51
|
Guo L, Sakamoto A, Cornelissen A, Hong CC, Finn AV. Ironing-Out the Role of Hepcidin in Atherosclerosis. Arterioscler Thromb Vasc Biol 2019; 39:303-305. [PMID: 30811251 DOI: 10.1161/atvbaha.119.312369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Liang Guo
- From the CVPath Institute, Gaithersburg, MD (L.G., A.S., A.C., A.V.F.)
| | - Atsushi Sakamoto
- From the CVPath Institute, Gaithersburg, MD (L.G., A.S., A.C., A.V.F.)
| | - Anne Cornelissen
- From the CVPath Institute, Gaithersburg, MD (L.G., A.S., A.C., A.V.F.)
| | - Charles C Hong
- Department of Medicine, University of Maryland School of Medicine, Baltimore (C.C.H., A.V.F.)
| | - Aloke V Finn
- From the CVPath Institute, Gaithersburg, MD (L.G., A.S., A.C., A.V.F.).,Department of Medicine, University of Maryland School of Medicine, Baltimore (C.C.H., A.V.F.)
| |
Collapse
|
52
|
Malhotra R, Wunderer F, Barnes HJ, Bagchi A, Buswell MD, O'Rourke CD, Slocum CL, Ledsky CD, Peneyra KM, Sigurslid H, Corman B, Johansson KB, Rhee DK, Bloch KD, Bloch DB. Hepcidin Deficiency Protects Against Atherosclerosis. Arterioscler Thromb Vasc Biol 2019; 39:178-187. [PMID: 30587002 DOI: 10.1161/atvbaha.118.312215] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective- Inflammatory stimuli enhance the progression of atherosclerotic disease. Inflammation also increases the expression of hepcidin, a hormonal regulator of iron homeostasis, which decreases intestinal iron absorption, reduces serum iron levels and traps iron within macrophages. The role of macrophage iron in the development of atherosclerosis remains incompletely understood. The objective of this study was to investigate the effects of hepcidin deficiency and decreased macrophage iron on the development of atherosclerosis. Approach and Results- Hepcidin- and LDL (low-density lipoprotein) receptor-deficient ( Hamp-/-/ Ldlr-/-) mice and Hamp+/+/ Ldlr-/- control mice were fed a high-fat diet for 21 weeks. Compared with control mice, Hamp-/-/ Ldlr-/- mice had decreased aortic macrophage activity and atherosclerosis. Because hepcidin deficiency is associated with both increased serum iron and decreased macrophage iron, the possibility that increased serum iron was responsible for decreased atherosclerosis in Hamp-/-/ Ldlr-/- mice was considered. Hamp+/+/ Ldlr-/- mice were treated with iron dextran so as to produce a 2-fold increase in serum iron. Increased serum iron did not decrease atherosclerosis in Hamp+/+/ Ldlr-/- mice. Aortic macrophages from Hamp-/-/ Ldlr-/- mice had less labile free iron and exhibited a reduced proinflammatory (M1) phenotype compared with macrophages from Hamp+/+/ Ldlr-/- mice. THP1 human macrophages treated with an iron chelator were used to model hepcidin deficiency in vitro. Treatment with an iron chelator reduced LPS (lipopolysaccharide)-induced M1 phenotypic expression and decreased uptake of oxidized LDL. Conclusions- In summary, in a hyperlipidemic mouse model, hepcidin deficiency was associated with decreased macrophage iron, a reduced aortic macrophage inflammatory phenotype and protection from atherosclerosis. The results indicate that decreasing hepcidin activity, with the resulting decrease in macrophage iron, may prove to be a novel strategy for the treatment of atherosclerosis.
Collapse
Affiliation(s)
- Rajeev Malhotra
- From the Cardiovascular Research Center and Cardiology Division of the Department of Medicine (R.M., H.J.B., M.D.B., C.L.S., H.S., D.K.R., K.D.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Florian Wunderer
- the Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (F.W., A.B., C.D.O., C.D.L., K.M.P., B.C., K.B.J., K.D.B., D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston.,Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany (F.W.)
