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Teumer A, Trenkwalder T, Kessler T, Jamshidi Y, van den Berg ME, Kaess B, Nelson CP, Bastiaenen R, De Bortoli M, Rossini A, Deisenhofer I, Stark K, Assa S, Braund PS, Cabrera C, Dominiczak AF, Gögele M, Hall LM, Ikram MA, Kavousi M, Lackner KJ, Müller C, Münzel T, Nauck M, Padmanabhan S, Pfeiffer N, Spector TD, Uitterlinden AG, Verweij N, Völker U, Warren HR, Zafar M, Felix SB, Kors JA, Snieder H, Munroe PB, Pattaro C, Fuchsberger C, Schmidt G, Nolte IM, Schunkert H, Pramstaller PP, Wild PS, van der Harst P, Stricker BH, Schnabel RB, Samani NJ, Hengstenberg C, Dörr M, Behr ER, Reinhard W. KCND3 potassium channel gene variant confers susceptibility to electrocardiographic early repolarization pattern. JCI Insight 2019; 4:131156. [PMID: 31600170 PMCID: PMC6962032 DOI: 10.1172/jci.insight.131156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUNDThe presence of an early repolarization pattern (ERP) on the surface ECG is associated with risk of ventricular fibrillation and sudden cardiac death. Family studies have shown that ERP is a highly heritable trait, but molecular genetic determinants are unknown.METHODSTo identify genetic susceptibility loci for ERP, we performed a GWAS and meta-analysis in 2,181 cases and 23,641 controls of European ancestry.RESULTSWe identified a genome-wide significant (P < 5 × 10-8) locus in the potassium voltage-gated channel subfamily D member 3 (KCND3) gene that was successfully replicated in additional 1,124 cases and 12,510 controls. A subsequent joint meta-analysis of the discovery and replication cohorts identified rs1545300 as the lead SNP at the KCND3 locus (OR 0.82 per minor T allele, P = 7.7 × 10-12) but did not reveal additional loci. Colocalization analyses indicate causal effects of KCND3 gene expression levels on ERP in both cardiac left ventricle and tibial artery.CONCLUSIONSIn this study, we identified for the first time to our knowledge a genome-wide significant association of a genetic variant with ERP. Our findings of a locus in the KCND3 gene provide insights not only into the genetic determinants but also into the pathophysiological mechanism of ERP, discovering a promising candidate for functional studies.FUNDINGThis project was funded by the German Center for Cardiovascular Research (DZHK Shared Expertise SE081 - STATS). For detailed funding information per study, see the Supplemental Acknowledgments.
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Affiliation(s)
- Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Teresa Trenkwalder
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thorsten Kessler
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yalda Jamshidi
- Genetics Research Centre, Institute of Molecular and Clinical Sciences, Saint George's University of London, London, United Kingdom
| | - Marten E van den Berg
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Bernhard Kaess
- Medizinische Klinik I, St. Josefs-Hospital, Wiesbaden, Germany
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Rachel Bastiaenen
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, Saint George's, University of London, London, United Kingdom
| | - Marzia De Bortoli
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Alessandra Rossini
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Isabel Deisenhofer
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Stark
- Department of Genetic Epidemiology, University Regensburg, Regensburg, Germany
| | - Solmaz Assa
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Peter S Braund
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Claudia Cabrera
- Clinical Pharmacology, William Harvey Research Institute, and.,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom.,Centre for Translational Bioinformatics, William Harvey Research Institute, Barts and the London, London, United Kingdom, and School of Medicine and Dentistry, Charterhouse Square, London, United Kingdom
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Martin Gögele
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Leanne M Hall
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,DZHK, partner site Rhine-Main, Mainz, Germany
| | | | - Christian Müller
- University Heart & Vascular Center Hamburg, Hamburg, Germany.,DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Münzel
- DZHK, partner site Rhine-Main, Mainz, Germany.,Cardiology I, Center for Cardiology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Matthias Nauck
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Andre G Uitterlinden
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niek Verweij
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Uwe Völker
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Interfaculty Institute for Genetics and Functional Genomics and
