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Hasser EK, Brody JA, Bartz TM, Thibord F, Li-Gao R, Kauko A, Wiggins KL, Teder-Laving M, Kim J, Munsch G, Haile HG, Deleuze JF, van Hylckama Vlieg A, Wolberg AS, Boland A, Morange PE, Kraft P, Lowenstein CJ, Emmerich J, Sitlani CM, Suchon P, Rosendaal FR, Niiranen T, Kabrhel C, Trégouët DA, Smith NL. Genome-wide investigation of exogenous female hormones, genetic variation, and venous thromboembolism risk. J Thromb Haemost 2024:S1538-7836(24)00294-0. [PMID: 38782299 DOI: 10.1016/j.jtha.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/02/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Increased risk of venous thromboembolism (VTE) is a life-threatening side effect for users of oral contraceptives (OCs) or hormone therapy (HT). OBJECTIVES To investigate the potential for genetic predisposition to VTE in OC or HT users, we conducted a gene-by-environment case-only meta-analysis of genome-wide association studies (GWAS). METHODS Use or nonuse of OCs (7 studies) or HT (8 studies) at the time of the VTE event was determined by pharmacy records or self-report. A synergy index (SI) was modeled for each variant in each study and submultiplicative/supramultiplicative gene-by-environment interactions were estimated. The SI parameters were first meta-analyzed across OC and HT studies and subsequently meta-analyzed to obtain an overall estimate. The primary analysis was agnostic GWAS and interrogated all imputed genotypes using a P value threshold of <5.0 × 10-8; secondary analyses were candidate-based. RESULTS The VTE case-only OC meta-analysis included 2895 OC users and 6607 nonusers; the case-only HT meta-analysis included 2434 HT users and 12 793 nonusers. In primary GWAS meta-analyses, no variant reached genome-wide significance, but the smallest P value approached statistical significance: rs9386463 (P = 5.03 × 10-8). We tested associations for 138 candidate variants and identified 2 that exceeded statistical significance (0.05/138 = 3.62 × 10-4): F5 rs6025 (P = 1.87 × 10-5; SI, 1.29; previously observed) and F11 rs2036914 (P = 2.0 × 10-4; SI, 0.91; new observation). CONCLUSION The candidate variant approach to identify submultiplictive/supramultiplicative associations between genetic variation and OC and HT use identified a new association with common genetic variation in F11, while the agnostic interrogations did not yield new discoveries.
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Affiliation(s)
- Emily K Hasser
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Traci M Bartz
- Departments of Biostatistics and Medicine, University of Washington, Seattle, WA, USA
| | - Florian Thibord
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France; Laboratory of Excellence on Medical Genomics (GENMED), Evry, France
| | - Ruifang Li-Gao
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anni Kauko
- Department of Internal Medicine, University of Turku, Turku, Finland
| | - Kerri L Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Jihye Kim
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gaëlle Munsch
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France
| | - Helen G Haile
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jean-Francois Deleuze
- CEA, Centre National de Recherche en Génomique Humaine (CNRGH), Université Paris-Saclay, Evry, France; Centre D'Etude du Polymorphisme Humain, Fondation Jean Dausset, Paris, France; Laboratory of Excellence on Medical Genomics (GENMED), Evry, France
| | | | - Alisa S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anne Boland
- CEA, Centre National de Recherche en Génomique Humaine (CNRGH), Université Paris-Saclay, Evry, France; Laboratory of Excellence on Medical Genomics (GENMED), Evry, France
| | - Pierre-Emmanuel Morange
- Hematology Laboratory, La Timone University Hospital of Marseille, Marseille, France; Centre de recherche en CardioVasculaire et Nutrition, INSERM, INRAE, Aix-Marseille University, Marseille, France
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Joseph Emmerich
- Department of Vascular Medicine, Saint-Joseph Hospital Group, University of Paris Cité, Paris, France; UMR1153, INSERM Centre for Research in Epidemiology and Statistics (CRESS), Paris, France
| | - Colleen M Sitlani
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Pierre Suchon
- Hematology Laboratory, La Timone University Hospital of Marseille, Marseille, France; Centre de recherche en CardioVasculaire et Nutrition, INSERM, INRAE, Aix-Marseille University, Marseille, France
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Teemu Niiranen
- Department of Internal Medicine, University of Turku, Turku, Finland; Department of Internal Medicine, Division of Medicine, Turku University Hospital, Turku, Finland; Department of Public Health Solutions, Finish Institute of Health and Welfare, Helsinki, Finland
| | - Christopher Kabrhel
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - David-Alexandre Trégouët
- INSERM, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France; Laboratory of Excellence on Medical Genomics (GENMED), Evry, France
| | - Nicholas L Smith
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA, USA.
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He XY, Wu BS, Yang L, Guo Y, Deng YT, Li ZY, Fei CJ, Liu WS, Ge YJ, Kang J, Feng J, Cheng W, Dong Q, Yu JT. Genetic associations of protein-coding variants in venous thromboembolism. Nat Commun 2024; 15:2819. [PMID: 38561338 PMCID: PMC10984941 DOI: 10.1038/s41467-024-47178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Previous genetic studies of venous thromboembolism (VTE) have been largely limited to common variants, leaving the genetic determinants relatively incomplete. We performed an exome-wide association study of VTE among 14,723 cases and 334,315 controls. Fourteen known and four novel genes (SRSF6, PHPT1, CGN, and MAP3K2) were identified through protein-coding variants, with broad replication in the FinnGen cohort. Most genes we discovered exhibited the potential to predict future VTE events in longitudinal analysis. Notably, we provide evidence for the additive contribution of rare coding variants to known genome-wide polygenic risk in shaping VTE risk. The identified genes were enriched in pathways affecting coagulation and platelet activation, along with liver-specific expression. The pleiotropic effects of these genes indicated the potential involvement of coagulation factors, blood cell traits, liver function, and immunometabolic processes in VTE pathogenesis. In conclusion, our study unveils the valuable contribution of protein-coding variants in VTE etiology and sheds new light on its risk stratification.
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Affiliation(s)
- Xiao-Yu He
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bang-Sheng Wu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liu Yang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Guo
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yue-Ting Deng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ze-Yu Li
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Chen-Jie Fei
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei-Shi Liu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Jun Ge
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jujiao Kang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Department of Computer Science, University of Warwick, Coventry, UK
| | - Wei Cheng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China.