| | - Hanna J Barnes
- From the Cardiovascular Research Center and Cardiology Division of the Department of Medicine (R.M., H.J.B., M.D.B., C.L.S., H.S., D.K.R., K.D.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Aranya Bagchi
- the Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (F.W., A.B., C.D.O., C.D.L., K.M.P., B.C., K.B.J., K.D.B., D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Mary D Buswell
- From the Cardiovascular Research Center and Cardiology Division of the Department of Medicine (R.M., H.J.B., M.D.B., C.L.S., H.S., D.K.R., K.D.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Caitlin D O'Rourke
- the Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (F.W., A.B., C.D.O., C.D.L., K.M.P., B.C., K.B.J., K.D.B., D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Charles L Slocum
- From the Cardiovascular Research Center and Cardiology Division of the Department of Medicine (R.M., H.J.B., M.D.B., C.L.S., H.S., D.K.R., K.D.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Clara D Ledsky
- the Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (F.W., A.B., C.D.O., C.D.L., K.M.P., B.C., K.B.J., K.D.B., D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Kathryn M Peneyra
- the Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (F.W., A.B., C.D.O., C.D.L., K.M.P., B.C., K.B.J., K.D.B., D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Haakon Sigurslid
- From the Cardiovascular Research Center and Cardiology Division of the Department of Medicine (R.M., H.J.B., M.D.B., C.L.S., H.S., D.K.R., K.D.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Benjamin Corman
- the Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (F.W., A.B., C.D.O., C.D.L., K.M.P., B.C., K.B.J., K.D.B., D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Kimberly B Johansson
- the Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (F.W., A.B., C.D.O., C.D.L., K.M.P., B.C., K.B.J., K.D.B., D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - David K Rhee
- From the Cardiovascular Research Center and Cardiology Division of the Department of Medicine (R.M., H.J.B., M.D.B., C.L.S., H.S., D.K.R., K.D.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Kenneth D Bloch
- From the Cardiovascular Research Center and Cardiology Division of the Department of Medicine (R.M., H.J.B., M.D.B., C.L.S., H.S., D.K.R., K.D.B.), Massachusetts General Hospital and Harvard Medical School, Boston.,the Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (F.W., A.B., C.D.O., C.D.L., K.M.P., B.C., K.B.J., K.D.B., D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| | - Donald B Bloch
- the Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine (F.W., A.B., C.D.O., C.D.L., K.M.P., B.C., K.B.J., K.D.B., D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston.,Division of Rheumatology, Allergy and Immunology of the Department of Medicine (D.B.B.), Massachusetts General Hospital and Harvard Medical School, Boston
| |
Collapse
|
53
|
Cornelissen A, Guo L, Sakamoto A, Virmani R, Finn AV. New insights into the role of iron in inflammation and atherosclerosis. EBioMedicine 2019; 47:598-606. [PMID: 31416722 PMCID: PMC6796517 DOI: 10.1016/j.ebiom.2019.08.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/24/2022] Open
Abstract
Iron is fundamental for life-essential processes. However, it can also cause oxidative damage, which is thought to trigger numerous pathologies, including cardiovascular diseases. The role of iron in the pathogenesis of atherosclerosis is still not completely understood. Macrophages are both key players in the handling of iron throughout the body and in the onset, progression and destabilization of atherosclerotic plaques. Iron itself might impact atherosclerosis through its effects on macrophages. However, while targeting iron metabolism within macrophages may have some beneficial effects on preventing atherosclerotic plaque progression there may also be negative consequences. Thus, the prevailing view of iron being capable of accelerating the progression of coronary disease through lipid peroxidation may not fully take into account the multi-faceted role of iron in pathogenesis of atherosclerosis. In this review, we will summarize the current understanding of iron metabolism in the context of the complex interplay between iron, inflammation, and atherosclerosis.
Collapse
Affiliation(s)
- Anne Cornelissen
- CVPath Institute, Gaithersburg, MD, USA; University Hospital RWTH Aachen, Department of Cardiology, Aachen, Germany.
| | - Liang Guo
- CVPath Institute, Gaithersburg, MD, USA.
| | | | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD, USA; University of Maryland, School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
54
|
Wilman HR, Parisinos CA, Atabaki-Pasdar N, Kelly M, Thomas EL, Neubauer S, Mahajan A, Hingorani AD, Patel RS, Hemingway H, Franks PW, Bell JD, Banerjee R, Yaghootkar H. Genetic studies of abdominal MRI data identify genes regulating hepcidin as major determinants of liver iron concentration. J Hepatol 2019; 71:594-602. [PMID: 31226389 PMCID: PMC6694204 DOI: 10.1016/j.jhep.2019.05.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND & AIMS Excess liver iron content is common and is linked to the risk of hepatic and extrahepatic diseases. We aimed to identify genetic variants influencing liver iron content and use genetics to understand its link to other traits and diseases. METHODS First, we performed a genome-wide association study (GWAS) in 8,289 individuals from UK Biobank, whose liver iron level had been quantified by magnetic resonance imaging, before validating our findings in an independent cohort (n = 1,513 from IMI DIRECT). Second, we used Mendelian randomisation to test the causal effects of 25 predominantly metabolic traits on liver iron content. Third, we tested phenome-wide associations between liver iron variants and 770 traits and disease outcomes. RESULTS We identified 3 independent genetic variants (rs1800562 [C282Y] and rs1799945 [H63D] in HFE and rs855791 [V736A] in TMPRSS6) associated with liver iron content that reached the GWAS significance threshold (p <5 × 10-8). The 2 HFE variants account for ∼85% of all cases of hereditary haemochromatosis. Mendelian randomisation analysis provided evidence that higher central obesity plays a causal role in increased liver iron content. Phenome-wide association analysis demonstrated shared aetiopathogenic mechanisms for elevated liver iron, high blood pressure, cirrhosis, malignancies, neuropsychiatric and rheumatological conditions, while also highlighting inverse associations with anaemias, lipidaemias and ischaemic heart disease. CONCLUSION Our study provides genetic evidence that mechanisms underlying higher liver iron content are likely systemic rather than organ specific, that higher central obesity is causally associated with higher liver iron, and that liver iron shares common aetiology with multiple metabolic and non-metabolic diseases. LAY SUMMARY Excess liver iron content is common and is associated with liver diseases and metabolic diseases including diabetes, high blood pressure, and heart disease. We identified 3 genetic variants that are linked to an increased risk of developing higher liver iron content. We show that the same genetic variants are linked to higher risk of many diseases, but they may also be associated with some health advantages. Finally, we use genetic variants associated with waist-to-hip ratio as a tool to show that central obesity is causally associated with increased liver iron content.