| | - Helen R Warren
- Clinical Pharmacology, William Harvey Research Institute, and.,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Mobeen Zafar
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Stephan B Felix
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Patricia B Munroe
- Clinical Pharmacology, William Harvey Research Institute, and.,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Cristian Pattaro
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Christian Fuchsberger
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Georg Schmidt
- Innere Medizin I, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,DZHK, partner site Munich Heart Alliance, Munich, Germany
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Heribert Schunkert
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany.,DZHK, partner site Munich Heart Alliance, Munich, Germany
| | - Peter P Pramstaller
- Eurac Research, Institute for Biomedicine, affiliated with the University of Lübeck, Bolzano, Italy
| | - Philipp S Wild
- DZHK, partner site Rhine-Main, Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Renate B Schnabel
- University Heart & Vascular Center Hamburg, Hamburg, Germany.,DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, Saint George's University of London, London, United Kingdom.,Saint George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Wibke Reinhard
- Klinik für Herz-und Kreislauferkrankungen, Deutsches Herzzentrum München, School of Medicine, Technical University of Munich, Munich, Germany
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Münzel T, Hahad O, Gori T, Hollmann S, Arnold N, Prochaska JH, Schulz A, Beutel M, Pfeiffer N, Schmidtmann I, Lackner KJ, Keaney JF, Wild PS. Heart rate, mortality, and the relation with clinical and subclinical cardiovascular diseases: results from the Gutenberg Health Study. Clin Res Cardiol 2019; 108:1313-1323. [PMID: 30953178 PMCID: PMC6868108 DOI: 10.1007/s00392-019-01466-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Higher, but also lower resting heart rate (HR), has been associated with increased cardiovascular events and mortality. Little is known about the interplay between HR, cardiovascular risk factors, concomitant diseases, vascular (endothelial) function, neurohormonal biomarkers, and all-cause mortality in the general population. Thus, we aimed to investigate these relationships in a population-based cohort. METHODS 15,010 individuals (aged 35-74 at enrolment in 2007-2012) from the Gutenberg Health Study were analyzed. Multivariable regression modeling was used to assess the relation between the variables and conditional density plots were generated for cardiovascular risk factors, diseases, and mortality to show their dependence on HR. RESULTS There were 714 deaths in the total sample at 7.67 ± 1.68 years of follow-up. The prevalence of diabetes mellitus, arterial hypertension, coronary and peripheral artery disease, chronic heart failure, and previous myocardial infarction exhibited a J-shaped association with HR. Mortality showed a similar relation with a nadir of 64 beats per minute (bpm) in the total sample. Each 10 bpm HR reduction in HR < 64 subjects was independently associated with increased mortality (Hazard Ratio 1.36; 95% confidence interval 1.06-1.75). This increased risk was also present in HR > 64 subjects (Hazard Ratio 1.29; 95% confidence interval 1.19-1.41 per 10 bpm increase in HR). Results found for vascular and neurohormonal biomarkers exhibited a differential picture in subjects with a HR below and above the nadir. DISCUSSION These results indicate that in addition to a higher HR, a lower HR is associated with increased mortality.
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Affiliation(s)
- Thomas Münzel
- Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
- Partner site RhineMain, German Center for Cardiovascular Research (DZHK), Mainz, Germany.
| | - Omar Hahad
- Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Tommaso Gori
- Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- Partner site RhineMain, German Center for Cardiovascular Research (DZHK), Mainz, Germany
| | - Sebastian Hollmann
- Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Natalie Arnold
- Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Partner site RhineMain, German Center for Cardiovascular Research (DZHK), Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karl J Lackner
- Partner site RhineMain, German Center for Cardiovascular Research (DZHK), Mainz, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - John F Keaney
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Partner site RhineMain, German Center for Cardiovascular Research (DZHK), Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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