- Department of Computer Science, University of Warwick, Coventry, UK.
| | - Qiang Dong
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Løchen Arnesen CA, Evensen LH, Hveem K, Gabrielsen ME, Hansen JB, Brækkan SK. Proportion of venous thromboembolism attributed to recognized prothrombotic genotypes in men and women. Res Pract Thromb Haemost 2024; 8:102343. [PMID: 38476459 PMCID: PMC10926210 DOI: 10.1016/j.rpth.2024.102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
Background Data on the proportion of venous thromboembolism (VTE) risk attributed to prothrombotic genotypes in men and women are limited. Objectives We aimed to estimate the population attributable fraction (PAF) of VTE for recognized, common prothrombotic genotypes in men and women using a population-based case cohort. Methods Cases with incident VTE (n = 1493) and a randomly sampled subcohort (n = 13,069) were derived from the Tromsø study (1994-2012) and the Trøndelag Health Study (1995-2008) cohorts. DNA samples were genotyped for 17 single-nucleotide polymorphisms (SNPs) previously associated with VTE. PAFs with 95% bias-corrected CIs (based on 10,000 bootstrap samples) were estimated for SNPs significantly associated with VTE, and a 6-SNP cumulative model was constructed for both sexes. Results In women, the individual PAFs for SNPs included in the cumulative model were 16.9% for ABO (rs8176719), 17.6% for F11 (rs2036914), 15.1% for F11 (rs2289252), 8.7% for FVL (rs6025), 6.0% for FGG (rs2066865), and 0.2% for F2 (rs1799963). The cumulative PAF for this 6-SNP model was 37.8%. In men, the individual PAFs for SNPs included in the cumulative model were 21.3% for ABO, 12.2% for F11 (rs2036914), 10.4% for F11 (rs2289252), 7.5% for FVL, 7.8% for FGG, and 1.1% for F2. This resulted in a cumulative PAF in men of 51.9%. Conclusion Our findings in a Norwegian population suggest that 52% and 38% of the VTEs can be attributed to known prothrombotic genotypes in men and women, respectively.
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Affiliation(s)
- Carl Arne Løchen Arnesen
- Thrombosis Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Line H Evensen
- Thrombosis Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Kristian Hveem
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Maiken E Gabrielsen
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - John-Bjarne Hansen
- Thrombosis Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- Thrombosis Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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5
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Han J, van Hylckama Vlieg A, Rosendaal FR. Genomic science of risk prediction for venous thromboembolic disease: convenient clarification or compounding complexity. J Thromb Haemost 2023; 21:3292-3303. [PMID: 37838557 DOI: 10.1016/j.jtha.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 10/16/2023]
Abstract
Venous thromboembolism (VTE) refers to abnormal blood clots in veins occurring in 1 to 2 per 1000 individuals every year. While anticoagulant treatment can prevent VTE, it increases the risk of bleeding. This emphasizes the importance of identifying individuals with a high risk of VTE and providing prophylactic interventions to these individuals to reduce both VTE and bleeding risks. Current risk assessment of VTE is based on the combination of mainly clinical risk factors. With the identification of an increasing number of genetic variants associated with the risk of VTE, the addition of genetic findings to clinical prediction models can improve risk prediction for VTE. Especially for individuals in high-risk situations, the added value of genetic findings to clinical prediction models may have benefits such as better prophylaxis of VTE and the reduced side effects of bleeding from unnecessary treatment. Nevertheless, the question of whether these models will eventually have clinical utility remains to be proven. Here, we review the current state of knowledge on genetic risk factors for VTE, explore genetic prediction models for VTE, and discuss their clinical implications and challenges.
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Affiliation(s)
- Jihee Han
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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6
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Seyerle AA, Laurie CA, Coombes BJ, Jain D, Conomos MP, Brody J, Chen MH, Gogarten SM, Beutel KM, Gupta N, Heckbert SR, Jackson RD, Johnson AD, Ko D, Manson JE, McKnight B, Metcalf GA, Morrison AC, Reiner AP, Sofer T, Tang W, Wiggins KL, Boerwinkle E, de Andrade M, Gabriel SB, Gibbs RA, Laurie CC, Psaty BM, Vasan RS, Rice K, Kooperberg C, Pankow JS, Smith NL, Pankratz N. Whole Genome Analysis of Venous Thromboembolism: the Trans-Omics for Precision Medicine Program. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:e003532. [PMID: 36960714 PMCID: PMC10151032 DOI: 10.1161/circgen.121.003532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/04/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Risk for venous thromboembolism has a strong genetic component. Whole genome sequencing from the TOPMed program (Trans-Omics for Precision Medicine) allowed us to look for new associations, particularly rare variants missed by standard genome-wide association studies. METHODS The 3793 cases and 7834 controls (11.6% of cases were individuals of African, Hispanic/Latino, or Asian ancestry) were analyzed using a single variant approach and an aggregate gene-based approach using our primary filter (included only loss-of-function and missense variants predicted to be deleterious) and our secondary filter (included all missense variants). RESULTS Single variant analyses identified associations at 5 known loci. Aggregate gene-based analyses identified only PROC (odds ratio, 6.2 for carriers of rare variants; P=7.4×10-14) when using our primary filter. Employing our secondary variant filter led to a smaller effect size at PROC (odds ratio, 3.8; P=1.6×10-14), while excluding variants found only in rare isoforms led to a larger one (odds ratio, 7.5). Different filtering strategies improved the signal for 2 other known genes: PROS1 became significant (minimum P=1.8×10-6 with the secondary filter), while SERPINC1 did not (minimum P=4.4×10-5 with minor allele frequency <0.0005). Results were largely the same when restricting the analyses to include only unprovoked cases; however, one novel gene, MS4A1, became significant (P=4.4×10-7 using all missense variants with minor allele frequency <0.0005). CONCLUSIONS Here, we have demonstrated the importance of using multiple variant filtering strategies, as we detected additional genes when filtering variants based on their predicted deleteriousness, frequency, and presence on the most expressed isoforms. Our primary analyses did not identify new candidate loci; thus larger follow-up studies are needed to replicate the novel MS4A1 locus and to identify additional rare variation associated with venous thromboembolism.
