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Tang X, Zhuang H, Yu H. A bidirectional Mendelian randomization analysis between COVID-19 and cardiac arrest. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-12. [PMID: 38864502 DOI: 10.1080/09603123.2024.2365304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
Epidemiological studies link COVID-19 to increased cardiac arrest (CA) risk, but causality remains unclear due to potential confounding factors in observational studies . We conducted a Mendelian randomization (MR) analysis using genome-wide association study (GWAS) data, employing COVID-19-associated single nucleotide polymorphisms (SNPs) with significance values smaller than 5 × 10⁻⁸. We calculated inverse-variance weighted (IVW) MR estimates and performed sensitivity analyses using MR methods robust to horizontal pleiotropy. Additionally, a reverse MR analysis was conducted using CA-associated SNPs with significance values smaller than 1 × 10⁻⁵. Results indicated that infected COVID-19 (OR = 1.12, 95% CI = 0.47-2.67, p = 0.79), hospitalized COVID-19 (OR = 1.02, 95% CI = 0.70-1.49, p = 0.920), and severe respiratory COVID-19 (OR = 0.99, 95% CI = 0.81-1.21, p = 0.945) did not causally influence CA risk. Reverse MR analysis also did not support a causal effect of CA on COVID-19. Thus, associations in observational studies may stem from shared biological factors or environmental confounding.
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Affiliation(s)
- Xisha Tang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Mitochondrial Metabolism and Perioperative Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huijia Zhuang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Mitochondrial Metabolism and Perioperative Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
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Palanca A, Bartual-Rodrigo A, Cuenca C, Mayo-López OD, Ampudia-Blasco FJ, González-Navarro H, Ascaso JF, García-García AB, Chaves FJ, Real JT, Martínez-Hervás S. Association of carotid atheroma plaque with IL-18 levels and with polymorphisms in the IL-18 receptor gene in a Mediterranean population. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024:S0214-9168(23)00120-1. [PMID: 38216380 DOI: 10.1016/j.arteri.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Atherosclerosis is an inflammatory disease. Interleukin 18 (IL-18) is an inflammatory molecule that has been linked to the development of atherosclerosis and cardiovascular disease. OBJECTIVE To evaluate the possible relationship between plasma levels of IL-18 and the presence of atherosclerosis evaluated at the carotid level, as well as to analyze the possible modulation by different polymorphisms in a Mediterranean population. MATERIAL AND METHODS Seven hundred and forty-six individuals from the metropolitan area of Valencia were included, recruited over a period of 2 years. Hydrocarbon and lipid metabolism parameters were determined using standard methodology and IL-18 using ELISA. In addition, carotid ultrasound was performed and the genotype of four SNPs related to the IL-18 signaling pathway was analyzed. RESULTS Patients with higher plasma levels of IL-18 had other associated cardiovascular risk factors. Elevated IL-18 levels were significantly associated with higher carotid IMT and the presence of atheromatous plaques. The genotype with the A allele of the SNP rs2287037 was associated with a higher prevalence of carotid atheromatous plaque. On the contrary, the genotype with the C allele of the SNP rs2293224 was associated with a lower prevalence of atheromatous plaque. CONCLUSIONS High levels of IL-18 were significantly associated with a higher carotid IMT and the presence of atheromatous plaques, which appear to be influenced by genetic factors, as evidenced by associations between SNPs in the IL-18 receptor gene and the presence of atheroma plaque.