Collapse
Affiliation(s)
- Henry R Wilman
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK; Perspectum Diagnostics Ltd., Oxford, UK
| | - Constantinos A Parisinos
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK.
| | - Naeimeh Atabaki-Pasdar
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
| | | | - E Louise Thomas
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK
| | - Stefan Neubauer
- Perspectum Diagnostics Ltd., Oxford, UK; Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Anubha Mahajan
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Riyaz S Patel
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
| | - Jimmy D Bell
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | | | - Hanieh Yaghootkar
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK; Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, UK.
| |
Collapse
|
55
|
Gill D, Brewer CF, Monori G, Trégouët D, Franceschini N, Giambartolomei C, Tzoulaki I, Dehghan A. Effects of Genetically Determined Iron Status on Risk of Venous Thromboembolism and Carotid Atherosclerotic Disease: A Mendelian Randomization Study. J Am Heart Assoc 2019; 8:e012994. [PMID: 31310728 PMCID: PMC6761644 DOI: 10.1161/jaha.119.012994] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
Background Systemic iron status has been implicated in atherosclerosis and thrombosis. The aim of this study was to investigate the effect of genetically determined iron status on carotid intima-media thickness, carotid plaque, and venous thromboembolism using Mendelian randomization. Methods and Results Genetic instrumental variables for iron status were selected from a genome-wide meta-analysis of 48 972 subjects. Genetic association estimates for carotid intima-media thickness and carotid plaque were obtained using data from 71 128 and 48 434 participants, respectively, and estimates for venous thromboembolism were obtained using data from a study incorporating 7507 cases and 52 632 controls. Conventional 2-sample summary data Mendelian randomization was performed for the main analysis. Higher genetically determined iron status was associated with increased risk of venous thromboembolism. Odds ratios per SD increase in biomarker levels were 1.37 (95% CI 1.14-1.66) for serum iron, 1.25 (1.09-1.43) for transferrin saturation, 1.92 (1.28-2.88) for ferritin, and 0.76 (0.63-0.92) for serum transferrin (with higher transferrin levels representing lower iron status). In contrast, higher iron status was associated with lower risk of carotid plaque. Corresponding odds ratios were 0.85 (0.73-0.99) for serum iron and 0.89 (0.80-1.00) for transferrin saturation, with concordant trends for serum transferrin and ferritin that did not reach statistical significance. There was no Mendelian randomization evidence of an effect of iron status on carotid intima-media thickness. Conclusions These findings support previous work to suggest that higher genetically determined iron status is protective against some forms of atherosclerotic disease but increases the risk of thrombosis related to stasis of blood.
Collapse
Affiliation(s)
- Dipender Gill
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | | | - Grace Monori
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | | | - Nora Franceschini
- Department of EpidemiologyUNC Gillings Global School of Public HealthChapel HillNC
| | - Claudia Giambartolomei
- Department of Pathology and Laboratory MedicineUniversity of California, Los AngelesLos AngelesCA
| | | | - Ioanna Tzoulaki
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
- MRC‐PHE Centre for EnvironmentSchool of Public HealthImperial College LondonLondonUnited Kingdom
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Abbas Dehghan
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
- MRC‐PHE Centre for EnvironmentSchool of Public HealthImperial College LondonLondonUnited Kingdom
| |
Collapse
|
56
|
Benn M, Nordestgaard BG. From genome-wide association studies to Mendelian randomization: novel opportunities for understanding cardiovascular disease causality, pathogenesis, prevention, and treatment. Cardiovasc Res 2019; 114:1192-1208. [PMID: 29471399 DOI: 10.1093/cvr/cvy045] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/16/2018] [Indexed: 12/22/2022] Open
Abstract
The Mendelian randomization approach is an epidemiological study design incorporating genetic information into traditional epidemiological studies to infer causality of biomarkers, risk factors, or lifestyle factors on disease risk. Mendelian randomization studies often draw on novel information generated in genome-wide association studies on causal associations between genetic variants and a risk factor or lifestyle factor. Such information can then be used in a largely unconfounded study design free of reverse causation to understand if and how risk factors and lifestyle factors cause cardiovascular disease. If causation is demonstrated, an opportunity for prevention of disease is identified; importantly however, before prevention or treatment can be implemented, randomized intervention trials altering risk factor levels or improving deleterious lifestyle factors needs to document reductions in cardiovascular disease in a safe and side-effect sparse manner. Documentation of causality can also inform on potential drug targets, more likely to be successful than prior approaches often relying on animal or cell studies mainly. The present review summarizes the history and background of Mendelian randomization, the study design, assumptions for using the design, and the most common caveats, followed by a discussion on advantages and disadvantages of different types of Mendelian randomization studies using one or more samples and different levels of information on study participants. The review also provides an overview of results on many of the risk factors and lifestyle factors for cardiovascular disease examined to date using the Mendelian randomization study design.
