology of venous thromboembolism and suggest a greater overlap among venous and arterial cardiovascular disease than previously thought.
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Affiliation(s)
- Derek Klarin
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Vascular Surgery and Endovascular Therapy, University of Florida School of Medicine, Gainesville, FL, USA
| | - Emma Busenkell
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Renae Judy
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie Lynch
- Veterans Affairs Informatics and Computing Infrastructure, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Massachusetts College of Nursing & Health Sciences, Boston, MA, USA
| | - Michael Levin
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffery Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Krishna Aragam
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Mark Chaffin
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Mary Haas
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sara Lindström
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Themistocles L Assimes
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jie Huang
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Kyung Min Lee
- Veterans Affairs Informatics and Computing Infrastructure, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, MA, USA
| | - Qing Shao
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Jennifer E Huffman
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Christopher Kabrhel
- Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yunfeng Huang
- Department of Epidemiology, Emory University Rollins School of Public Health, Department of Biomedical Informatics Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Department of Biomedical Informatics Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| | - Marijana Vujkovic
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA, USA
| | - Danish Saleheen
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA, USA
| | - Donald R Miller
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, MA, USA
| | - Peter Reaven
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Scott DuVall
- Veterans Affairs Informatics and Computing Infrastructure, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - William E Boden
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Saiju Pyarajan
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alex P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David-Alexandre Trégouët
- Bordeaux Population Health Research Center (INSERM UMR S 1219), University of Bordeaux, Bordeaux, France
| | - Peter Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John Concato
- Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel J Rader
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kyong-Mi Chang
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter W F Wilson
- Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
- Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA
| | - Nicholas L Smith
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Christopher J O'Donnell
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philip S Tsao
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Sekar Kathiresan
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Verve Therapeutics, Cambridge, MA, USA
| | - Andrea Obi
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Scott M Damrauer
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pradeep Natarajan
- Veterans Affairs Boston Healthcare System, Boston, MA, USA.
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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21
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Emdin CA, Khera AV, Aragam K, Haas M, Chaffin M, Klarin D, Natarajan P, Bick A, Zekavat SM, Nomura A, Ardissino D, Wilson JG, Schunkert H, McPherson R, Watkins H, Elosua R, Bown MJ, Samani NJ, Baber U, Erdmann J, Gupta N, Danesh J, Saleheen D, Gabriel S, Kathiresan S. DNA Sequence Variation in ACVR1C Encoding the Activin Receptor-Like Kinase 7 Influences Body Fat Distribution and Protects Against Type 2 Diabetes. Diabetes 2019; 68:226-234. [PMID: 30389748 PMCID: PMC6302541 DOI: 10.2337/db18-0857] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/14/2018] [Accepted: 10/21/2018] [Indexed: 12/21/2022]
Abstract
A genetic predisposition to higher waist-to-hip ratio adjusted for BMI (WHRadjBMI), a measure of body fat distribution, associates with increased risk for type 2 diabetes. We conducted an exome-wide association study of coding variation in UK Biobank (405,569 individuals) to identify variants that lower WHRadjBMI and protect against type 2 diabetes. We identified four variants in the gene ACVR1C (encoding the activin receptor-like kinase 7 receptor expressed on adipocytes and pancreatic β-cells), which independently associated with reduced WHRadjBMI: Asn150His (-0.09 SD, P = 3.4 × 10-17), Ile195Thr (-0.15 SD, P = 1.0 × 10-9), Ile482Val (-0.019 SD, P = 1.6 × 10-5), and rs72927479 (-0.035 SD, P = 2.6 × 10-12). Carriers of these variants exhibited reduced percent abdominal fat in DEXA imaging. Pooling across all four variants, a 0.2 SD decrease in WHRadjBMI through ACVR1C was associated with a 30% lower risk of type 2 diabetes (odds ratio [OR] 0.70, 95% CI 0.63, 0.77; P = 5.6 × 10-13). In an analysis of exome sequences from 55,516 individuals, carriers of predicted damaging variants in ACVR1C were at 54% lower risk of type 2 diabetes (OR 0.46, 95% CI 0.27, 0.81; P = 0.006). These findings indicate that variants predicted to lead to loss of ACVR1C gene function influence body fat distribution and protect from type 2 diabetes.