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Affiliation(s)
- Ana Palanca
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valencia, Valencia, España; INCLIVA, Instituto de Investigación Sanitaria, Valencia, España
| | - Amparo Bartual-Rodrigo
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Carolina Cuenca
- INCLIVA, Instituto de Investigación Sanitaria, Valencia, España
| | | | - Francisco Javier Ampudia-Blasco
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valencia, Valencia, España; INCLIVA, Instituto de Investigación Sanitaria, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas asociadas, Instituto de Salud Carlos III, Madrid, España; Departament de Medicina, Universitat de València, Valencia, España
| | - Herminia González-Navarro
- INCLIVA, Instituto de Investigación Sanitaria, Valencia, España; Departamento de Bioquímica y Biología Molecular, Universitat de València, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas asociadas, Instituto de Salud Carlos III, Madrid, España
| | - Juan F Ascaso
- INCLIVA, Instituto de Investigación Sanitaria, Valencia, España; Departament de Medicina, Universitat de València, Valencia, España
| | - Ana Bárbara García-García
- INCLIVA, Instituto de Investigación Sanitaria, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas asociadas, Instituto de Salud Carlos III, Madrid, España; Unidad de Genómica y Diabetes, INCLIVA, Instituto de Investigación Sanitaria, Valencia, España
| | - Felipe Javier Chaves
- INCLIVA, Instituto de Investigación Sanitaria, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas asociadas, Instituto de Salud Carlos III, Madrid, España; Unidad de Genómica y Diabetes, INCLIVA, Instituto de Investigación Sanitaria, Valencia, España
| | - José T Real
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valencia, Valencia, España; INCLIVA, Instituto de Investigación Sanitaria, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas asociadas, Instituto de Salud Carlos III, Madrid, España; Departament de Medicina, Universitat de València, Valencia, España
| | - Sergio Martínez-Hervás
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valencia, Valencia, España; INCLIVA, Instituto de Investigación Sanitaria, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas asociadas, Instituto de Salud Carlos III, Madrid, España; Departament de Medicina, Universitat de València, Valencia, España.
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Lu H, Cao Y, Zhong M. No causal association between COVID-19 and sepsis: a bidirectional two-sample Mendelian randomization study. Front Immunol 2023; 14:1183489. [PMID: 37876930 PMCID: PMC10591217 DOI: 10.3389/fimmu.2023.1183489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
Background Sepsis and COVID-19 have a well-established observable relationship. Whether COVID-19 increases the likelihood of developing sepsis and whether patients with sepsis are at increased risk for COVID-19 infection is unknown. Using a bidirectional 2-sample Mendelian randomization (TSMR) analysis techniques in sizable cohorts, we sought to answer this question. Methods The current study performed Mendelian randomization (MR) on publicly accessible genome-wide association study (GWAS) summary data in order to investigate the causal linkages between COVID-19 and sepsis. A Two-Sample MR(TSMR) analyses was performed. As instrumental variables, a COVID-19 dataset of single nucleotide polymorphisms (SNPs) with significance value smaller than 5*10-8 was employed and Sepsis dataset of SNPs with significance value smaller than 5*10-7was employed. Results The results suggested that Very severe respiratory confirmed COVID-19(VSRC), hospitalized COVID-19(HC) and Infected COVID-19(IC) had no causal influence on sepsis risk using the inverse variance weighted (IVW) technique (VSRC OR = 1.000, 95% CI, 0.956-1.046, P = 0.996, HC OR = 0.976, 95% CI, 0.920-1.036, P = 0.430, IC OR = 0.923, 95% CI, 0.796-1.071, P = 0.291) and there was no causal effect of sepsis on the risk of VSRC, HC and IC (VSRC OR = 0.955, 95% CI, 0.844-1.173, P = 0.953, HC OR = 0.993, 95% CI, 0.859-1.147, P = 0.921, IC OR = 1.001, 95% CI, 0.959-1.045, P = 0.961). Conclusions Our findings do not support a causal relationship between COVID-19 and sepsis risk, nor do they suggest a causal link between sepsis and COVID-19. The bidirectional relationship between COVID-19 and sepsis warrants further investigation in large cohorts.