Collapse
Affiliation(s)
- Marianne Benn
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Børge G Nordestgaard
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, Denmark
| |
Collapse
|
57
|
Satoh K, Shimokawa H. Recent Advances in the Development of Cardiovascular Biomarkers. Arterioscler Thromb Vasc Biol 2019; 38:e61-e70. [PMID: 29695533 DOI: 10.1161/atvbaha.118.310226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Kimio Satoh
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| |
Collapse
|
58
|
Leong A, Chen J, Wheeler E, Hivert MF, Liu CT, Merino J, Dupuis J, Tai ES, Rotter JI, Florez JC, Barroso I, Meigs JB. Mendelian Randomization Analysis of Hemoglobin A 1c as a Risk Factor for Coronary Artery Disease. Diabetes Care 2019; 42:1202-1208. [PMID: 30659074 PMCID: PMC6609962 DOI: 10.2337/dc18-1712] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Observational studies show that higher hemoglobin A1c (A1C) predicts coronary artery disease (CAD). It remains unclear whether this association is driven entirely by glycemia. We used Mendelian randomization (MR) to test whether A1C is causally associated with CAD through glycemic and/or nonglycemic factors. RESEARCH DESIGN AND METHODS To examine the association of A1C with CAD, we selected 50 A1C-associated variants (log10 Bayes factor ≥6) from an A1C genome-wide association study (GWAS; n = 159,940) and performed an inverse-variance weighted average of variant-specific causal estimates from CAD GWAS data (CARDIoGRAMplusC4D; 60,801 CAD case subjects/123,504 control subjects). We then replicated results in UK Biobank (18,915 CAD case subjects/455,971 control subjects) and meta-analyzed all results. Next, we conducted analyses using two subsets of variants, 16 variants associated with glycemic measures (fasting or 2-h glucose) and 20 variants associated with erythrocyte indices (e.g., hemoglobin [Hb]) but not glycemic measures. In additional MR analyses, we tested the association of Hb with A1C and CAD. RESULTS Genetically increased A1C was associated with higher CAD risk (odds ratio [OR] 1.61 [95% CI 1.40, 1.84] per %-unit, P = 6.9 × 10-12). Higher A1C was associated with increased CAD risk when using only glycemic variants (OR 2.23 [1.73, 2.89], P = 1.0 × 10-9) and when using only erythrocytic variants (OR 1.30 [1.08, 1.57], P = 0.006). Genetically decreased Hb, with concomitantly decreased mean corpuscular volume, was associated with higher A1C (0.30 [0.27, 0.33] %-unit, P = 2.9 × 10-6) per g/dL and higher CAD risk (OR 1.19 [1.04, 1.37], P = 0.02). CONCLUSIONS Genetic evidence supports a causal link between higher A1C and higher CAD risk. This relationship is driven not only by glycemic but also by erythrocytic, glycemia-independent factors.
Collapse
Affiliation(s)
- Aaron Leong
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Ji Chen
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, U.K
| | - Eleanor Wheeler
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, U.K
| | - Marie-France Hivert
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Jordi Merino
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Jose C Florez
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Inês Barroso
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, U.K
| | - James B Meigs
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| |
Collapse
|
59
|
von Eckardstein A. Iron in Coronary Heart Disease—J-Shaped Associations and Ambivalent Relationships. Clin Chem 2019; 65:821-823. [DOI: 10.1373/clinchem.2019.303420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 12/24/2022]
|
60
|
Li M, Kwok MK, Fong SSM, Schooling CM. Indoleamine 2,3-dioxygenase and ischemic heart disease: a Mendelian Randomization study. Sci Rep 2019; 9:8491. [PMID: 31186442 PMCID: PMC6560130 DOI: 10.1038/s41598-019-44819-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/16/2019] [Indexed: 12/14/2022] Open
Abstract
Tryptophan is an essential amino acid. Indoleamine 2,3-dioxygenase (IDO), the rate-limiting enzyme in the tryptophan-kynurenine pathway, is positively associated with cardiac events, and may be relevant to cancer. We used Mendelian Randomization to obtain unconfounded estimates of the association of IDO1 with ischemic heart disease (IHD), ischemic stroke and their risk factors, all-cancer, cancer of the prostate, lung and bronchus, and breast. We obtained genetic instruments independently and strongly (p-value < 5 × 10-8) predicting plasma IDO1 from a proteome genome-wide association study (GWAS), and applied them to consortia GWAS of the outcomes, including the UK Biobank SOFT CAD GWAS (cases < = 76 014, non-cases < = 264 785) for IHD. Estimates were obtained using inverse variance weighting; with MR-Egger, weighted median and MR-PRESSO as sensitivity analyses. IDO1 was inversely associated with IHD (odds ratio (OR) 0.96 per standard deviation, 95% confidence interval (CI) 0.93 to 1.00, p-value = 0.04), diabetes (OR 0.91, 95% CI 0.85 to 0.97) and prostate cancer (OR 0.96, 95% CI 0.93 to 0.99) with a directionally consistent estimate for stroke (OR 0.98, 95% CI 0.95 to 1.02) but not with blood pressure, or the other cancers considered. IDO1 might be a potential therapeutic target for IHD, diabetes and prostate cancer.