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Affiliation(s)
- Connor A Emdin
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Amit V Khera
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Krishna Aragam
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Mary Haas
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Mark Chaffin
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Derek Klarin
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Pradeep Natarajan
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Alexander Bick
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Seyedeh M Zekavat
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
- Yale Medical School and Department of Computational Biology and Bioinformatics, Yale University, New Haven, CT
| | - Akihiro Nomura
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung, München, Germany
| | - Ruth McPherson
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, U.K
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, U.K
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
- Facultat de Medicina, Universitat de Vic-Central de Cataluña, Vic, Spain
| | - Matthew J Bown
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research) partner site Hamburg/Lübeck/Kiel, Lübeck, Germany
| | - Namrata Gupta
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - John Danesh
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, U.K
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge. Cambridge, U.K
| | - Danish Saleheen
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Non-Communicable Diseases, Karachi, Pakistan
| | - Stacey Gabriel
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Sekar Kathiresan
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
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22
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Klarin D, Lynch J, Aragam K, Assimes T, Lee K, Shao Q, Chaffin M, Natarajan P, Arya S, Small A, Sun YV, Saleheen D, Lee JS, Miller D, Reaven P, DuVall S, Boden W, Gaziano JM, Concato J, Kathiresan S, Rader DJ, Cho K, Wilson PW, Chang KM, O'Donnell CJ, Tsao PS, Damrauer SM. Abstract 126: Genome Wide Association Study in the Million Veteran Program Identifies a Novel Role for Thrombosis in the Pathogenesis of Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
PAD is a leading cause of cardiovascular morbidity and mortality. Previously published GWAS have been limited by small sample sizes and have only identified 3 genome-wide significant (P<5x10
-8
) risk loci to date.
Hypothesis:
DNA sequence variants affecting multiple biological pathways are associated with PAD risk.
Methods:
Using electronic health record data, we identified individuals with and without clinical PAD from the 353,323 Million Veteran Program (MVP) participants genotyped on a customized Affymetrix Biobank array. We tested 32 million genotyped and imputed DNA variants for association with clinical PAD separately in participants of European (EUR), African (AFR), and Hispanic (HIS) ancestry using logistic regression models controlling for age, sex and population structure, and then performed trans-ethnic meta-analysis. The results were replicated with data from the UK Biobank.
Results:
We identified 31,307 individuals (24,009 EUR, 5,373 AFR, 1,925 HIS) with, and 211,753 individuals without, PAD. Following meta-analysis and replication, there were 19 genome-wide significant risk loci associated with PAD. We replicated a known association at
9p21
(P=4.3 x10
-39
), and identified several novel loci associated with PAD that were previously known to be associated with atherosclerosis (
LPA
,
HDAC9
), diabetes (
TCF7L2
), lipid levels (
LPL
,
CELSR2
), and tobacco use (
CHRNA3
). We also identified a novel association with PAD for the Factor V Leiden (FVL) mutation (OR 1.20, P=1.6x10
-12
), which remained significant after controlling for venous thromboembolism (OR 1.10, P=8.7x10
-4
). Sensitivity analysis demonstrated FVL is associated with increasing risk estimates for PAD severity (claudication OR 1.19, P=0.0012; rest pain OR 1.41, P=0.004; tissue loss OR 1.57, P=7x10
-9
).
Conclusions:
Using the MVP, we assembled the largest reported cohort of individuals with clinical PAD and genetic data worldwide. Our data replicate known causal risk factors and identify a novel association for FVL and its putative role for thrombosis in the development of clinical PAD.