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Affiliation(s)
- Amanda A. Seyerle
- Division of Pharmaceutical Outcomes & Policy, Eshelman School of Pharmacy, Univ of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Health Informatics Program, Univ of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Deepti Jain
- Dept of Biostatistics, Univ of Washington, Seattle, WA
| | | | - Jennifer Brody
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
| | - Ming-Huei Chen
- NHLB’s The Framingham Heart Study, Population Sciences Branch, Division of Intramural Rsrch, National Heart, Lung, and Blood Inst, Framingham, MA
| | | | - Kathleen M. Beutel
- Dept of Laboratory Medicine & Pathology, School of Medicine, Univ of Minnesota, Minneapolis, MN
| | | | - Susan R. Heckbert
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
- Dept of Epidemiology, Univ of Washington, Seattle, WA
| | - Rebecca D. Jackson
- Division of Endocrinology, Diabetes & Metabolism, Ohio State Univ, Columbus, OH
| | - Andrew D. Johnson
- NHLB’s The Framingham Heart Study, Population Sciences Branch, Division of Intramural Rsrch, National Heart, Lung, and Blood Inst, Framingham, MA
| | - Darae Ko
- Cardiovascular Medicine Section, Boston Univ School of Medicine
| | - JoAnn E. Manson
- Dept of Epidemiology, TH Chan School of Public Health, Harvard Univ, Boston, MA
| | | | | | - Alanna C. Morrison
- Human Genetics Ctr, Dept of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, Univ of Texas Health Science Ctr at Houston, Houston, TX
| | | | - Tamar Sofer
- Division of Sleep & Circadian Disorders, Brigham and Women’s Hospital
- Dept of Medicine, Harvard Medical School, Boston, MA
| | - Weihong Tang
- Division of Epidemiology & Community Health, Univ of Minnesota, Minneapolis, MN
| | - Kerri L. Wiggins
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
| | | | - Eric Boerwinkle
- Human Genetics Ctr, Dept of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, Univ of Texas Health Science Ctr at Houston, Houston, TX
| | | | | | | | | | - Bruce M. Psaty
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
- Dept of Epidemiology, Univ of Washington, Seattle, WA
- Depts of Medicine & Health Services, Univ of Washington, Seattle, WA
- Kaiser Permanente Washington Health Rsrch Inst, Seattle, WA
| | | | - Ken Rice
- Dept of Biostatistics, Univ of Washington, Seattle, WA
| | | | - James S. Pankow
- Division of Epidemiology & Community Health, Univ of Minnesota, Minneapolis, MN
| | - Nicholas L. Smith
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
- Dept of Epidemiology, Univ of Washington, Seattle, WA
- Seattle Epidemiologic Rsrch & Information Ctr, VA Office of Rsrch & Development, Seattle, WA
| | - Nathan Pankratz
- Dept of Laboratory Medicine & Pathology, School of Medicine, Univ of Minnesota, Minneapolis, MN
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Brink A, Elf J, Svensson PJ, Engström G, Melander O, Zöller B. Sex-Specific Risk Factors for Deep Venous Thrombosis and Pulmonary Embolism in a Population-Based Historical Cohort Study of Middle-Aged and Older Individuals. J Am Heart Assoc 2023; 12:e027502. [PMID: 36847045 PMCID: PMC10111440 DOI: 10.1161/jaha.122.027502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Whether sex-specific differences exist for risk factors for pulmonary embolism (PE) and deep venous thrombosis (DVT), with the exception of pregnancy and estrogen therapy, has been sparsely studied. We aimed to study whether sex-specific differences of risk factors exist for noncancer-related DVT and PE in middle-aged and older individuals without cardiovascular history or previous diagnosis in a population-based historical (retrospective) cohort. Methods and Results Potential venous thromboembolism (VTE) risk factors were registered at baseline in 15 807 women and 9996 men aged 44 to 74 years, who participated in the Malmö Diet and Cancer study (1991-1996). We excluded subjects with a previous history of VTE, cancer, a diagnosis of cardiovascular disease, or a diagnosis of cancer-associated VTE during follow-up. Patients were followed up from baseline until the first event of PE or DVT, death, or December 31, 2018. During the follow-up period, 365 (2.3%) women and 168 (1.7%) men were affected by first DVT, and 309 (2.0%) women and 154 (1.5%) men were affected by first PE. In the multivariable Cox regression models, the anthropometric obesity markers of weight, body mass index, waist and hip circumference, fat percentage, and muscle weight were in a dose-dependent way associated with DVT and PE among women but not men. In an analysis that included patients with cardiovascular disease and cancer-related VTE, the results were similar for women. For men, several obesity measures became significantly associated with PE or DVT but were weaker than in women, especially for DVT. Conclusions Anthropometric obesity measures are more important risk factors for both DVT and PE among women than men, especially for individuals without cardiovascular history or previous diagnosis or cancer-related VTE.
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Affiliation(s)
- Annie Brink
- Center for Primary Health Care Research Lund University and Region Skåne Malmö Sweden
| | - Johan Elf
- Department of Clinical Sciences Lund University, Skåne University Hospital Malmö Sweden
| | - Peter J Svensson
- Department of Clinical Sciences Lund University, Skåne University Hospital Malmö Sweden
| | - Gunnar Engström
- Department of Clinical Sciences Lund University, Skåne University Hospital Malmö Sweden
| | - Olle Melander
- Department of Clinical Sciences Lund University, Skåne University Hospital Malmö Sweden
| | - Bengt Zöller
- Center for Primary Health Care Research Lund University and Region Skåne Malmö Sweden
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8
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1139] [Impact Index Per Article: 1139.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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9
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2367] [Impact Index Per Article: 1183.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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10
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Zöller B, Pirouzifard M, Svensson PJ, Holmquist B, Stenman E, Elston RC, Song YE, Sundquist J, Sundquist K. Familial Segregation of Venous Thromboembolism in Sweden: A Nationwide Family Study of Heritability and Complex Segregation Analysis. J Am Heart Assoc 2021; 10:e020323. [PMID: 34913365 PMCID: PMC9075256 DOI: 10.1161/jaha.120.020323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background This is the first nationwide segregation analysis that aimed to determine whether familial venous thromboembolism (VTE) is attributable to inheritance and/or shared environment, and the possible mode of inheritance. Methods and Results The Swedish Multi‐Generation Register was linked to the Swedish patient register for the period 1964 to 2015. Three generational families of Swedish‐born individuals were identified. Heritability was examined using Falconer regression. Complex segregation analysis was conducted using the Statistical Analysis for Genetic Epidemiology software (version 6.4, 64‐bit Linux). Among the 4 301 174 relatives from 450 558 pedigrees, 177 865 (52% women) individuals were affected with VTE. VTE occurred in 2 or more affected relatives in 61 217 (13.6%) of the pedigrees. Heritability showed age and sex dependence with higher heritability for men and young individuals. In 18 933 pedigrees, VTE occurred only in the first generation and was not inherited. Segregation analysis was performed in the remaining 42 284 pedigrees with inherited VTE and included 939 192 individuals. Prevalence constraints were imposed in the models to allow for the selection of the pedigrees analyzed. The sporadic nongenetic model could be discarded. The major‐type‐only model, with a correlation structure compatible with some polygenic effects, was the preferred model. Among the Mendelian models, the mixed codominant (plus polygenic) model was preferred. Conclusions This nationwide segregation analysis of VTE supports a genetic cause of the familial aggregation of VTE. Heritability was higher for men and younger individuals, suggesting a Carter effect, in agreement with a multifactorial threshold inheritance.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research Lund University/Region Skåne Malmö Sweden