Collapse
Affiliation(s)
- Mengyu Li
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shirley Siu Ming Fong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Catherine Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- City University of New York, Graduate School of Public Health and Health Policy, New York, NY, USA.
| |
Collapse
|
61
|
Gill D, Benyamin B, Moore LSP, Monori G, Zhou A, Koskeridis F, Evangelou E, Laffan M, Walker AP, Tsilidis KK, Dehghan A, Elliott P, Hyppönen E, Tzoulaki I. Associations of genetically determined iron status across the phenome: A mendelian randomization study. PLoS Med 2019; 16:e1002833. [PMID: 31220083 PMCID: PMC6586257 DOI: 10.1371/journal.pmed.1002833] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/21/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Iron is integral to many physiological processes, and variations in its levels, even within the normal range, can have implications for health. The objective of this study was to explore the broad clinical effects of varying iron status. METHODS AND FINDINGS Genome-wide association study (GWAS) summary data obtained from 48,972 European individuals (55% female) across 19 cohorts in the Genetics of Iron Status Consortium were used to identify 3 genetic variants (rs1800562 and rs1799945 in the hemochromatosis gene [HFE] and rs855791 in the transmembrane protease serine 6 gene [TMPRSS6]) that associate with increased serum iron, ferritin, and transferrin saturation and decreased transferrin levels, thus serving as instruments for systemic iron status. Phenome-wide association study (PheWAS) of these instruments was performed on 424,439 European individuals (54% female) in the UK Biobank who were aged 40-69 years when recruited from 2006 to 2010, with their genetic data linked to Hospital Episode Statistics (HES) from April, 1995 to March, 2016. Two-sample summary data mendelian randomization (MR) analysis was performed to investigate the effect of varying iron status on outcomes across the human phenome. MR-PheWAS analysis for the 3 iron status genetic instruments was performed separately and then pooled by meta-analysis. Correction was made for testing of multiple correlated phenotypes using a 5% false discovery rate (FDR) threshold. Heterogeneity between MR estimates for different instruments was used to indicate possible bias due to effects of the genetic variants through pathways unrelated to iron status. There were 904 distinct phenotypes included in the MR-PheWAS analyses. After correcting for multiple testing, the 3 genetic instruments for systemic iron status demonstrated consistent evidence of a causal effect of higher iron status on decreasing risk of traits related to anemia (iron deficiency anemia: odds ratio [OR] scaled to a standard deviation [SD] increase in genetically determined serum iron levels 0.72, 95% confidence interval [CI] 0.64-0.81, P = 4 × 10-8) and hypercholesterolemia (hypercholesterolemia: OR 0.88, 95% CI 0.83-0.93, P = 2 × 10-5) and increasing risk of traits related to infection of the skin and related structures (cellulitis and abscess of the leg: OR 1.25, 95% CI 1.10-1.42, P = 6 × 10-4). The main limitations of this study relate to possible bias from pleiotropic effects of the considered genetic variants and misclassification of diagnoses in the HES data. Furthermore, this work only investigated participants with European ancestry, and the findings may not be applicable to other ethnic groups. CONCLUSIONS Our findings offer novel, to our knowledge, insight into previously unreported effects of iron status, highlighting a potential protective effect of higher iron status on hypercholesterolemia and a detrimental role on risk of skin and skin structure infections. Given the modifiable and variable nature of iron status, these findings warrant further investigation.