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Affiliation(s)
- Hao Lu
- School of Medicine, Xiamen University, Xiamen, China
| | - Yu Cao
- School of Medicine, Xiamen University, Xiamen, China
| | - Ming Zhong
- School of Medicine, Xiamen University, Xiamen, China
- Department of Oral Histopathology, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, Liaoning, China
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Hamaya R, Mora S. Young, hot and sweet: The complex relationship of inflammation, type 1 diabetes, and vascular health. Atherosclerosis 2023; 379:117184. [PMID: 37537080 DOI: 10.1016/j.atherosclerosis.2023.117184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Rikuta Hamaya
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Samia Mora
- Center for Lipid Metabolomics, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Ain QU, Dewi TI, Kurniati NF. Plasma Levels of Interleukin-6 and -18 Significantly Increase in Patients with Acute Coronary Syndrome. Oman Med J 2023; 38:e532. [PMID: 37727149 PMCID: PMC10505690 DOI: 10.5001/omj.2023.94] [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: 10/11/2022] [Accepted: 01/23/2023] [Indexed: 09/21/2023] Open
Abstract
Objectives Inflammatory pathways play a significant role in atherosclerosis that leads to acute coronary syndrome (ACS). The initial stages of atherosclerosis are often asymptomatic; when atherosclerotic plaques become unstable it leads to ACS. Therefore, early detection, diagnosis, and treatment of atherosclerosis must be sought. These circumstances underpin the need for diagnostic values of inflammatory markers, warranting their routine clinical application to develop anti-atherosclerotic therapeutic approaches. The aim of this case-control observational study was to evaluate the plasma levels of interleukin (IL)-6, IL-18, IL-1β, and IL-10. Methods The research was conducted at Hasan Sadikin Hospital from September to December 2021. Patients were recruited based on the typical clinical history of ACS (non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, and unstable angina) and electrocardiographic and cardiac enzyme data. Healthy subjects having no more than one cardiovascular disease risk factor at admission were included. A total of 43 subjects were included in the study, of which 23 subjects were patients diagnosed with ACS and 20 were healthy controls. Results The results showed that the mean plasma levels of IL-6 (298.6±432.9 pg/mL) in ACS patients were significantly higher than the mean concentration of IL-6 (33.7±96.6 pg/mL) in the control group (p < 0.05). Similarly, the mean plasma level of IL-18 (181.4±81.4 pg/mL) in ACS patients was significantly higher compared to the mean concentration (125.0±29.8 pg/mL) in the control group (p < 0.05), suggesting that both IL-6 and IL-18 were associated with ACS. However, there is no statistically significant difference between IL-1β and IL-10 levels. A Pearson's correlation analysis showed that a positive correlation exists between IL-6 and IL-18. Conclusions Both IL-6 and IL-18 are associated with ACS.
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Affiliation(s)
- Qurrat Ul Ain
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia
- Department of Pharmacy, The University of Faisalabad, Faisalabad, Pakistan
| | - Triwedya Indra Dewi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Neng Fisheri Kurniati
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia
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Kasprzak Ł, Twardawa M, Formanowicz P, Formanowicz D. The Mutual Contribution of 3-NT, IL-18, Albumin, and Phosphate Foreshadows Death of Hemodialyzed Patients in a 2-Year Follow-Up. Antioxidants (Basel) 2022; 11:antiox11020355. [PMID: 35204237 PMCID: PMC8868576 DOI: 10.3390/antiox11020355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 02/05/2023] Open
Abstract
Patients with chronic kidney disease (CKD), especially those who are hemodialyzed (HD), are at significantly high risk of contracting cardiovascular disease and having increased mortality. This study aimed to find potential death predictors, the measurement of which may reflect increased mortality in HD patients, and then combine the most promising ones in frames of a simple death risk assessment model. For this purpose, HD patients (n=71) with acute myocardial infarction in the last year (HD group) and healthy people (control group) as a comparative group (n=32) were included in the study. Various laboratory determinations and non-invasive cardiovascular tests were performed. Next, patients were followed for two years, and data on cardiovascular (CV) deaths were collected. On this basis, two HD groups were formed: patients who survived (HD-A, n=51) and patients who died (HD-D, n=20). To model HD mortality, 21 out of 90 potential variables collected or calculated from the raw data were selected. The best explanatory power (95.5%) was reached by a general linear model with four variables: interleukin 18, 3-nitrotyrosine, albumin, and phosphate. The interplay between immuno-inflammatory processes, nitrosative and oxidative stress, malnutrition, and calcium-phosphate disorders has been indicated to be essential in predicting CV-related mortality in studied HD patients. ClinicalTrials.gov Identifier: NCT05214872.
