1
|
Le A, Peng H, Golinsky D, Di Scipio M, Lali R, Paré G. What Causes Premature Coronary Artery Disease? Curr Atheroscler Rep 2024; 26:189-203. [PMID: 38573470 DOI: 10.1007/s11883-024-01200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW This review provides an overview of genetic and non-genetic causes of premature coronary artery disease (pCAD). RECENT FINDINGS pCAD refers to coronary artery disease (CAD) occurring before the age of 65 years in women and 55 years in men. Both genetic and non-genetic risk factors may contribute to the onset of pCAD. Recent advances in the genetic epidemiology of pCAD have revealed the importance of both monogenic and polygenic contributions to pCAD. Familial hypercholesterolemia (FH) is the most common monogenic disorder associated with atherosclerotic pCAD. However, clinical overreliance on monogenic genes can result in overlooked genetic causes of pCAD, especially polygenic contributions. Non-genetic factors, notably smoking and drug use, are also important contributors to pCAD. Cigarette smoking has been observed in 25.5% of pCAD patients relative to 12.2% of non-pCAD patients. Finally, myocardial infarction (MI) associated with spontaneous coronary artery dissection (SCAD) may result in similar clinical presentations as atherosclerotic pCAD. Recognizing the genetic and non-genetic causes underlying pCAD is important for appropriate prevention and treatment. Despite recent progress, pCAD remains incompletely understood, highlighting the need for both awareness and research.
Collapse
Affiliation(s)
- Ann Le
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Helen Peng
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada
| | - Danielle Golinsky
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada
| | - Matteo Di Scipio
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada
| | - Ricky Lali
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
- Department of Medical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Biochemistry and Biomedical Sciences, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
- Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8L 4K1, Canada.
| |
Collapse
|
2
|
Marie PY, Visvikis-Siest S. Integrating polymorphism signatures with myocardial perfusion imaging data to improve the prevention of coronary artery disease: Science or science-fiction? J Nucl Cardiol 2022; 29:2917-2919. [PMID: 33393010 DOI: 10.1007/s12350-020-02450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Pierre-Yves Marie
- CHRU-Nancy, Université de Lorraine, Nuclear Medicine & Nancyclotep Experimental Platform, 54000, Nancy, France.
- Université de Lorraine, INSERM, UMR-1116, 54000, Nancy, France.
| | | |
Collapse
|
3
|
Lali R, Chong M, Omidi A, Mohammadi-Shemirani P, Le A, Cui E, Paré G. Calibrated rare variant genetic risk scores for complex disease prediction using large exome sequence repositories. Nat Commun 2021; 12:5852. [PMID: 34615865 PMCID: PMC8494733 DOI: 10.1038/s41467-021-26114-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Rare variants are collectively numerous and may underlie a considerable proportion of complex disease risk. However, identifying genuine rare variant associations is challenging due to small effect sizes, presence of technical artefacts, and heterogeneity in population structure. We hypothesize that rare variant burden over a large number of genes can be combined into a predictive rare variant genetic risk score (RVGRS). We propose a method (RV-EXCALIBER) that leverages summary-level data from a large public exome sequencing database (gnomAD) as controls and robustly calibrates rare variant burden to account for the aforementioned biases. A calibrated RVGRS strongly associates with coronary artery disease (CAD) in European and South Asian populations by capturing the aggregate effect of rare variants through a polygenic model of inheritance. The RVGRS identifies 1.5% of the population with substantial risk of early CAD and confers risk even when adjusting for known Mendelian CAD genes, clinical risk factors, and a common variant genetic risk score.
Collapse
Affiliation(s)
- Ricky Lali
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Faculty of Health Sciences, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Michael Chong
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Faculty of Health Sciences, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Arghavan Omidi
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - Pedrum Mohammadi-Shemirani
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, McMaster University, Faculty of Health Sciences, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Ann Le
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, McMaster University, Faculty of Health Sciences, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Edward Cui
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Faculty of Health Sciences, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Biochemistry and Biomedical Sciences, McMaster University, Faculty of Health Sciences, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Medical Sciences, McMaster University, Faculty of Health Sciences, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2×2, Canada.
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| |
Collapse
|
4
|
Coto E, Pascual I, Avanzas P, Cuesta-Lavona E, Lorca R, Martín M, Vázquez-Coto D, Díaz-Corte C, Morís C, Rodríguez-Reguero J, Gómez J. IL17RA in early-onset coronary artery disease: Total leukocyte transcript analysis and promoter polymorphism (rs4819554) association. Cytokine 2020; 136:155285. [PMID: 32950026 DOI: 10.1016/j.cyto.2020.155285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS The interleukin-17 (IL-17) pathway would play an important role in the pathogenesis of atherosclerosis and coronary-artery disease (CAD). The IL-17 inflammatory mediators are expressed by Th17 cells, a group of CD4 + leukocytes that infiltrate the vascular milieu and are pivotal in the origin, progression, stability and rupture of the atherosclerotic lesion. Cigarette smoke compounds stimulated the expression of IL-17 and IL-17-receptors. In atherogenic mice models the deficiency of IL-17RA resulted in a reduction of the atherosclerotic lesion size and leukocyte infiltrate. We hypothesised that common the IL-17RA transcript might be differential expressed in the leukocytes from CAD patients and healthy individuals. METHODS The relative amount of the IL-17RA to ACTB transcript was determined in total leukocytes of 55 patients and 50 controls, all smokers. We genotyped the IL-17RA rs48195554 promoter polymorphisms in 390 healthy controls and 450 early-onset CAD patients. RESULTS Patients showed significantly higher mean IL-17RA normalised transcript value than controls (p < 0.001). For the IL-17RA rs48195554 promoter polymorphisms, IL-17RA G-carriers showed higher transcript values. However, allele and genotype frequencies did not differ between patients and controls and we thus excluded a significant association with CAD. CONCLUSIONS The higher levels of the IL-17RA transcript among CAD-patients was in agreement with a role for the IL-17 pathway in the pathogenesis of coronary atherosclerosis.
