1
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Mosley JD, Shelley JP, Dickson AL, Zanussi J, Daniel LL, Zheng NS, Bastarache L, Wei WQ, Shi M, Jarvik GP, Rosenthal EA, Khan A, Sherafati A, Kullo IJ, Walunas TL, Glessner J, Hakonarson H, Cox NJ, Roden DM, Frangakis SG, Vanderwerff B, Stein CM, Van Driest SL, Borinstein SC, Shu XO, Zawistowski M, Chung CP, Kawai VK. Clinical associations with a polygenic predisposition to benign lower white blood cell counts. Nat Commun 2024; 15:3384. [PMID: 38649760 PMCID: PMC11035609 DOI: 10.1038/s41467-024-47804-5] [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: 08/20/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
Polygenic variation unrelated to disease contributes to interindividual variation in baseline white blood cell (WBC) counts, but its clinical significance is uncharacterized. We investigated the clinical consequences of a genetic predisposition toward lower WBC counts among 89,559 biobank participants from tertiary care centers using a polygenic score for WBC count (PGSWBC) comprising single nucleotide polymorphisms not associated with disease. A predisposition to lower WBC counts was associated with a decreased risk of identifying pathology on a bone marrow biopsy performed for a low WBC count (odds-ratio = 0.55 per standard deviation increase in PGSWBC [95%CI, 0.30-0.94], p = 0.04), an increased risk of leukopenia (a low WBC count) when treated with a chemotherapeutic (n = 1724, hazard ratio [HR] = 0.78 [0.69-0.88], p = 4.0 × 10-5) or immunosuppressant (n = 354, HR = 0.61 [0.38-0.99], p = 0.04). A predisposition to benign lower WBC counts was associated with an increased risk of discontinuing azathioprine treatment (n = 1,466, HR = 0.62 [0.44-0.87], p = 0.006). Collectively, these findings suggest that there are genetically predisposed individuals who are susceptible to escalations or alterations in clinical care that may be harmful or of little benefit.
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Affiliation(s)
- Jonathan D Mosley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - John P Shelley
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alyson L Dickson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacy Zanussi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura L Daniel
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Neil S Zheng
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mingjian Shi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gail P Jarvik
- Department of Genome Sciences, University of Washington Medical Center, Seattle, WA, USA
- Department of Medicine (Medical Genetics), University of Washington Medical Center, Seattle, WA, USA
| | - Elisabeth A Rosenthal
- Department of Medicine (Medical Genetics), University of Washington Medical Center, Seattle, WA, USA
| | - Atlas Khan
- Division of Nephrology, Dept of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Alborz Sherafati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Theresa L Walunas
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph Glessner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hakon Hakonarson
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy J Cox
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dan M Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephan G Frangakis
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brett Vanderwerff
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - C Michael Stein
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara L Van Driest
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott C Borinstein
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xiao-Ou Shu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Matthew Zawistowski
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | | | - Vivian K Kawai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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2
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Mosley JD, Shelley JP, Dickson AL, Zanussi J, Daniel LL, Zheng NS, Bastarache L, Wei WQ, Shi M, Jarvik GP, Rosenthal EA, Khan A, Sherafati A, Kullo IJ, Walunas TL, Glessner J, Hakonarson H, Cox NJ, Roden DM, Frangakis SG, Vanderwerff B, Stein CM, Van Driest SL, Borinstein SC, Shu XO, Zawistowski M, Chung CP, Kawai VK. Clinical consequences of a polygenic predisposition to benign lower white blood cell counts: Consequences of benign WBC count genetics. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.20.23294331. [PMID: 37662324 PMCID: PMC10473820 DOI: 10.1101/2023.08.20.23294331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Polygenic variation unrelated to disease contributes to interindividual variation in baseline white blood cell (WBC) counts, but its clinical significance is undefined. We investigated the clinical consequences of a genetic predisposition toward lower WBC counts among 89,559 biobank participants from tertiary care centers using a polygenic score for WBC count (PGSWBC) comprising single nucleotide polymorphisms not associated with disease. A predisposition to lower WBC counts was associated with a decreased risk of identifying pathology on a bone marrow biopsy performed for a low WBC count (odds-ratio=0.55 per standard deviation increase in PGSWBC [95%CI, 0.30 - 0.94], p=0.04), an increased risk of leukopenia (a low WBC count) when treated with a chemotherapeutic (n=1,724, hazard ratio [HR]=0.78 [0.69 - 0.88], p=4.0×10-5) or immunosuppressant (n=354, HR=0.61 [0.38 - 0.99], p=0.04). A predisposition to benign lower WBC counts was associated with an increased risk of discontinuing azathioprine treatment (n=1,466, HR=0.62 [0.44 - 0.87], p=0.006). Collectively, these findings suggest that a WBC count polygenic score identifies individuals who are susceptible to escalations or alterations in clinical care that may be harmful or of little benefit.