| | - MirNabi Pirouzifard
- Center for Primary Health Care Research Lund University/Region Skåne Malmö Sweden
| | - Peter J Svensson
- Department of Coagulation Disorders Skåne University HospitalLund University Malmö Sweden
| | | | - Emelie Stenman
- Center for Primary Health Care Research Lund University/Region Skåne Malmö Sweden
| | - Robert C Elston
- Department of Population and Quantitative Health Sciences Case Western Reserve University Cleveland OH
| | - Yeunjoo E Song
- Department of Population and Quantitative Health Sciences Case Western Reserve University Cleveland OH
| | - Jan Sundquist
- Center for Primary Health Care Research Lund University/Region Skåne Malmö Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research Lund University/Region Skåne Malmö Sweden
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11
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Michels A, Swystun LL, Dwyer CN, Rawley O, Nesbitt K, Notley C, Lillicrap D. Stabilin-2 deficiency increases thrombotic burden and alters the composition of venous thrombi in a mouse model. J Thromb Haemost 2021; 19:2440-2453. [PMID: 34152080 DOI: 10.1111/jth.15429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stabilin-2 is an endocytic scavenger receptor that mediates the clearance of glycosaminoglycans, phosphatidylserine-expressing cells, and the von Willebrand factor-factor VIII (FVIII) complex. In a genome-wide screening study, pathogenic loss-of-function variants in the human STAB2 gene associated with an increased incidence of unprovoked venous thromboembolism (VTE). However, the specific mechanism(s) by which stabilin-2 deficiency influences the pathogenesis of VTE is unknown. OBJECTIVES The aim of this study was to assess the influence of stabilin-2 on deep vein thrombosis (DVT) and to characterize the underlying prothrombotic phenotype of stabilin-2 deficiency in a mouse model. METHODS DVT was induced using the inferior vena cava (IVC) stenosis model in two independent cohorts (littermates and non-littermates) of wild-type (Stab2+/+ ) and stabilin-2 (Stab2-/- )-deficient mice. Thrombus structure and contents were quantified by immunohistochemistry. Plasma procoagulant activity was assessed and complete blood counts were performed. RESULTS Incidence of thrombus formation was not altered between Stab2+/+ and Stab2-/- mice. When thrombi were formed, Stab2-/- mice developed significantly larger thrombi than Stab2+/+ controls. Thrombi from Stab2-/- mice contained significantly more leukocytes and citrullinated histone H3 than Stab2+/+ thrombi. Stab2-/- mice had increased FVIII activity. Circulating levels of monocytes and granulocytes were significantly elevated in Stab2-/- mice, and Stab2-/- mice had elevated plasma cell-free DNA 24 hours post-IVC stenosis compared to their Stab2+/+ counterparts. CONCLUSIONS These data suggest that stabilin-2 deficiency associates with a prothrombotic phenotype involving elevated levels of neutrophil extracellular trap-releasing leukocytes coupled with endogenous procoagulant activity, resulting in larger and qualitatively distinct venous thrombi.
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Affiliation(s)
- Alison Michels
- Department of Pathology and Molecular Medicine, Queens University, Kingston, Ontario, Canada
| | - Laura L Swystun
- Department of Pathology and Molecular Medicine, Queens University, Kingston, Ontario, Canada
| | - Courtney N Dwyer
- Department of Pathology and Molecular Medicine, Queens University, Kingston, Ontario, Canada
| | - Orla Rawley
- Department of Pathology and Molecular Medicine, Queens University, Kingston, Ontario, Canada
| | - Kate Nesbitt
- Department of Pathology and Molecular Medicine, Queens University, Kingston, Ontario, Canada
| | - Colleen Notley
- Department of Pathology and Molecular Medicine, Queens University, Kingston, Ontario, Canada
| | - David Lillicrap
- Department of Pathology and Molecular Medicine, Queens University, Kingston, Ontario, Canada
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12
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Eichinger S, Morange PE, Cattaneo M, Fretigny M, Rauch A, van Hylckama Vlieg A, Trégouët DA, Ruf W, Levi M, Páramo JA, van der Poll T, Kyrle PA, Garagiola I, Peyvandi F. The EHA Research Roadmap: Blood Coagulation and Hemostatic Disorders. Hemasphere 2021; 5:e643. [PMID: 34522845 PMCID: PMC8432639 DOI: 10.1097/hs9.0000000000000643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022] Open
Abstract
In 2016, the European Hematology Association (EHA) published the EHA Roadmap for European Hematology Research1 aiming to highlight achievements in the diagnostics and treatment of blood disorders, and to better inform European policy makers and other stakeholders about the urgent clinical and scientific needs and priorities in the field of hematology. Each section was coordinated by 1-2 section editors who were leading international experts in the field. In the 5 years that have followed, advances in the field of hematology have been plentiful. As such, EHA is pleased to present an updated Research Roadmap, now including 11 sections, each of which will be published separately. The updated EHA Research Roadmap identifies the most urgent priorities in hematology research and clinical science, therefore supporting a more informed, focused, and ideally funded future for European hematology research. The 11 EHA Research Roadmap sections include Normal Hematopoiesis; Malignant Lymphoid Diseases; Malignant Myeloid Diseases; Anemias and Related Diseases; Platelet Disorders; Blood Coagulation and Hemostatic Disorders; Transfusion Medicine; Infections in Hematology; Hematopoietic Stem Cell Transplantation; CAR-T and Other Cell-based Immune Therapies; and Gene Therapy.
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Affiliation(s)
- Sabine Eichinger
- Department of Medicine I, Division of Hematology and Hemostasis, Medical University of Vienna, Austria
| | | | | | | | - Antoine Rauch
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, France
| | | | | | - Wolfram Ruf
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Marcel Levi
- Amsterdam University Medical Centers, Department of Vascular Medicine, University of Amsterdam, The Netherlands
- Department of Medicine, University College London Hospitals, United Kingdom
| | | | - Tom van der Poll
- Amsterdam University Medical Centers, Division of Infectious Diseases & Center of Experimental Molecular Medicine, University of Amsterdam, The Netherlands
| | - Paul A. Kyrle
- Department of Medicine I, Division of Hematology and Hemostasis, Medical University of Vienna, Austria
| | - Isabella Garagiola
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
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13
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Abstract
Venous disease is a term that broadly covers both venous thromboembolic disease and chronic venous disease. The basic pathophysiology of venous thromboembolism and chronic venous disease differ as venous thromboembolism results from an imbalance of hemostasis and thrombosis while chronic venous disease occurs in the setting of tissue damage because of prolonged venous hypertension. Both diseases are common and account for significant mortality and morbidity, respectively, and collectively make up a large health care burden. Despite both diseases having well-characterized environmental components, it has been known for decades that family history is an important risk factor, implicating a genetic element to a patient's risk. Our understanding of the pathogenesis of these diseases has greatly benefited from an expansion of population genetic studies from pioneering familial studies to large genome-wide association studies; we now have multiple risk loci for each venous disease. In this review, we will highlight the current state of knowledge on the epidemiology and genetics of venous thromboembolism and chronic venous disease and directions for future research.