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Affiliation(s)
| | - Julie Lynch
- Dept of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
| | | | | | - Kyung Lee
- Edith Nourse Rogers VA Hosp, Bedford, MA
| | - Qing Shao
- Edith Nourse Rodgers VA Hosp, Bedford, MA
| | | | | | | | | | - Yan V Sun
- Emory Univ Sch of Medicine, Atlanta, GA
| | - Danish Saleheen
- Univ of Pennsylvania Perelman Sch of Medicine, Philadelphia, PA
| | | | | | - Peter Reaven
- Univ of Arizona College of Medicine, Phoenix, AZ
| | - Scott DuVall
- Univ of Utah Sch of Medicine, Salt Lake City, UT
| | | | | | - John Concato
- VA Connecticut Healthcare System, West Haven, CT
| | | | - Daniel J Rader
- Univ of Pennsylvania Perelman Sch of Medicine, Philadelphia, PA
| | - Kelly Cho
- VA Boston Healthcare System, Boston, MA
| | | | - Kyong-Mi Chang
- Univ of Pennsylvania Perelman Sch of Medicine, Philadelphia, PA
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23
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Emdin CA, Khera AV, Chaffin M, Klarin D, Natarajan P, Aragam K, Haas M, Bick A, Zekavat SM, Nomura A, Ardissino D, Wilson JG, Schunkert H, McPherson R, Watkins H, Elosua R, Bown MJ, Samani NJ, Baber U, Erdmann J, Gupta N, Danesh J, Chasman D, Ridker P, Denny J, Bastarache L, Lichtman JH, D'Onofrio G, Mattera J, Spertus JA, Sheu WHH, Taylor KD, Psaty BM, Rich SS, Post W, Rotter JI, Chen YDI, Krumholz H, Saleheen D, Gabriel S, Kathiresan S. Analysis of predicted loss-of-function variants in UK Biobank identifies variants protective for disease. Nat Commun 2018; 9:1613. [PMID: 29691411 PMCID: PMC5915445 DOI: 10.1038/s41467-018-03911-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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: 10/03/2017] [Accepted: 03/21/2018] [Indexed: 02/02/2023] Open
Abstract
Less than 3% of protein-coding genetic variants are predicted to result in loss of protein function through the introduction of a stop codon, frameshift, or the disruption of an essential splice site; however, such predicted loss-of-function (pLOF) variants provide insight into effector transcript and direction of biological effect. In >400,000 UK Biobank participants, we conduct association analyses of 3759 pLOF variants with six metabolic traits, six cardiometabolic diseases, and twelve additional diseases. We identified 18 new low-frequency or rare (allele frequency < 5%) pLOF variant-phenotype associations. pLOF variants in the gene GPR151 protect against obesity and type 2 diabetes, in the gene IL33 against asthma and allergic disease, and in the gene IFIH1 against hypothyroidism. In the gene PDE3B, pLOF variants associate with elevated height, improved body fat distribution and protection from coronary artery disease. Our findings prioritize genes for which pharmacologic mimics of pLOF variants may lower risk for disease.