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Affiliation(s)
- Jonathan D. Mosley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John P. Shelley
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alyson L. Dickson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacy Zanussi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura L. Daniel
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Neil S. Zheng
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mingjian Shi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gail P. Jarvik
- Department of Genome Sciences, University of Washington Medical Center, Seattle WA, USA
- Department of Medicine (Medical Genetics), University of Washington Medical Center, Seattle WA, USA
| | - Elisabeth A. Rosenthal
- Department of Medicine (Medical Genetics), University of Washington Medical Center, Seattle WA, USA
| | - Atlas Khan
- Division of Nephrology, Dept of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Alborz Sherafati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester MN USA
| | - Iftikhar J. Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester MN USA
| | - Theresa L. Walunas
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joe Glessner
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hakon Hakonarson
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy J. Cox
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dan M. Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephan G. Frangakis
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Brett Vanderwerff
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - C. Michael Stein
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara L. Van Driest
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott C. Borinstein
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xiao-Ou Shu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Matthew Zawistowski
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Cecilia P. Chung
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vivian K. Kawai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Mackie SL, Owen CE, Buchanan RRC, McGonagle D. A shared basis for overlapping immunopathologies in giant cell arteritis and polymyalgia rheumatica. THE LANCET. RHEUMATOLOGY 2021; 3:e826-e829. [PMID: 38287629 DOI: 10.1016/s2665-9913(21)00361-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds LS7 4SA, UK
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4
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Van Driest SL, Abul-Husn NS, Glessner JT, Bastarache L, Nirenberg S, Schildcrout JS, Eswarappa MS, Belbin GM, Shaffer CM, Mentch F, Connolly J, Shi M, Stein CM, Roden DM, Hakonarson H, Cox NJ, Borinstein SC, Mosley JD. Association Between a Common, Benign Genotype and Unnecessary Bone Marrow Biopsies Among African American Patients. JAMA Intern Med 2021; 181:1100-1105. [PMID: 34180972 PMCID: PMC8239990 DOI: 10.1001/jamainternmed.2021.3108] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Up to two-thirds of African American individuals carry the benign rs2814778-CC genotype that lowers total white blood cell (WBC) count. OBJECTIVE To examine whether the rs2814778-CC genotype is associated with an increased likelihood of receiving a bone marrow biopsy (BMB) for an isolated low WBC count. DESIGN, SETTING, AND PARTICIPANTS This retrospective genetic association study assessed African American patients younger than 90 years who underwent a BMB at Vanderbilt University Medical Center, Mount Sinai Health System, or Children's Hospital of Philadelphia from January 1, 1998, to December 31, 2020. EXPOSURE The rs2814778-CC genotype. MAIN OUTCOMES AND MEASURES The proportion of individuals with the CC genotype who underwent BMB for an isolated low WBC count and had a normal biopsy result compared with the proportion of individuals with the CC genotype who underwent BMB for other indications and had a normal biopsy result. RESULTS Among 399 individuals who underwent a BMB (mean [SD] age, 41.8 [22.5] years, 234 [59%] female), 277 (69%) had the CC genotype. A total of 35 patients (9%) had clinical histories of isolated low WBC counts, and 364 (91%) had other histories. Of those with a clinical history of isolated low WBC count, 34 of 35 (97%) had the CC genotype vs 243 of 364 (67%) of those without a low WBC count history. Among those with the CC genotype, 33 of 34 (97%) had normal results for biopsies performed for isolated low WBC counts compared with 134 of 243 individuals (55%) with biopsies performed for other histories (P < .001). CONCLUSIONS AND RELEVANCE In this genetic association study, among patients of African American race who had a BMB with a clinical history of isolated low WBC counts, the rs2814778-CC genotype was highly prevalent, and 97% of these BMBs identified no hematologic abnormality. Accounting for the rs2814778-CC genotype in clinical decision-making could avoid unnecessary BMB procedures.