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Affiliation(s)
- Richard A. Baylis
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, CA
| | - Nicholas L. Smith
- Department of Epidemiology, University of Washington, Seattle WA 98195, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle WA 98101, USA
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle WA 98108, USA
| | - Derek Klarin
- Division of Vascular Surgery, University of Florida College of Medicine, Gainesville, FL
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Eri Fukaya
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, CA
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14
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Hodeib H, Youssef A, Allam AA, Selim A, Tawfik MA, Abosamak MF, Esam A, Abd Elghafar MS, Samir S, ELshora OA. Genetic Risk Profiling Associated with Recurrent Unprovoked Venous Thromboembolism. Genes (Basel) 2021; 12:genes12060874. [PMID: 34200207 PMCID: PMC8230078 DOI: 10.3390/genes12060874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and/or pulmonary embolism (PE), is a common, acute, multifactorial disease with a five-years cumulative incidence of recurrence of approximately 25%. Actually, no single genetic defect can predict the risk of recurrence of VTE. Therefore, individual genetic risk profiling could be useful for the prediction of VTE recurrence. AIM OF THE STUDY To assess the combined effect of the common prothrombotic genotypes on the risk of recurrence of VTE in recently diagnosed unprovoked VTE patients. PATIENTS AND METHODS This population based, prospective follow-up study was carried out from January 2015 to December 2020 in (internal medicine, cardiovascular medicine and anesthesia and ICU departments, Tanta University Hospital, Egypt) on 224 recently diagnosed unprovoked VTE patients. Whole blood was collected by standard venipuncture at the time of admission prior to the beginning of anticoagulant therapy. Genomic DNA was extracted and was genotyped for the 5-SNPs Genetic risk score (GRS), previously validated for first venous thrombosis (FVL rs6025, PTM rs1799963, ABO rs8176719, FGG rs2066865 and FXI rs2036914). RESULTS The main important finding in the present study was that patients having ≥3 risk alleles were associated with higher risk of VTE recurrence compared to those having ≤2 risk alleles (the reference group) (HR 2.5, 95% CI 1.48-4.21) (p = 0.001). Patients with GRS ≥ 3 had a significantly shorter time recurrence free survival (43.07 months) compared to the low risk group of patients with GRS (0-2) (p < 0.001). CONCLUSION GRS model could be an effective and useful model in risk stratification of VTE patients, and genetic risk profiling of VTE patients could be used for the prediction of recurrence of VTE.
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Affiliation(s)
- Hossam Hodeib
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta 31512, Egypt; (H.H.); (A.Y.); (O.A.E.)
| | - Amira Youssef
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta 31512, Egypt; (H.H.); (A.Y.); (O.A.E.)
| | - Alzahraa A. Allam
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31512, Egypt; (A.A.A.); (A.S.)
| | - Amal Selim
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31512, Egypt; (A.A.A.); (A.S.)
| | - Mohamed A. Tawfik
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta 31512, Egypt; (A.A.A.); (A.S.)
- Correspondence:
| | - Mohammed F. Abosamak
- Anesthesia/ICU Department, Faculty of Medicine, Tanta University Hospital, Tanta 31512, Egypt; (M.F.A.); (A.E.); (M.S.A.E.)
| | - Ahmed Esam
- Anesthesia/ICU Department, Faculty of Medicine, Tanta University Hospital, Tanta 31512, Egypt; (M.F.A.); (A.E.); (M.S.A.E.)
| | - Mohamed S. Abd Elghafar
- Anesthesia/ICU Department, Faculty of Medicine, Tanta University Hospital, Tanta 31512, Egypt; (M.F.A.); (A.E.); (M.S.A.E.)
| | - Sameh Samir
- Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta 31511, Egypt;
| | - Ola A. ELshora
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta 31512, Egypt; (H.H.); (A.Y.); (O.A.E.)
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15
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Gomez K. Genomic Analysis for the Detection of Bleeding and Thrombotic Disorders. Semin Thromb Hemost 2021; 47:174-182. [PMID: 33636748 DOI: 10.1055/s-0041-1722865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The development of high-throughput sequencing technologies has ushered in a new era of genomic testing in clinical medicine. This has greatly enhanced our diagnostic repertoire for hemostatic diseases particularly for milder or rarer bleeding disorders. New genetic causes for heritable platelet disorders have been discovered along with the recognition of clinical manifestations outside hemostasis, such as the association of leukemia with RUNX1 variation. Genome-wide association studies in heritable thrombophilia have demonstrated that some of the genetic variants that are commonly included in thrombophilia testing are of no clinical relevance, while uncovering new variants that should potentially be included. The implementation of new technology has necessitated far-reaching changes in clinical practice to deal with incidental findings, variants of uncertain significance, and genetic disease modifiers. Mild bleeding disorders that were previously considered to have a monogenic basis now appear to have an oligogenic etiology. To harness these advances in knowledge large databases have been developed to capture the new genomic information with phenotypic features on a population-wide scale. The use of this so-called "big data" requires new bioinformatics tools with the promise of delivering precision medicine in the foreseeable future. This review discusses the use of these technologies in clinical practice, the benefits of genomic testing, and some of the challenges associated with implementation.