Collapse
Affiliation(s)
- Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
| | - Beben Benyamin
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Luke S. P. Moore
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, United Kingdom
- Chelsea & Westminster NHS Foundation Trust, London, United Kingdom
- Imperial Biomedical Research Centre, Imperial College London and Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Grace Monori
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Ang Zhou
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
| | - Fotios Koskeridis
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Evangelos Evangelou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Mike Laffan
- Centre for Haematology, Imperial College London, United Kingdom
| | - Ann P. Walker
- Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Medical Research Council-Public Health England Centre for Environment, School of Public Health, Imperial College London, London, United Kingdom
- UK Dementia Research Institute, Imperial College London, London, United Kingdom
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Imperial Biomedical Research Centre, Imperial College London and Imperial College NHS Healthcare Trust, London, United Kingdom
- Medical Research Council-Public Health England Centre for Environment, School of Public Health, Imperial College London, London, United Kingdom
- UK Dementia Research Institute, Imperial College London, London, United Kingdom
- Health Data Research UK-London, London, United Kingdom
| | - Elina Hyppönen
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- Medical Research Council-Public Health England Centre for Environment, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
62
|
Hu Q, Hao P, Liu Q, Dong M, Gong Y, Zhang C, Zhang Y. Mendelian randomization studies on atherosclerotic cardiovascular disease: evidence and limitations. SCIENCE CHINA-LIFE SCIENCES 2019; 62:758-770. [DOI: 10.1007/s11427-019-9537-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/26/2019] [Indexed: 12/26/2022]
|
63
|
Hong C, Liao KP, Cai T. Semi‐supervised validation of multiple surrogate outcomes with application to electronic medical records phenotyping. Biometrics 2019; 75:78-89. [DOI: 10.1111/biom.12971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 09/14/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Chuan Hong
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Katherine P. Liao
- Division of RheumatologyBrigham and Womens HospitalBostonMassachusetts
| | - Tianxi Cai
- Department of BiostatisticsHarvard T.H. Chan School of Public HealthBostonMassachusetts
| |
Collapse
|
64
|
Pilling LC, Tamosauskaite J, Jones G, Wood AR, Jones L, Kuo CL, Kuchel GA, Ferrucci L, Melzer D. Common conditions associated with hereditary haemochromatosis genetic variants: cohort study in UK Biobank. BMJ 2019; 364:k5222. [PMID: 30651232 PMCID: PMC6334179 DOI: 10.1136/bmj.k5222] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare prevalent and incident morbidity and mortality between those with the HFE p.C282Y genetic variant (responsible for most hereditary haemochromatosis type 1) and those with no p.C282Y mutations, in a large UK community sample of European descent. DESIGN Cohort study. SETTING 22 centres across England, Scotland, and Wales in UK Biobank (2006-10). PARTICIPANTS 451 243 volunteers of European descent aged 40 to 70 years, with a mean follow-up of seven years (maximum 9.4 years) through hospital inpatient diagnoses and death certification. MAIN OUTCOME MEASURE Odds ratios and Cox hazard ratios of disease rates between participants with and without the haemochromatosis mutations, adjusted for age, genotyping array type, and genetic principal components. The sexes were analysed separately as morbidity due to iron excess occurs later in women. RESULTS Of 2890 participants homozygous for p.C282Y (0.6%, or 1 in 156), haemochromatosis was diagnosed in 21.7% (95% confidence interval 19.5% to 24.1%, 281/1294) of men and 9.8% (8.4% to 11.2%, 156/1596) of women by end of follow-up. p.C282Y homozygous men aged 40 to 70 had a higher prevalence of diagnosed haemochromatosis (odds ratio 411.1, 95% confidence interval 299.0 to 565.3, P<0.001), liver disease (4.30, 2.97 to 6.18, P<0.001), rheumatoid arthritis (2.23, 1.51 to 3.31, P<0.001), osteoarthritis (2.01, 1.71 to 2.36, P<0.001), and diabetes mellitus (1.53, 1.16 to 1.98, P=0.002), versus no p.C282Y mutations (n=175 539). During the seven year follow-up, 15.7% of homozygous men developed at least one incident associated condition versus 5.0% (P<0.001) with no p.C282Y mutations (women 10.1% v 3.4%, P<0.001). Haemochromatosis diagnoses were more common in p.C282Y/p.H63D heterozygotes, but excess morbidity was modest. CONCLUSIONS In a large community sample, HFE p.C282Y homozygosity was associated with substantial prevalent and incident clinically diagnosed morbidity in both men and women. As p.C282Y associated iron overload is preventable and treatable if intervention starts early, these findings justify re-examination of options for expanded early case ascertainment and screening.