Collapse
Affiliation(s)
- Eliecer Coto
- Genética Molecular, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento Medicina, Universidad de Oviedo, Oviedo, Spain; Red de Investigación Renal (REDINREN), Madrid, Spain.
| | - Isaac Pascual
- Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain
| | - Pablo Avanzas
- Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain
| | - Elías Cuesta-Lavona
- Genética Molecular, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| | - Rebeca Lorca
- Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain
| | - María Martín
- Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain
| | | | - Carmen Díaz-Corte
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento Medicina, Universidad de Oviedo, Oviedo, Spain; Red de Investigación Renal (REDINREN), Madrid, Spain; Nefrología, Hospital Universitario Central Asturias, Oviedo, Spain
| | - César Morís
- Cardiología, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento Medicina, Universidad de Oviedo, Oviedo, Spain
| | | | - Juan Gómez
- Genética Molecular, Hospital Universitario Central Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| |
Collapse
|
5
|
Mahtta D, Khalid U, Misra A, Samad Z, Nasir K, Virani SS. Premature Atherosclerotic Cardiovascular Disease: What Have We Learned Recently? Curr Atheroscler Rep 2020; 22:44. [PMID: 32671484 DOI: 10.1007/s11883-020-00862-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In contrast to patients with non-premature atherosclerotic cardiovascular disease (ASCVD), patients with premature ASCVD have not observed a similar decline in cardiovascular mortality and recurrent adverse events. We sought to review the underlying risk factors, potential gaps in medical management, associated outcomes, and tools for risk prognostication among patients with premature ASCVD. RECENT FINDINGS In addition to traditional cardiovascular risk factors (i.e., diabetes, familial hypercholesterolemia), non-traditional risk factors such as chronic inflammatory conditions, recreational drug use, genetics, and pregnancy-related complications play a key role in development and progression of premature ASCVD. Patients with premature ASCVD, and especially women, receive less optimal medical management as compared to their non-premature counterparts. There is an increasing prevalence of cardiovascular risk factors among young adults. Hence, this population remains at an elevated risk for premature ASCVD and subsequent adverse cardiovascular events. Future studies evaluating different risk assessment tools and focusing on young patients across all three major domains of ASCVD are needed.
Collapse
Affiliation(s)
- Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Umair Khalid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Arunima Misra
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Zainab Samad
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Khurram Nasir
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA. .,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. .,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
| |
Collapse
|
6
|
Kohl WK, Dobos G, Cramer H. Conventional and Complementary Healthcare Utilization Among US Adults With Cardiovascular Disease or Cardiovascular Risk Factors: A Nationally Representative Survey. J Am Heart Assoc 2020; 9:e014759. [PMID: 32347141 PMCID: PMC7428557 DOI: 10.1161/jaha.119.014759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Cardiovascular diseases (CVDs) and their risk factors need guideline‐oriented treatment to provide the best benefit for patients. These guidelines include recommendations for regular checkups, realized by general medical practitioners. In addition, individuals with CVD or CVD risk factors tend to use complementary methods for their condition. There is limited information on the association between complementary healthcare utilization and the adherence to recommended conventional health care. Methods and Results In this cross‐sectional analysis of the nationally representative 2017 National Health Interview Survey (n=26 742; response rate 80.7%) we examined the prevalence of conventional and complementary healthcare utilization within the past 12 months in individuals with CVD and/or CVD risk factors and the interactions between the two categories of health care. Of all participants, 38.1% reported risk factors for CVD and 11.4% a CVD diagnosis (groups show an overlap). Overall prevalence of visits to conventional and complementary medicine providers and the use of mind–body medicine was high within the population analyzed. Individuals with CVD and/or CVD risk factors using complementary health care were as likely or more likely to consult general practitioners (CVD: adjusted odds ratio [aOR], 1.17; 95% CI, 0.93–1.47; CVD risk: aOR, 1.21; 95% CI, 1.05–1.39) and medical specialists (CVD: aOR, 1.38; 95% CI, 1.17–1.64; CVD risk: aOR, 1.42; 95% CI, 1.28–1.58) than those not using complementary health care. Those using complementary health care were as likely to adhere to medical checkup as those not using complementary health care. Conclusions Complementary healthcare utilization use was not associated with a reduced adherence to conventional health care and recommended checkups. The potential positive association of complementary and conventional healthcare utilization needs to be confirmed in further studies.
Collapse
Affiliation(s)
- Wiebke Kathrin Kohl
- Department of Internal and Integrative Medicine Evangelische Kliniken Essen-Mitte Faculty of Medicine University of Duisburg-Essen Essen Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine Evangelische Kliniken Essen-Mitte Faculty of Medicine University of Duisburg-Essen Essen Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine Evangelische Kliniken Essen-Mitte Faculty of Medicine University of Duisburg-Essen Essen Germany
| |
Collapse
|