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Affiliation(s)
- Sara L Van Driest
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Noura S Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph T Glessner
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Center for Applied Genomics, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sharon Nirenberg
- Department of Scientific Computing, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Meghana S Eswarappa
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gillian M Belbin
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christian M Shaffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Frank Mentch
- The Center for Applied Genomics, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John Connolly
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Mingjian Shi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - C Michael Stein
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dan M Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hakon Hakonarson
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nancy J Cox
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott C Borinstein
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan D Mosley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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5
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Mosley JD, Benson MD, Smith JG, Melander O, Ngo D, Shaffer CM, Ferguson JF, Herzig MS, McCarty CA, Chute CG, Jarvik GP, Gordon AS, Palmer MR, Crosslin DR, Larson EB, Carrell DS, Kullo IJ, Pacheco JA, Peissig PL, Brilliant MH, Kitchner TE, Linneman JG, Namjou B, Williams MS, Ritchie MD, Borthwick KM, Kiryluk K, Mentch FD, Sleiman PM, Karlson EW, Verma SS, Zhu Y, Vasan RS, Yang Q, Denny JC, Roden DM, Gerszten RE, Wang TJ. Probing the Virtual Proteome to Identify Novel Disease Biomarkers. Circulation 2019; 138:2469-2481. [PMID: 30571344 DOI: 10.1161/circulationaha.118.036063] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Proteomic approaches allow measurement of thousands of proteins in a single specimen, which can accelerate biomarker discovery. However, applying these technologies to massive biobanks is not currently feasible because of the practical barriers and costs of implementing such assays at scale. To overcome these challenges, we used a "virtual proteomic" approach, linking genetically predicted protein levels to clinical diagnoses in >40 000 individuals. METHODS We used genome-wide association data from the Framingham Heart Study (n=759) to construct genetic predictors for 1129 plasma protein levels. We validated the genetic predictors for 268 proteins and used them to compute predicted protein levels in 41 288 genotyped individuals in the Electronic Medical Records and Genomics (eMERGE) cohort. We tested associations for each predicted protein with 1128 clinical phenotypes. Lead associations were validated with directly measured protein levels and either low-density lipoprotein cholesterol or subclinical atherosclerosis in the MDCS (Malmö Diet and Cancer Study; n=651). RESULTS In the virtual proteomic analysis in eMERGE, 55 proteins were associated with 89 distinct diagnoses at a false discovery rate q<0.1. Among these, 13 associations involved lipid (n=7) or atherosclerosis (n=6) phenotypes. We tested each association for validation in MDCS using directly measured protein levels. At Bonferroni-adjusted significance thresholds, levels of apolipoprotein E isoforms were associated with hyperlipidemia, and circulating C-type lectin domain family 1 member B and platelet-derived growth factor receptor-β predicted subclinical atherosclerosis. Odds ratios for carotid atherosclerosis were 1.31 (95% CI, 1.08-1.58; P=0.006) per 1-SD increment in C-type lectin domain family 1 member B and 0.79 (0.66-0.94; P=0.008) per 1-SD increment in platelet-derived growth factor receptor-β. CONCLUSIONS We demonstrate a biomarker discovery paradigm to identify candidate biomarkers of cardiovascular and other diseases.