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Affiliation(s)
- Connor A Emdin
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Cardiology Division, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Amit V Khera
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Cardiology Division, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Mark Chaffin
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Cardiology Division, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Derek Klarin
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Pradeep Natarajan
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Cardiology Division, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Krishna Aragam
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Cardiology Division, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Mary Haas
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Cardiology Division, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Alexander Bick
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Seyedeh M Zekavat
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
- Department of Computational Biology & Bioinformatics, Yale Medical School, Yale University, New Haven, MA, 06510, USA
| | - Akihiro Nomura
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Cardiology Division, Harvard Medical School, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, 43121, Italy
- Associazione per lo Studio Della Trombosi in Cardiologia, Pavia, 27100, Italy
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung, München, 80333, Germany
| | - Ruth McPherson
- University of Ottawa Heart Institute, Ottawa, ON, K1Y4W7, Canada
| | - Hugh Watkins
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, OX1 2JD, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX1 2JD, UK
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, Hospital del Mar Research Institute, Barcelona, 08003, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, 28029, Spain
- Facultat de Medicina, Universitat de Vic-Central de Cataluña, Barcelona, VIC, 08500, Spain
| | - Matthew J Bown
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Leicester, LE1 7RH, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, and NIHR Leicester Biomedical Research Centre, Leicester, LE1 7RH, UK
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Jeanette Erdmann
- Institute for Integrative and Experimental Genomics, University of Lübeck, Lübeck, 23562, Germany
| | - Namrata Gupta
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - John Danesh
- Department of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, CB2 0SR, UK
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
- National Institute of Health Research Blood and Transplant; Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, CB2 1TN, UK
| | - Daniel Chasman
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, 02115, USA
| | - Paul Ridker
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, 02115, USA
| | - Joshua Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37235, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37235, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale University, New Haven, CT, 06520, USA
| | - Jennifer Mattera
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, 06510, USA
| | - John A Spertus
- Department of Biomedical & Saint Luke's Mid America Heart Institute and the Health Informatics, Division of Endocrinology and Metabolism, University of Missouri-Kansas City, Kansas City, MO, 64110, USA
| | - Wayne H-H Sheu
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, LABioMed and Department of Pediatrics at Harbor-UCLA Medical Center, Torrance, CA, 90095, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, 98195, WA, USA
- Cardiovascular Health Research Unit, Kaiser Permanente Washington Health Research Institute, 98101, Seattle, WA, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Wendy Post
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, LABioMed and Department of Pediatrics at Harbor-UCLA Medical Center, Torrance, CA, 90095, USA
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, LABioMed and Department of Pediatrics at Harbor-UCLA Medical Center, Torrance, CA, 90095, USA
| | - Harlan Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, 06510, USA
| | - Danish Saleheen
- Center for Non-Communicable Diseases, Karachi, 74800, Pakistan
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Stacey Gabriel
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Sekar Kathiresan
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
- Department of Medicine, Massachusetts General Hospital, Cardiology Division, Harvard Medical School, Boston, MA, 02114, USA.
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA.
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24
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Emdin CA, Khera AV, Klarin D, Natarajan P, Zekavat SM, Nomura A, Haas M, Aragam K, Ardissino D, Wilson JG, Schunkert H, McPherson R, Watkins H, Elosua R, Bown MJ, Samani NJ, Baber U, Erdmann J, Gormley P, Palotie A, Stitziel NO, Gupta N, Danesh J, Saleheen D, Gabriel S, Kathiresan S. Phenotypic Consequences of a Genetic Predisposition to Enhanced Nitric Oxide Signaling. Circulation 2017; 137:222-232. [PMID: 28982690 DOI: 10.1161/circulationaha.117.028021] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [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] [Received: 04/10/2017] [Accepted: 09/25/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nitric oxide signaling plays a key role in the regulation of vascular tone and platelet activation. Here, we seek to understand the impact of a genetic predisposition to enhanced nitric oxide signaling on risk for cardiovascular diseases, thus informing the potential utility of pharmacological stimulation of the nitric oxide pathway as a therapeutic