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Affiliation(s)
- Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, United Kingdom
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16
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Zöller B, Svensson PJ, Dahlbäck B, Lind-Hallden C, Hallden C, Elf J. Genetic risk factors for venous thromboembolism. Expert Rev Hematol 2020; 13:971-981. [DOI: 10.1080/17474086.2020.1804354] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter J. Svensson
- Center for Thrombosis and Haemostasis, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn Dahlbäck
- Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Christina Lind-Hallden
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
| | - Christer Hallden
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
| | - Johan Elf
- Center for Thrombosis and Haemostasis, Lund University, Skåne University Hospital, Malmö, Sweden
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17
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Desch KC, Ozel AB, Halvorsen M, Jacobi PM, Golden K, Underwood M, Germain M, Tregouet DA, Reitsma PH, Kearon C, Mokry L, Richards JB, Williams F, Li JZ, Goldstein D, Ginsburg D. Whole-exome sequencing identifies rare variants in STAB2 associated with venous thromboembolic disease. Blood 2020; 136:533-541. [PMID: 32457982 PMCID: PMC7393257 DOI: 10.1182/blood.2019004161] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/12/2020] [Indexed: 12/13/2022] Open
Abstract
Deep vein thrombosis and pulmonary embolism, collectively defined as venous thromboembolism (VTE), are the third leading cause of cardiovascular death in the United States. Common genetic variants conferring increased varying degrees of VTE risk have been identified by genome-wide association studies (GWAS). Rare mutations in the anticoagulant genes PROC, PROS1 and SERPINC1 result in perinatal lethal thrombosis in homozygotes and markedly increased VTE risk in heterozygotes. However, currently described VTE variants account for an insufficient portion of risk to be routinely used for clinical decision making. To identify new rare VTE risk variants, we performed a whole-exome study of 393 individuals with unprovoked VTE and 6114 controls. This study identified 4 genes harboring an excess number of rare damaging variants in patients with VTE: PROS1, STAB2, PROC, and SERPINC1. At STAB2, 7.8% of VTE cases and 2.4% of controls had a qualifying rare variant. In cell culture, VTE-associated variants of STAB2 had a reduced surface expression compared with reference STAB2. Common variants in STAB2 have been previously associated with plasma von Willebrand factor and coagulation factor VIII levels in GWAS, suggesting that haploinsufficiency of stabilin-2 may increase VTE risk through elevated levels of these procoagulants. In an independent cohort, we found higher von Willebrand factor levels and equivalent propeptide levels in individuals with rare STAB2 variants compared with controls. Taken together, this study demonstrates the utility of gene-based collapsing analyses to identify loci harboring an excess of rare variants with functional connections to a complex thrombotic disease.
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Affiliation(s)
| | - Ayse B Ozel
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
| | - Matt Halvorsen
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Marine Germain
- INSERM UMR_S 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - David-Alexandre Tregouet
- INSERM UMR_S 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Pieter H Reitsma
- Einthoven Laboratory for Experimental Vascular and Regenerative Medicine, Leiden, The Netherlands
| | - Clive Kearon
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lauren Mokry
- Department of Medicine, Human Genetics, Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - J Brent Richards
- Department of Medicine, Human Genetics, Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - Frances Williams
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, United Kingdom
| | - Jun Z Li
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
| | - David Goldstein
- Columbia University, Institute for Genomic Medicine, New York, NY; and
| | - David Ginsburg
- Department of Pediatrics and
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
- Department of Internal Medicine, Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI
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18
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Ahmad A, Sundquist K, Palmér K, Svensson PJ, Sundquist J, Memon AA. Risk prediction of recurrent venous thromboembolism: a multiple genetic risk model. J Thromb Thrombolysis 2019; 47:216-226. [PMID: 30368761 PMCID: PMC6394443 DOI: 10.1007/s11239-018-1762-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A single genetic biomarker is unable to accurately predict the risk for venous thromboembolism (VTE) recurrence. We aimed to: (a) develop a multiple single nucleotide polymorphisms (SNPs) model to predict the risk of VTE recurrence and (b) validate a previously described genetic risk score (GRS) and compare its performance with the model developed in this study. Twenty-two SNPs, including established and putative SNPs associated with VTE risk, were genotyped in the Malmö thrombophilia study cohort (MATS; n = 1465, follow-up ~ 10 years) by using TaqMan PCR. Out of 22-SNPs, 12 had an association with the risk of VTE recurrence and were included for calculating GRSs. The risk of VTE recurrence was calculated by stratifying patients according to number of risk alleles. In 12-SNP GRS, patients with ≥ 7 risk alleles were associated with higher risk of VTE recurrence compared to patients having ≤ 6 risk alleles. In a simplified model (8-SNP GRS), the discriminative power of 8-SNP GRS was similar to that of 12-SNP GRS based on post-test probabilities (PP). Furthermore, 8-SNP GRS further improved the risk prediction of VTE recurrence in unprovoked VTE and male patients (PP% = 15.4 vs 8.3, 17.1 vs 7.2 and 19.0 vs 7.1 for high risk groups vs low risk groups in whole population, males and unprovoked VTE patients respectively). In addition, we also validated previously described 5-SNP GRS in our cohort and found that the 8-SNP GRS performed better than the 5-SNP GRS in terms of higher PP. Our results show that a multiple SNP GRS consisting of 8-SNPs may be an effective model for prediction of VTE recurrence, particularly in unprovoked VTE and male patients.
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Affiliation(s)
- Abrar Ahmad
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
- Wallenberg Laboratory, 6th Floor, Inga Marie Nilssons Gata 53, 20502, Malmö, Sweden.