Collapse
Affiliation(s)
- Luke C Pilling
- Epidemiology and Public Health Group, University of Exeter Medical School, RD&E Wonford, Exeter EX2 5DW, UK
| | - Jone Tamosauskaite
- Epidemiology and Public Health Group, University of Exeter Medical School, RD&E Wonford, Exeter EX2 5DW, UK
| | - Garan Jones
- Epidemiology and Public Health Group, University of Exeter Medical School, RD&E Wonford, Exeter EX2 5DW, UK
| | - Andrew R Wood
- Genetics of Complex Traits Group, University of Exeter Medical School, Exeter, UK
| | - Lindsay Jones
- Epidemiology and Public Health Group, University of Exeter Medical School, RD&E Wonford, Exeter EX2 5DW, UK
| | - Chai-Ling Kuo
- Biostatistics Center, CT Institute for Clinical & Translational Science, University of Connecticut Health Center, Farmington, CT, USA
| | - George A Kuchel
- Center on Aging, University of Connecticut Health Center, Farmington, CT, USA
| | | | - David Melzer
- Epidemiology and Public Health Group, University of Exeter Medical School, RD&E Wonford, Exeter EX2 5DW, UK
- Center on Aging, University of Connecticut Health Center, Farmington, CT, USA
| |
Collapse
|
65
|
Gill D, Monori G, Tzoulaki I, Dehghan A. Iron Status and Risk of Stroke. Stroke 2018; 49:2815-2821. [PMID: 30571402 PMCID: PMC6257507 DOI: 10.1161/strokeaha.118.022701] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/06/2018] [Accepted: 09/24/2018] [Indexed: 01/22/2023]
Abstract
Background and Purpose- Both iron deficiency and excess have been associated with stroke risk in observational studies. However, such associations may be attributable to confounding from environmental factors. This study uses the Mendelian randomization technique to overcome these limitations by investigating the association between genetic variants related to iron status and stroke risk. Methods- A study of 48 972 subjects performed by the Genetics of Iron Status consortium identified genetic variants with concordant relations to 4 biomarkers of iron status (serum iron, transferrin saturation, ferritin, and transferrin) that supported their use as instruments for overall iron status. Genetic estimates from the MEGASTROKE consortium were used to investigate the association between the same genetic variants and stroke risk. The 2-sample ratio method Mendelian randomization approach was used for the main analysis, with the MR-Egger and weighted median techniques used in sensitivity analyses. Results- The main results, reported as odds ratio (OR) of stroke per SD unit increase in genetically determined iron status biomarker, showed a detrimental effect of increased iron status on stroke risk (serum iron OR, 1.07; 95% CI, 1.01-1.14; [log-transformed] ferritin OR, 1.18; 95% CI, 1.02-1.36; and transferrin saturation OR, 1.06; 95% CI, 1.01-1.11). A higher transferrin, indicative of lower iron status, was also associated with decreased stroke risk (OR, 0.92; 95% CI, 0.86-0.99). Examining ischemic stroke subtypes, we found the detrimental effect of iron status to be driven by cardioembolic stroke. These results were supported in statistical sensitivity analyses more robust to the inclusion of pleiotropic variants. Conclusions- This study provides Mendelian randomization evidence that higher iron status is associated with increased stroke risk and, in particular, cardioembolic stroke. Further work is required to investigate the underlying mechanism and whether this can be targeted in preventative strategies.
Collapse
Affiliation(s)
- Dipender Gill
- From the Department of Biostatistics and Epidemiology (D.G., G.M., I.T., A.D.), Imperial College London, United Kingdom
- School of Public Health, and Department of Stroke Medicine (D.G.), Imperial College London, United Kingdom
| | - Grace Monori
- From the Department of Biostatistics and Epidemiology (D.G., G.M., I.T., A.D.), Imperial College London, United Kingdom
| | - Ioanna Tzoulaki
- From the Department of Biostatistics and Epidemiology (D.G., G.M., I.T., A.D.), Imperial College London, United Kingdom
- MRC-PHE Centre for Environment (I.T., A.D.), Imperial College London, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Greece (I.T.)
| | - Abbas Dehghan
- From the Department of Biostatistics and Epidemiology (D.G., G.M., I.T., A.D.), Imperial College London, United Kingdom
- MRC-PHE Centre for Environment (I.T., A.D.), Imperial College London, United Kingdom
| |
Collapse
|
66
|
Shu L, Blencowe M, Yang X. Translating GWAS Findings to Novel Therapeutic Targets for Coronary Artery Disease. Front Cardiovasc Med 2018; 5:56. [PMID: 29900175 PMCID: PMC5989327 DOI: 10.3389/fcvm.2018.00056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/11/2018] [Indexed: 12/21/2022] Open
Abstract
The success of genome-wide association studies (GWAS) has significantly advanced our understanding of the etiology of coronary artery disease (CAD) and opens new opportunities to reinvigorate the stalling CAD drug development. However, there exists remarkable disconnection between the CAD GWAS findings and commercialized drugs. While this could implicate major untapped translational and therapeutic potentials in CAD GWAS, it also brings forward extensive technical challenges. In this review we summarize the motivation to leverage GWAS for drug discovery, outline the critical bottlenecks in the field, and highlight several promising strategies such as functional genomics and network-based approaches to enhance the translational value of CAD GWAS findings in driving novel therapeutics
Collapse
Affiliation(s)
- Le Shu
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States.,Molecular, Cellular, and Integrative Physiology Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Montgomery Blencowe
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Xia Yang
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States.,Molecular, Cellular, and Integrative Physiology Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States.,Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States.,Institute for Quantitative and Computational Biosciences, University of California, Los Angeles, Los Angeles, CA, United States.,Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
67
|
Suárez-Ortegón MF, McLachlan S, Price AH, Fernández-Balsells M, Franch-Nadal J, Mata-Cases M, Barrot-de la Puente J, Mundet-Tudurí X, Mauricio D, Ricart W, Wild SH, Strachan MWJ, Price JF, Fernández-Real JM. Decreased iron stores are associated with cardiovascular disease in patients with type 2 diabetes both cross-sectionally and longitudinally. Atherosclerosis 2018; 272:193-199. [PMID: 29625295 DOI: 10.1016/j.atherosclerosis.2018.03.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/27/2018] [Accepted: 03/15/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS The possible contribution of iron to cardiovascular complications of type 2 diabetes (T2D) has been scarcely investigated. We aimed to study whether serum ferritin is linked to prevalent/incident cardiovascular disease (CVD) in T2D. METHODS The prevalence of coronary heart disease (CHD), cerebrovascular disease (CEVD) and CVD was evaluated in the SIDIAP study (n = 38,617) and prevalence and 7-year incidence were analysed in the Edinburgh Type 2 Diabetes Study (ET2DS) (n = 821). Logistic and Cox regressions were used to describe associations between serum ferritin and CVD adjusting for confounding variables. RESULTS Increase of 1 SD unit in log-ferritin was associated with lower CVD prevalence in fully-adjusted models (ET2DS odds ratio (OR) 95% confidence interval (CI): 0.81 (0.68-0.96), p = 0.018; SIDIAP study: 0.91 (0.88-0.94), p < 0.001). In ET2DS, ferritin in the highest (vs. the lowest) quintile was associated with lower incidence of CVD (fully adjusted HR 95% CI: 0.46 (0.26-0.83), p = 0.010). This association persisted after removing subjects with CVD at baseline (n = 536) (HR 95% CI: 0.34 (0.14-0.81), p = 0.016). CONCLUSIONS Low iron status was associated with CVD risk in T2D. This pattern was consistent in populations at different cardiovascular risk. Low iron status seems to be harmful for cardiovascular health in T2D and it may be a target for intervention.