strategy. METHODS We analyzed the association of common and rare genetic variants in 2 genes that mediate nitric oxide signaling (Nitric Oxide Synthase 3 [NOS3] and Guanylate Cyclase 1, Soluble, Alpha 3 [GUCY1A3]) with a range of human phenotypes. We selected 2 common variants (rs3918226 in NOS3 and rs7692387 in GUCY1A3) known to associate with increased NOS3 and GUCY1A3 expression and reduced mean arterial pressure, combined them into a genetic score, and standardized this exposure to a 5 mm Hg reduction in mean arterial pressure. Using individual-level data from 335 464 participants in the UK Biobank and summary association results from 7 large-scale genome-wide association studies, we examined the effect of this nitric oxide signaling score on cardiometabolic and other diseases. We also examined whether rare loss-of-function mutations in NOS3 and GUCY1A3 were associated with coronary heart disease using gene sequencing data from the Myocardial Infarction Genetics Consortium (n=27 815). RESULTS A genetic predisposition to enhanced nitric oxide signaling was associated with reduced risks of coronary heart disease (odds ratio, 0.37; 95% confidence interval [CI], 0.31-0.45; P=5.5*10-26], peripheral arterial disease (odds ratio 0.42; 95% CI, 0.26-0.68; P=0.0005), and stroke (odds ratio, 0.53; 95% CI, 0.37-0.76; P=0.0006). In a mediation analysis, the effect of the genetic score on decreased coronary heart disease risk extended beyond its effect on blood pressure. Conversely, rare variants that inactivate the NOS3 or GUCY1A3 genes were associated with a 23 mm Hg higher systolic blood pressure (95% CI, 12-34; P=5.6*10-5) and a 3-fold higher risk of coronary heart disease (odds ratio, 3.03; 95% CI, 1.29-7.12; P=0.01). CONCLUSIONS A genetic predisposition to enhanced nitric oxide signaling is associated with reduced risks of coronary heart disease, peripheral arterial disease, and stroke. Pharmacological stimulation of nitric oxide signaling may prove useful in the prevention or treatment of cardiovascular disease.
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Affiliation(s)
- Connor A Emdin
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.).,Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
| | - Amit V Khera
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.).,Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
| | - Derek Klarin
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.).,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.K.)
| | - Pradeep Natarajan
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.).,Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
| | - Seyedeh M Zekavat
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.).,Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
| | - Akihiro Nomura
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.).,Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
| | - Mary Haas
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.).,Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
| | - Krishna Aragam
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.).,Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy (D.A.).,Associazione per lo Studio Della Trombosi in Cardiologia, Pavia, Italy (D.A.)
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (J.G.W.)
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung, München, Germany (H.S.)
| | - Ruth McPherson
- University of Ottawa Heart Institute, Ontario, Canada (R.M.)
| | - Hugh Watkins
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom (H.W.).,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (H.W.)
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, Hospital del Mar Research Institute, Barcelona, Spain (R.E).,CIBER Enfermedades Cardiovasculares, Barcelona, Spain (R.E.).,Facultat de Medicina, Universitat de Vic-Central de Cataluña, Spain (R.E.)
| | - Matthew J Bown
- Department of Cardiovascular Sciences, University of Leicester, National Institute for Health Research, Leicester Biomedical Research Centre, United Kingdom (M.J.B., N.J.S.)
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, National Institute for Health Research, Leicester Biomedical Research Centre, United Kingdom (M.J.B., N.J.S.)
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (U.B.)
| | - Jeanette Erdmann
- Institute for Integrative and Experimental Genomics, University of Lübeck, Germany (J.E.)
| | - Padhraig Gormley
- Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
| | - Aarno Palotie
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.).,Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
| | - Nathan O Stitziel
- Departments of Medicine and Genetics, Cardiovascular Division, McDonnell Genome Institute, Washington University School of Medicine, St Louis, MO (N.O.S.)
| | - Namrata Gupta
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.)
| | - John Danesh
- Department of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, United Kingdom (J.D.).,Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (J.D).,National Institute of Health Research Blood and Transplant, Research Unit in Donor Health and Genomics, University of Cambridge, United Kingdom (J.D.)
| | - Danish Saleheen
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (D.S.).,Center for Non-Communicable Diseases, Karachi, Pakistan (D.S.)
| | - Stacey Gabriel
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.)
| | - Sekar Kathiresan
- Center for Genomic Medicine (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., K.A., A.P., N.G., S.G., S.K.) .,Department of Medicine, Cardiology Division (C.A.E., A.V.K., P.N., S.M.Z., A.N., P.G., A.P., M.H., K.A., S.K.).,Massachusetts General Hospital, Harvard Medical School, Boston, MA. Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.A.E., A.V.K., D.K., P.N., S.M.Z., A.N., M.H., P.G., A.P., K.A., S.K.)
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