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Affiliation(s)
- Jonathan D Mosley
- Department of Medicine (J.D.M., C.M.S., J.F.F., J.C.D., T.J.W.), Vanderbilt University Medical Center, Nashville, TN
| | - Mark D Benson
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.D.B.).,Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.D.B., M.S.H., R.E.G.)
| | - J Gustav Smith
- Molecular Epidemiology and Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden (J.G.S., O.M.)
| | - Olle Melander
- Molecular Epidemiology and Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden (J.G.S., O.M.)
| | - Debby Ngo
- Department of Medicine and the Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (D.N.)
| | - Christian M Shaffer
- Department of Medicine (J.D.M., C.M.S., J.F.F., J.C.D., T.J.W.), Vanderbilt University Medical Center, Nashville, TN
| | - Jane F Ferguson
- Department of Medicine (J.D.M., C.M.S., J.F.F., J.C.D., T.J.W.), Vanderbilt University Medical Center, Nashville, TN
| | - Matthew S Herzig
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.D.B., M.S.H., R.E.G.)
| | | | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.)
| | - Gail P Jarvik
- Departments of Medicine (J.P.J., A.S.G., M.R.P., E.B.L.), University of Washington, Seattle
| | - Adam S Gordon
- Departments of Medicine (J.P.J., A.S.G., M.R.P., E.B.L.), University of Washington, Seattle
| | - Melody R Palmer
- Departments of Medicine (J.P.J., A.S.G., M.R.P., E.B.L.), University of Washington, Seattle
| | - David R Crosslin
- Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle
| | - Eric B Larson
- Departments of Medicine (J.P.J., A.S.G., M.R.P., E.B.L.), University of Washington, Seattle.,Kaiser Permanente Washington Health Research Institute, Seattle, WA (E.B.L., D.S.C.)
| | - David S Carrell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA (E.B.L., D.S.C.)
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.)
| | - Jennifer A Pacheco
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.)
| | - Peggy L Peissig
- Biomedical Informatics Research Center (P.L.P., J.G.L.), Marshfield Clinic Research Institute, WI
| | - Murray H Brilliant
- Center for Computational and Biomedical Informatics (M.H.B., T.E.K.), Marshfield Clinic Research Institute, WI
| | - Terrie E Kitchner
- Center for Computational and Biomedical Informatics (M.H.B., T.E.K.), Marshfield Clinic Research Institute, WI
| | - James G Linneman
- Biomedical Informatics Research Center (P.L.P., J.G.L.), Marshfield Clinic Research Institute, WI
| | - Bahram Namjou
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, OH (B.N.)
| | - Marc S Williams
- Genomic Medicine Institute (M.S.W.), Geisinger Health System, Danville, PA
| | - Marylyn D Ritchie
- Departments of Bioinformatics and Genetics (M.D.R.), University of Pennsylvania, Philadelphia
| | - Kenneth M Borthwick
- Biomedical and Translational Informatics (K.M.B.), Geisinger Health System, Danville, PA
| | - Krzysztof Kiryluk
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY (K.K.)
| | - Frank D Mentch
- Center for Applied Genomics, Children's Hospital of Philadelphia, PA (F.D.M., P.M.S.)
| | - Patrick M Sleiman
- Center for Applied Genomics, Children's Hospital of Philadelphia, PA (F.D.M., P.M.S.)
| | - Elizabeth W Karlson
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.W.K.)
| | - Shefali S Verma
- Perelman School of Medicine, Department of Genetics (S.S.V.), University of Pennsylvania, Philadelphia
| | - Yineng Zhu
- Department of Biostatistics, Boston University School of Public Health, MA (Y.Z., Q.Y.)
| | | | - Qiong Yang
- Department of Biostatistics, Boston University School of Public Health, MA (Y.Z., Q.Y.)
| | - Josh C Denny
- Department of Medicine (J.D.M., C.M.S., J.F.F., J.C.D., T.J.W.), Vanderbilt University Medical Center, Nashville, TN.,Biomedical Informatics (J.C.D., D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Dan M Roden
- Biomedical Informatics (J.C.D., D.M.R.), Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology (D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.D.B., M.S.H., R.E.G.)