Collapse
Affiliation(s)
- Milton Fabian Suárez-Ortegón
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK; Nutrition Group, Universidad Del Valle, Cali, Colombia.
| | - Stela McLachlan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Anna H Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Mercé Fernández-Balsells
- Department of Diabetes, Endocrinology and Nutrition, Institut D'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Josep Franch-Nadal
- DAP-Catgroup, Unitat de Suport a La Recerca Barcelona Ciutat, Institut Universitari D'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Primary Health Care Center Raval Sud, Gerència D'Àmbit D'Atenció Primària Barcelona Ciutat, Institut Català de La Salut, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain
| | - Manel Mata-Cases
- DAP-Catgroup, Unitat de Suport a La Recerca Barcelona Ciutat, Institut Universitari D'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain; Primary Health Care La Mina (Sant Adrià de Besò), Gerència D'Àmbit D'Atenció Primària Barcelona Ciutat, Institut Català de La Salut, Barcelona, Spain
| | - Joan Barrot-de la Puente
- DAP-Catgroup, Unitat de Suport a La Recerca Barcelona Ciutat, Institut Universitari D'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Xavier Mundet-Tudurí
- DAP-Catgroup, Unitat de Suport a La Recerca Barcelona Ciutat, Institut Universitari D'Investigació en AtencióPrimària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Didac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain
| | - Wifredo Ricart
- Department of Diabetes, Endocrinology and Nutrition, Institut D'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Jackie F Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - José-Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Institut D'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain.
| |
Collapse
|
68
|
The Pros and Cons of Mendelian Randomization Studies to Evaluate Emerging Cardiovascular Risk Factors. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0566-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
69
|
Kobayashi M, Suhara T, Baba Y, Kawasaki NK, Higa JK, Matsui T. Pathological Roles of Iron in Cardiovascular Disease. Curr Drug Targets 2018; 19:1068-1076. [PMID: 29874997 PMCID: PMC6469984 DOI: 10.2174/1389450119666180605112235] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 01/19/2023]
Abstract
Iron is an essential mineral required for a variety of vital biological functions. Despite being vital for life, iron also has potentially toxic aspects. Iron has been investigated as a risk factor for coronary artery disease (CAD), however, iron's toxicity in CAD patients still remains controversial. One possible mechanism behind the toxicity of iron is "ferroptosis", a newly described form of irondependent cell death. Ferroptosis is an iron-dependent form of regulated cell death that is distinct from apoptosis, necroptosis, and other types of cell death. Ferroptosis has been reported in ischemiareperfusion (I/R) injury and several other diseases. Recently, we reported that ferroptosis is a significant form of cell death in cardiomyocytes. Moreover, myocardial hemorrhage, a major event in the pathogenesis of heart failure, could trigger the release of free iron into cardiac muscle and is an independent predictor of adverse left ventricular remodeling after myocardial infarction. Iron deposition in the heart can now be detected with advanced imaging methods, such as T2 star (T2*) cardiac magnetic resonance imaging, which can non-invasively predict iron levels in the myocardium and detect myocardial hemorrhage, thus existing technology could be used to assess myocardial iron. We will discuss the role of iron in cardiovascular diseases and especially with regard to myocardial I/R injury.
Collapse
Affiliation(s)
- Motoi Kobayashi
- Department of Anatomy, Biochemistry & Physiology, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Tomohiro Suhara
- Department of Anatomy, Biochemistry & Physiology, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuichi Baba
- Department of Anatomy, Biochemistry & Physiology, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Nicholas K. Kawasaki
- Department of Anatomy, Biochemistry & Physiology, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Jason K. Higa
- Department of Anatomy, Biochemistry & Physiology, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| | - Takashi Matsui
- Department of Anatomy, Biochemistry & Physiology, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI
| |
Collapse
|