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Karolina Palmér
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter J Svensson
- Department of Coagulation Disorders, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Ashfaque A Memon
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Zöller B, Svensson PJ, Sundquist J, Sundquist K, Pirouzifard M. Postoperative Joint Replacement Complications in Swedish Patients With a Family History of Venous Thromboembolism. JAMA Netw Open 2018; 1:e181924. [PMID: 30646144 PMCID: PMC6324480 DOI: 10.1001/jamanetworkopen.2018.1924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE The associations of a family history of venous thromboembolism (FH-VTE) with postoperative venous thromboembolism (VTE) and major bleeding after joint replacement surgical procedures are unknown. OBJECTIVE To determine the risk of VTE and major bleeding in patients after primary hip or knee replacement surgical procedures. DESIGN, SETTING, AND PARTICIPANTS Cohort study using nationwide population-based databases of Swedish patients without a history of VTE who underwent joint replacement surgical procedures. Patients who had primary hip or knee replacement surgical procedures between July 1, 2005, and August 31, 2012, were identified. Patients born after 1931 without previous VTE were identified in the Swedish Multi-Generation Register. Only individuals with at least 1 parent and 1 full sibling alive between 1964 and the date for the surgical procedure were included. The data analysis was performed from September 1, 2017, to June 15, 2018. EXPOSURES Family history of VTE in a parent and/or a full sibling before the date of the surgical procedure. MAIN OUTCOMES AND MEASURES Venous thromboembolism and major bleeding within 90 days of the surgical procedure. RESULTS Of 69 505 study participants, 37 989 (54.7%) were women, and the median (interquartile range) age at the date of discharge was 65 (59-70) years. A total of 803 of 69 505 (1.2%) patients experienced postoperative VTE and 1285 (1.8%) experienced major bleeding. The cumulative VTE risk for those with FH-VTE was 231 of 15 858 (1.5%) and for those without an FH-VTE was 572 of 53 647 (1.1%) (P < .001). The cumulative bleeding risk for those with FH-VTE was 261 of 15 858 (1.6%) and for those without an FH-VTE was 1024 of 53 647 (1.9%) (P = .03). There was an association of patients with an FH-VTE who had increased VTE risk (adjusted hazard ratio [HR], 1.36; 95% CI, 1.17-1.59) and reduced bleeding risk (adjusted HR, 0.84; 95% CI, 0.74-0.97). There was an interaction between time after discharge and FH-VTE regarding VTE and major bleeding. An FH-VTE was not associated with VTE after discharge during the first week (HR, 1.13; 95% CI, 0.86-1.49). After 7 days from discharge, FH-VTE was associated with VTE (HR, 1.49; 95% CI, 1.24-1.79). An FH-VTE reduced major bleeding risk during the first 7 days after discharge (HR, 0.78; 95% CI, 0.66-0.91) but not thereafter (HR, 1.10; 95% CI, 0.84-1.44). Postoperative VTE heritability (SE) was 20% (6%). CONCLUSIONS AND RELEVANCE Familial and most likely genetic factors appear to affect VTE and major bleeding risk following hip and knee replacement surgical procedures. Prolonged VTE prophylaxis might be beneficial in predisposed individuals. There may be a possible evolutionary advantage of prothrombotic genes protecting against traumatic bleeding.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Peter J. Svensson
- Department of Coagulation Disorders, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - MirNabi Pirouzifard
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
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Zöller B, Ji J, Sundquist J, Sundquist K. Body Height and Incident Risk of Venous Thromboembolism: A Cosibling Design. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.116.001651. [PMID: 28874396 DOI: 10.1161/circgenetics.116.001651] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Body height has been associated with an increased risk of venous thromboembolism (VTE), but the association can be confounded with shared familial factors (genetic/environmental). A cosibling design is useful for deeper understanding about the relationship between VTE and height. METHODS AND RESULTS From Swedish national registry databases, we used a corelative design with full siblings alongside a general Swedish population sample. A cohort of male conscripts (n=1 610 870), born in 1951 to 1992 without previous VTE, was followed from enlistment (1969-2010) until 2012. Another cohort of first-time pregnant women (n=1 093 342) from the medical birth register, without previous VTE, was followed from first pregnancy (1982-2012) until 2012. Using the Multi-Generation Register, we identified all full-sibling pairs discordant for height. This cosibling design allowed for adjustment for familial factors (genetic/environmental). Compared with the tallest women (>185 cm) and men (>190 cm), there was a graded decreased risk by lower height for both men and women. The risk was lowest in women and men with the shortest stature (<155 and <160 cm, respectively): hazard ratios=0.31 (95% confidence interval, 0.22-0.42) and 0.35 (95% confidence interval, 0.22-0.55), respectively. There was a graded association also in the cosibling design comparing siblings with varying degree of discordance for height (reference was the taller sibling): ≥10 cm difference between brothers hazard ratios=0.69 (95% confidence interval, 0.61-0.78) and sisters hazard ratios=0.65 (95% confidence interval, 0.52-0.80), respectively. CONCLUSIONS Height is an independent predictor of VTE. The use of sibling pairs reduces the likelihood that familial confounding explains the results. The findings are important for the understanding of the pathogenesis of VTE.
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Affiliation(s)
- Bengt Zöller
- From the Center for Primary Health Care Research, Lund University, Malmö, Sweden.
| | - Jianguang Ji
- From the Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- From the Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- From the Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Delling FN, Li X, Li S, Yang Q, Xanthakis V, Martinsson A, Andell P, Lehman BT, Osypiuk EW, Stantchev P, Zöller B, Benjamin EJ, Sundquist K, Vasan RS, Smith JG. Heritability of Mitral Regurgitation: Observations From the Framingham Heart Study and Swedish Population. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.117.001736. [PMID: 28993406 DOI: 10.1161/circgenetics.117.001736] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/04/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Familial aggregation has been described for primary mitral regurgitation (MR) caused by mitral valve prolapse. We hypothesized that heritability of MR exists across different MR subtypes including nonprimary MR. METHODS AND RESULTS Study participants were FHS (Framingham Heart Study) Generation 3 (Gen 3) and Gen 2 cohort participants and all adult Swedish siblings born after 1932 identified in 1997 and followed through 2010. MR was defined as ≥ mild regurgitation on color Doppler in FHS and from International Classification of Diseases codes in Sweden. We estimated the association of sibling MR with MR in Gen 2/Gen 3/Swedish siblings. We also estimated heritability of MR in 539 FHS pedigrees (7580 individuals). Among 5132 FHS Gen 2/Gen 3 participants with sibling information, 1062 had MR. Of siblings with sibling MR, 28% (500/1797) had MR compared with 17% (562/3335) without sibling MR (multivariable-adjusted odds ratio, 1.20; 95% confidence interval [CI], 1.01-1.43; P=0.04). When we combined parental and sibling data in FHS pedigrees, heritability of MR was estimated at 0.15 (95% CI, 0.07-0.23), 0.12 (95% CI, 0.04-0.20) excluding mitral valve prolapse, and 0.44 (95% CI, 0.15-0.73) for ≥ moderate MR only (all P<0.05). In Sweden, sibling MR was associated with a hazard ratio of 3.57 (95% CI, 2.21-5.76; P<0.001) for development of MR. CONCLUSIONS Familial clustering of MR exists in the community, supporting a genetic susceptibility common to primary and nonprimary MR. Further studies are needed to elucidate the common regulatory pathways that may lead to MR irrespective of its cause.
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Affiliation(s)
- Francesca N Delling
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.).
| | - Xinjun Li
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Shuo Li
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Qiong Yang
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Vanessa Xanthakis
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Andreas Martinsson
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Pontus Andell
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Birgitta T Lehman
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Ewa W Osypiuk
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Plamen Stantchev
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Bengt Zöller
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Emelia J Benjamin
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Kristina Sundquist
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - Ramachandran S Vasan
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
| | - J Gustav Smith
- From the Boston University's and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (F.N.D., B.T.L., E.W.O., P.S., E.J.B., R.S.V.); Cardiovascular Division, Department of Medicine, University of California San Francisco (F.N.D.); Center for Primary Health Care Research, Lund University, Malmö, Sweden (X.L., B.Z., K.S.); Department of Biostatistics (S.L., Q.Y., V.X.), Department of Epidemiology (V.X., E.J.B., R.S.V.), and Cardiology and Preventive Medicine Sections, Department of Medicine (E.J.B., R.S.V.), Boston University School of Medicine, MA; Department of Cardiology, Clinical Sciences, Lund University, Sweden (A.M., P.A., J.G.S.); and Skåne University Hospital, Lund, Sweden (A.M., P.A., J.G.S.)