| | - Thomas J Wang
- Department of Medicine (J.D.M., C.M.S., J.F.F., J.C.D., T.J.W.), Vanderbilt University Medical Center, Nashville, TN
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6
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Langlotz CP, Allen B, Erickson BJ, Kalpathy-Cramer J, Bigelow K, Cook TS, Flanders AE, Lungren MP, Mendelson DS, Rudie JD, Wang G, Kandarpa K. A Roadmap for Foundational Research on Artificial Intelligence in Medical Imaging: From the 2018 NIH/RSNA/ACR/The Academy Workshop. Radiology 2019; 291:781-791. [PMID: 30990384 PMCID: PMC6542624 DOI: 10.1148/radiol.2019190613] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 01/08/2023]
Abstract
Imaging research laboratories are rapidly creating machine learning systems that achieve expert human performance using open-source methods and tools. These artificial intelligence systems are being developed to improve medical image reconstruction, noise reduction, quality assurance, triage, segmentation, computer-aided detection, computer-aided classification, and radiogenomics. In August 2018, a meeting was held in Bethesda, Maryland, at the National Institutes of Health to discuss the current state of the art and knowledge gaps and to develop a roadmap for future research initiatives. Key research priorities include: 1, new image reconstruction methods that efficiently produce images suitable for human interpretation from source data; 2, automated image labeling and annotation methods, including information extraction from the imaging report, electronic phenotyping, and prospective structured image reporting; 3, new machine learning methods for clinical imaging data, such as tailored, pretrained model architectures, and federated machine learning methods; 4, machine learning methods that can explain the advice they provide to human users (so-called explainable artificial intelligence); and 5, validated methods for image de-identification and data sharing to facilitate wide availability of clinical imaging data sets. This research roadmap is intended to identify and prioritize these needs for academic research laboratories, funding agencies, professional societies, and industry.
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Affiliation(s)
- Curtis P. Langlotz
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Bibb Allen
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Bradley J. Erickson
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Jayashree Kalpathy-Cramer
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Keith Bigelow
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Tessa S. Cook
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Adam E. Flanders
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Matthew P. Lungren
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - David S. Mendelson
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Jeffrey D. Rudie
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Ge Wang
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
| | - Krishna Kandarpa
- From the Department of Radiology, Stanford University, Stanford, CA 94305 (C.P.L., M.P.L.); Department of Radiology, Grandview Medical Center, Birmingham, Ala (B.A.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.K.C.); GE Healthcare, Chicago, Ill (K.B.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (T.S.C., J.D.R.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.E.F.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (D.S.M.); Biomedical Imaging Center, Rensselaer Polytechnic Institute, Troy, NY (G.W.); and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Washington, DC (K.K.)
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7
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Denny JC, Mosley JD. Disease Heritability Studies Harness the Healthcare System to Achieve Massive Scale. Cell 2019; 173:1568-1570. [PMID: 29906443 DOI: 10.1016/j.cell.2018.05.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Heritability studies are essential for defining genetic influences on disease risk and trait variability. Polubriaginof et al. show how massive amounts of data contained in electronic health records can be used for heritability studies on hundreds of phenotypes. Mining emergency contact information with comparison to existing gold standards showcases the broad utility of the approach.
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Affiliation(s)
- Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Jonathan D Mosley
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Robinson JR, Wei WQ, Roden DM, Denny JC. Defining Phenotypes from Clinical Data to Drive Genomic Research. Annu Rev Biomed Data Sci 2018; 1:69-92. [PMID: 34109303 DOI: 10.1146/annurev-biodatasci-080917-013335] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The rise in available longitudinal patient information in electronic health records (EHRs) and their coupling to DNA biobanks has resulted in a dramatic increase in genomic research using EHR data for phenotypic information. EHRs have the benefit of providing a deep and broad data source of health-related phenotypes, including drug response traits, expanding the phenome available to researchers for discovery. The earliest efforts at repurposing EHR data for research involved manual chart review of limited numbers of patients but now typically involve applications of rule-based and machine learning algorithms operating on sometimes huge corpora for both genome-wide and phenome-wide approaches. We highlight here the current methods, impact, challenges, and opportunities for repurposing clinical data to define patient phenotypes for genomics discovery. Use of EHR data has proven a powerful method for elucidation of genomic influences on diseases, traits, and drug-response phenotypes and will continue to have increasing applications in large cohort studies.
