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Bick AG, Akwo E, Robinson-Cohen C, Lee K, Lynch J, Assimes TL, DuVall S, Edwards T, Fang H, Freiberg SM, Giri A, Huffman JE, Huang J, Hull L, Kember RL, Klarin D, Lee JS, Levin M, Miller DR, Natarajan P, Saleheen D, Shao Q, Sun YV, Tang H, Wilson O, Chang KM, Cho K, Concato J, Gaziano JM, Kathiresan S, O'Donnell CJ, Rader DJ, Tsao PS, Wilson PW, Hung AM, Damrauer SM. Association of APOL1 Risk Alleles With Cardiovascular Disease in Blacks in the Million Veteran Program. Circulation 2019; 140:1031-1040. [PMID: 31337231 DOI: 10.1161/circulationaha.118.036589] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Approximately 13% of black individuals carry 2 copies of the apolipoprotein L1 (APOL1) risk alleles G1 or G2, which are associated with 1.5- to 2.5-fold increased risk of chronic kidney disease. There have been conflicting reports as to whether an association exists between APOL1 risk alleles and cardiovascular disease (CVD) that is independent of the effects of APOL1 on kidney disease. We sought to test the association of APOL1 G1/G2 alleles with coronary artery disease, peripheral artery disease, and stroke among black individuals in the Million Veteran Program. METHODS We performed a time-to-event analysis of retrospective electronic health record data using Cox proportional hazard and competing-risks Fine and Gray subdistribution hazard models. The primary exposure was APOL1 risk allele status. The primary outcome was incident coronary artery disease among individuals without chronic kidney disease during the 12.5-year follow-up period. We separately analyzed the cross-sectional association of APOL1 risk allele status with lipid traits and 115 cardiovascular diseases using phenome-wide association. RESULTS Among 30 903 black Million Veteran Program participants, 3941 (13%) carried the 2 APOL1 risk allele high-risk genotype. Individuals with normal kidney function at baseline with 2 risk alleles had slightly higher risk of developing coronary artery disease compared with those with no risk alleles (hazard ratio, 1.11 [95% CI, 1.01-1.21]; P=0.039). Similarly, modest associations were identified with incident stroke (hazard ratio, 1.20 [95% CI, 1.05-1.36; P=0.007) and peripheral artery disease (hazard ratio, 1.15 [95% CI, 1.01-1.29l; P=0.031). When both cardiovascular and renal outcomes were modeled, APOL1 was strongly associated with incident renal disease, whereas no significant association with the CVD end points could be detected. Cardiovascular phenome-wide association analyses did not identify additional significant associations with CVD subsets. CONCLUSIONS APOL1 risk variants display a modest association with CVD, and this association is likely mediated by the known APOL1 association with chronic kidney disease.
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Affiliation(s)
- Alexander G Bick
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.)
| | - Elvis Akwo
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Cassianne Robinson-Cohen
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Kyung Lee
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.)
| | - Julie Lynch
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.).,University of Massachusetts College of Nursing & Health Sciences, Boston (J.L.).,VA Informatics and Computing Infrastructure, Salt Lake City, UT (J.L., S.D.)
| | - Themistocles L Assimes
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Scott DuVall
- VA Informatics and Computing Infrastructure, Salt Lake City, UT (J.L., S.D.)
| | - Todd Edwards
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Huaying Fang
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - S Matthew Freiberg
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Ayush Giri
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Jennifer E Huffman
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.)
| | - Jie Huang
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.)
| | - Leland Hull
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.)
| | - Rachel L Kember
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Derek Klarin
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.)
| | - Jennifer S Lee
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Michael Levin
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Donald R Miller
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.).,Boston University, MA (D.R.M.)
| | - Pradeep Natarajan
- Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.)
| | - Danish Saleheen
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Qing Shao
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.)
| | - Yan V Sun
- Atlanta VA Medical Center, GA (Y.V.S., P.W.W.).,Emory University, Atlanta, GA (Y.V.S., P.W.W.)
| | - Hua Tang
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Otis Wilson
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.)
| | - Kyong-Mi Chang
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Kelly Cho
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.)
| | - John Concato
- VA Connecticut HealthCare System, New Haven (J.C.)