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Polymorphisms in PARK2 and MRPL37 are associated with higher risk of recurrent venous thromboembolism in a sex-specific manner. J Thromb Thrombolysis 2018; 46:154-165. [DOI: 10.1007/s11239-018-1662-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fat mass and obesity-associated gene rs9939609 polymorphism is a potential biomarker of recurrent venous thromboembolism in male but not in female patients. Gene 2018; 647:136-142. [PMID: 29325734 DOI: 10.1016/j.gene.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/03/2018] [Indexed: 11/20/2022]
Abstract
Multiple genetic variations have been identified in FTO (fat mass and obesity-associated) gene. Among them, FTO rs9939609 polymorphism is shown to be associated with the risk of primary venous thromboembolism (VTE). However, its role in recurrent VTE is not known. The aim of our study was to investigate the association between FTO rs9939609 polymorphism and the risk of VTE recurrence in a prospective follow-up study in both male and female patients. FTO rs9939609 polymorphism (T/A) was analyzed in the Malmö thrombophilia study (MATS, followed for ~10 years) by using TaqMan PCR. MATS patients (n = 1050) were followed from the discontinuation of anticoagulant treatment until diagnosis of VTE recurrence or the end of follow-up. A total of 126 patients (12%) had VTE recurrence during follow-up. Cox regression analyses showed that sex modified the potential effect of FTO rs9939609 polymorphism on VTE recurrence. Male patients with the AA genotype for the FTO rs9939609 polymorphism had significantly higher risk of VTE recurrence as compared to the TT or AT genotypes (univariate hazard ratio [HR] = 2.05, 95% confidence interval [CI] = 1.2-3.5, P = 0.009 and adjusted HR = 2.03, 95% CI 1.2-3.6, P = 0.013). There was no association between FTO rs9939609 polymorphism and VTE recurrence in female patients. In conclusion, our results show that FTO rs9939609 polymorphism in recurrent VTE may differ according to gender and FTO polymorphism may predict VTE recurrence in male patients.
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Kim J, Kraft P, Hagan KA, Harrington LB, Lindstroem S, Kabrhel C. Interaction of a genetic risk score with physical activity, physical inactivity, and body mass index in relation to venous thromboembolism risk. Genet Epidemiol 2018. [PMID: 29520861 DOI: 10.1002/gepi.22118] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is highly heritable. Physical activity, physical inactivity and body mass index (BMI) are also risk factors, but evidence of interaction between genetic and environmental risk factors is limited. METHODS Data on 2,134 VTE cases and 3,890 matched controls were obtained from the Nurses' Health Study (NHS), Nurses' Health Study II (NHS II), and Health Professionals Follow-up Study (HPFS). We calculated a weighted genetic risk score (wGRS) using 16 single nucleotide polymorphisms associated with VTE risk in published genome-wide association studies (GWAS). Data on three risk factors, physical activity (metabolic equivalent [MET] hours per week), physical inactivity (sitting hours per week) and BMI, were obtained from biennial questionnaires. VTE cases were incident since cohort inception; controls were matched to cases on age, cohort, and genotype array. Using conditional logistic regression, we assessed joint effects and interaction effects on both additive and multiplicative scales. We also ran models using continuous wGRS stratified by risk-factor categories. RESULTS We observed a supra-additive interaction between wGRS and BMI. Having both high wGRS and high BMI was associated with a 3.4-fold greater risk of VTE (relative excess risk due to interaction = 0.69, p = 0.046). However, we did not find evidence for a multiplicative interaction with BMI. No interactions were observed for physical activity or inactivity. CONCLUSION We found a synergetic effect between a genetic risk score and high BMI on the risk of VTE. Intervention efforts lowering BMI to decrease VTE risk may have particularly large beneficial effects among individuals with high genetic risk.
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Affiliation(s)
- Jihye Kim
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaitlin A Hagan
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura B Harrington
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sara Lindstroem
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Christopher Kabrhel
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Cunha MLR, Meijers JCM, Rosendaal FR, Vlieg AVH, Reitsma PH, Middeldorp S. Whole exome sequencing in thrombophilic pedigrees to identify genetic risk factors for venous thromboembolism. PLoS One 2017; 12:e0187699. [PMID: 29117201 PMCID: PMC5695603 DOI: 10.1371/journal.pone.0187699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Family studies have shown a strong heritability component for venous thromboembolism (VTE), but established genetic risk factors are present in only half of VTE patients. AIM To identify genetic risk factors in two large families with unexplained hereditary VTE. METHODS We performed whole exome sequencing in 10 affected relatives of two unrelated families with an unexplained tendency for VTE. We prioritized variants shared by all affected relatives from both families, and evaluated these in the remaining affected and unaffected individuals. We prioritized variants based on 3 different filter strategies: variants within candidate genes, rare variants across the exome, and SNPs present in patients with familial VTE and with low frequency in the general population. We used whole exome sequencing data available from 96 unrelated VTE cases with a positive family history of VTE from an affected sib study (the GIFT study) to identify additional carriers and compared the risk-allele frequencies with the general population. Variants found in only one individual were also retained for further analysis. Finally, we assessed the association of these variants with VTE in a population-based case-control study (the MEGA study) with 4,291 cases and 4,866 controls. RESULTS Six variants remained as putative disease-risk candidates. These variants are located in 6 genes spread among 3 different loci: 2p21 (PLEKHH2 NM_172069:c.3105T>C, LRPPRC rs372371276, SRBD1 rs34959371), 5q35.2 (UNC5A NM_133369.2:c.1869+23C>A), and 17q25.1 (GPRC5C rs142232982, RAB37 rs556450784). In GIFT, additional carriers were identified only for the variants located in the 2p21 locus. In MEGA, additional carriers for several of these variants were identified in both cases and controls, without a difference in prevalence; no carrier of the UNC5A variant was present. CONCLUSION Despite sequencing of several individuals from two thrombophilic families resulting in 6 candidate variants, we were unable to confirm their relevance as novel thrombophilic defects.
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Affiliation(s)
- Marisa L. R. Cunha
- Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost C. M. Meijers
- Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Plasma Proteins, Sanquin, Amsterdam, the Netherlands
| | - Frits R. Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Astrid van Hylckama Vlieg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter H. Reitsma
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia Middeldorp
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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