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Affiliation(s)
- Jamie R Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.,Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology, Vanderbilt University Medical Center
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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9
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Bayesian analysis of genetic association across tree-structured routine healthcare data in the UK Biobank. Nat Genet 2017; 49:1311-1318. [PMID: 28759005 PMCID: PMC5580804 DOI: 10.1038/ng.3926] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/06/2017] [Indexed: 12/15/2022]
Abstract
Genetic discovery from the multitude of phenotypes extractable from routine healthcare data can transform our understanding of the human phenome and accelerate progress towards precision medicine. However, a critical question when analysing high-dimensional and heterogeneous data is how to best interrogate increasingly specific subphenotypes whilst retaining statistical power to detect genetic associations. Here we develop and employ a novel Bayesian analysis framework that exploits the hierarchical structure of diagnosis classifications to analyse genetic variants against UK Biobank disease phenotypes derived from self-reporting and hospital episode statistics. Our method displays a more than 20% increase in power to detect genetic effects over other approaches and identifies novel associations between classical human leukocyte antigen (HLA) alleles and common immune-mediated diseases (IMDs). By applying the approach to genetic risk scores (GRSs) we reveal the extent of genetic sharing between IMDs and expose differences in disease perception or diagnosis with potential clinical implications.
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10
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Mosley JD, Shoemaker MB, Wells QS, Darbar D, Shaffer CM, Edwards TL, Bastarache L, McCarty CA, Thompson W, Chute CG, Jarvik GP, Crosslin DR, Larson EB, Kullo IJ, Pacheco JA, Peissig PL, Brilliant MH, Linneman JG, Witte JS, Denny JC, Roden DM. Investigating the Genetic Architecture of the PR Interval Using Clinical Phenotypes. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.116.001482. [PMID: 28416512 DOI: 10.1161/circgenetics.116.001482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 03/03/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND One potential use for the PR interval is as a biomarker of disease risk. We hypothesized that quantifying the shared genetic architectures of the PR interval and a set of clinical phenotypes would identify genetic mechanisms contributing to PR variability and identify diseases associated with a genetic predictor of PR variability. METHODS AND RESULTS We used ECG measurements from the ARIC study (Atherosclerosis Risk in Communities; n=6731 subjects) and 63 genetically modulated diseases from the eMERGE network (Electronic Medical Records and Genomics; n=12 978). We measured pairwise genetic correlations (rG) between PR phenotypes (PR interval, PR segment, P-wave duration) and each of the 63 phenotypes. The PR segment was genetically correlated with atrial fibrillation (rG=-0.88; P=0.0009). An analysis of metabolic phenotypes in ARIC also showed that the P wave was genetically correlated with waist circumference (rG=0.47; P=0.02). A genetically predicted PR interval phenotype based on 645 714 single-nucleotide polymorphisms was associated with atrial fibrillation (odds ratio=0.89 per SD change; 95% confidence interval, 0.83-0.95; P=0.0006). The differing pattern of associations among the PR phenotypes is consistent with analyses that show that the genetic correlation between the P wave and PR segment was not significantly different from 0 (rG=-0.03 [0.16]). CONCLUSIONS The genetic architecture of the PR interval comprises modulators of atrial fibrillation risk and obesity.