| | - J Michael Gaziano
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Harvard Medical School, Boston, MA (J.M.G., S.K., C.J.O.)
| | - Sekar Kathiresan
- Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.).,Harvard Medical School, Boston, MA (J.M.G., S.K., C.J.O.)
| | - Christopher J O'Donnell
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Harvard Medical School, Boston, MA (J.M.G., S.K., C.J.O.)
| | - Daniel J Rader
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.)
| | - Philip S Tsao
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Peter W Wilson
- Atlanta VA Medical Center, GA (Y.V.S., P.W.W.).,Emory University, Atlanta, GA (Y.V.S., P.W.W.)
| | - Adriana M Hung
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Scott M Damrauer
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
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Gutiérrez OM, Irvin MR, Chaudhary NS, Cushman M, Zakai NA, David VA, Limou S, Pamir N, Reiner AP, Naik RP, Sale MM, Safford MM, Hyacinth HI, Judd SE, Kopp JB, Winkler CA. APOL1 Nephropathy Risk Variants and Incident Cardiovascular Disease Events in Community-Dwelling Black Adults. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2018; 11:e002098. [PMID: 29899045 PMCID: PMC6339526 DOI: 10.1161/circgen.117.002098] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND APOL1 renal risk variants are strongly associated with chronic kidney disease in Black adults, but reported associations with cardiovascular disease (CVD) have been conflicting. METHODS We examined associations of APOL1 with incident coronary heart disease (n=323), ischemic stroke (n=331), and the composite CVD outcome (n=500) in 10 605 Black participants of the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Primary analyses compared individuals with APOL1 high-risk genotypes to APOL1 low-risk genotypes in Cox proportional hazards models adjusted for CVD risk factors and African ancestry. RESULTS APOL1 high-risk participants were younger and more likely to have albuminuria at baseline than APOL1 low-risk participants. The risk of incident stroke, coronary heart disease, or composite CVD end point did not significantly differ by APOL1 genotype status in multivariable models. The association of APOL1 genotype with incident composite CVD differed by diabetes mellitus status (Pinteraction=0.004). In those without diabetes mellitus, APOL1 high-risk genotypes associated with greater risk of incident composite CVD (hazard ratio, 1.67; 95% confidence interval, 1.12-2.47) compared with those with APOL1 low-risk genotypes in multivariable adjusted models. This latter association was driven by ischemic strokes (hazard ratio, 2.32; 95% confidence interval, 1.33-4.07), in particular, those related to small vessel disease (hazard ratio, 5.10; 95% confidence interval, 1.55-16.56). There was no statistically significant association of APOL1 genotypes with incident CVD in subjects with diabetes mellitus. The APOL1 high-risk genotype was associated with higher stroke risk in individuals without but not those with chronic kidney disease in fully adjusted models. CONCLUSIONS APOL1 high-risk status is associated with CVD events in community-dwelling Black adults without diabetes mellitus.
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Affiliation(s)
- Orlando M Gutiérrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL (O.M.G.)
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (M.R.I., N.S.C.)
| | - Ninad S Chaudhary
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (M.R.I., N.S.C.)
| | - Mary Cushman
- Division of Hematology and Oncology, University of Vermont, Burlington, VT (M.C., N.A.Z.)
| | - Neil A Zakai
- Division of Hematology and Oncology, University of Vermont, Burlington, VT (M.C., N.A.Z.)
| | - Victor A David
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD (V.A.D.)
| | - Sophie Limou
- Basic Research Laboratory, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research, Frederick National Laboratory, Frederick, MD (S.L., C.A.W.)
- Center for Research in Immunology and Transplantation, University of Nantes, Nantes, France (S.L.)
| | - Nathalie Pamir
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (N.P.)
| | - Alex P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA (A.P.R.)
| | - Rakhi P Naik
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.)
| | - Michele M Sale
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA (M.M. Sale)
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY (M.M. Safford)
| | - Hyacinth I Hyacinth
- Department of Pediatrics, Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (H.I.H.)
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL (S.E.J.)
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.B.K.).
| | - Cheryl A Winkler
- Basic Research Laboratory, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research, Frederick National Laboratory, Frederick, MD (S.L., C.A.W.)
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