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Affiliation(s)
- Jonathan D Mosley
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.).
| | - M Benjamin Shoemaker
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Quinn S Wells
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Dawood Darbar
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Christian M Shaffer
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Todd L Edwards
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Lisa Bastarache
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Catherine A McCarty
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Will Thompson
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Christopher G Chute
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Gail P Jarvik
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - David R Crosslin
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Eric B Larson
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Iftikhar J Kullo
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Jennifer A Pacheco
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Peggy L Peissig
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Murray H Brilliant
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - James G Linneman
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - John S Witte
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Josh C Denny
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Dan M Roden
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
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Mosley JD, van Driest SL, Wells QS, Shaffer CM, Edwards TL, Bastarache L, McCarty CA, Thompson W, Chute CG, Jarvik GP, Crosslin DR, Larson EB, Kullo IJ, Pacheco JA, Peissig PL, Brilliant MH, Linneman JG, Denny JC, Roden DM. Defining a Contemporary Ischemic Heart Disease Genetic Risk Profile Using Historical Data. ACTA ACUST UNITED AC 2016; 9:521-530. [PMID: 27780847 DOI: 10.1161/circgenetics.116.001530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 09/28/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Continued reductions in morbidity and mortality attributable to ischemic heart disease (IHD) require an understanding of the changing epidemiology of this disease. We hypothesized that we could use genetic correlations, which quantify the shared genetic architectures of phenotype pairs and extant risk factors from a historical prospective study to define the risk profile of a contemporary IHD phenotype. METHODS AND RESULTS We used 37 phenotypes measured in the ARIC study (Atherosclerosis Risk in Communities; n=7716, European ancestry subjects) and clinical diagnoses from an electronic health record (EHR) data set (n=19 093). All subjects had genome-wide single-nucleotide polymorphism genotyping. We measured pairwise genetic correlations (rG) between the ARIC and EHR phenotypes using linear mixed models. The genetic correlation estimates between the ARIC risk factors and the EHR IHD were modestly linearly correlated with hazards ratio estimates for incident IHD in ARIC (Pearson correlation [r]=0.62), indicating that the 2 IHD phenotypes had differing risk profiles. For comparison, this correlation was 0.80 when comparing EHR and ARIC type 2 diabetes mellitus phenotypes. The EHR IHD phenotype was most strongly correlated with ARIC metabolic phenotypes, including total:high-density lipoprotein cholesterol ratio (rG=-0.44, P=0.005), high-density lipoprotein (rG=-0.48, P=0.005), systolic blood pressure (rG=0.44, P=0.02), and triglycerides (rG=0.38, P=0.02). EHR phenotypes related to type 2 diabetes mellitus, atherosclerotic, and hypertensive diseases were also genetically correlated with these ARIC risk factors. CONCLUSIONS The EHR IHD risk profile differed from ARIC and indicates that treatment and prevention efforts in this population should target hypertensive and metabolic disease.
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Affiliation(s)
- Jonathan D Mosley
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI.
| | - Sara L van Driest
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Quinn S Wells
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Christian M Shaffer
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Todd L Edwards
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Lisa Bastarache
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Catherine A McCarty
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Will Thompson
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Christopher G Chute
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Gail P Jarvik
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - David R Crosslin
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Eric B Larson
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Iftikhar J Kullo
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Jennifer A Pacheco
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Peggy L Peissig
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Murray H Brilliant
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - James G Linneman
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Josh C Denny
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
| | - Dan M Roden
- From the Department of Medicine (J.D.M., S.L.v.D., Q.S.W., C.M.S., J.C.D., D.M.R.), Department of Pediatrics (S.L.v.D.), Vanderbilt Epidemiology Center (T.L.E.), Biomedical Informatics (L.B., J.C.D., D.M.R.), and Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, North Shore University Health System, Evanston, IL (W.T.); Department of Health Policy and Management Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD (C.G.C.); Departments of Medicine (Medical Genetics) and Genome Sciences (G.P.J.) and Departments of Biomedical Informatics and Medical Education (D.R.C.), University of Washington, Seattle; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); and Biomedical Informatics Research Center (P.L.P., J.G.L.) and Center for Human Genetics (M.H.B.), Marshfield Clinic Research Foundation, WI
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