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Affiliation(s)
- Łukasz Kasprzak
- Department of Nephrology with Dialysis Unit, Provincial Hospital in Leszno, 64-100 Leszno, Poland;
| | - Mateusz Twardawa
- Institute of Computing Science, Poznan University of Technology, 60-965 Poznan, Poland; (M.T.); (P.F.)
- ICT Security Department, Poznan Supercomputing and Networking Center Affiliated to the Institute of Bioorganic Chemistry, Polish Academy of Sciences, 61-139 Poznan, Poland
| | - Piotr Formanowicz
- Institute of Computing Science, Poznan University of Technology, 60-965 Poznan, Poland; (M.T.); (P.F.)
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, 61-704 Poznan, Poland
| | - Dorota Formanowicz
- Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
- Correspondence:
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Leong A, Cole JB, Brenner LN, Meigs JB, Florez JC, Mercader JM. Cardiometabolic risk factors for COVID-19 susceptibility and severity: A Mendelian randomization analysis. PLoS Med 2021; 18:e1003553. [PMID: 33661905 PMCID: PMC7971850 DOI: 10.1371/journal.pmed.1003553] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 03/18/2021] [Accepted: 01/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Epidemiological studies report associations of diverse cardiometabolic conditions including obesity with COVID-19 illness, but causality has not been established. We sought to evaluate the associations of 17 cardiometabolic traits with COVID-19 susceptibility and severity using 2-sample Mendelian randomization (MR) analyses. METHODS AND FINDINGS We selected genetic variants associated with each exposure, including body mass index (BMI), at p < 5 × 10-8 from genome-wide association studies (GWASs). We then calculated inverse-variance-weighted averages of variant-specific estimates using summary statistics for susceptibility and severity from the COVID-19 Host Genetics Initiative GWAS meta-analyses of population-based cohorts and hospital registries comprising individuals with self-reported or genetically inferred European ancestry. Susceptibility was defined as testing positive for COVID-19 and severity was defined as hospitalization with COVID-19 versus population controls (anyone not a case in contributing cohorts). We repeated the analysis for BMI with effect estimates from the UK Biobank and performed pairwise multivariable MR to estimate the direct effects and indirect effects of BMI through obesity-related cardiometabolic diseases. Using p < 0.05/34 tests = 0.0015 to declare statistical significance, we found a nonsignificant association of genetically higher BMI with testing positive for COVID-19 (14,134 COVID-19 cases/1,284,876 controls, p = 0.002; UK Biobank: odds ratio 1.06 [95% CI 1.02, 1.10] per kg/m2; p = 0.004]) and a statistically significant association with higher risk of COVID-19 hospitalization (6,406 hospitalized COVID-19 cases/902,088 controls, p = 4.3 × 10-5; UK Biobank: odds ratio 1.14 [95% CI 1.07, 1.21] per kg/m2, p = 2.1 × 10-5). The implied direct effect of BMI was abolished upon conditioning on the effect on type 2 diabetes, coronary artery disease, stroke, and chronic kidney disease. No other cardiometabolic exposures tested were associated with a higher risk of poorer COVID-19 outcomes. Small study samples and weak genetic instruments could have limited the detection of modest associations, and pleiotropy may have biased effect estimates away from the null. CONCLUSIONS In this study, we found genetic evidence to support higher BMI as a causal risk factor for COVID-19 susceptibility and severity. These results raise the possibility that obesity could amplify COVID-19 disease burden independently or through its cardiometabolic consequences and suggest that targeting obesity may be a strategy to reduce the risk of severe COVID-19 outcomes.
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Affiliation(s)
- Aaron Leong
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Joanne B. Cole
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Laura N. Brenner
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division on Pulmonary and Critical Care, Massachusetts General Hospital, Boston Massachusetts, United States of America
| | - James B. Meigs
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Jose C. Florez
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Josep M. Mercader
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Leong A, Cole J, Brenner LN, Meigs JB, Florez JC, Mercader JM. Cardiometabolic Risk Factors for COVID-19 Susceptibility and Severity: A Mendelian Randomization Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32909013 DOI: 10.1101/2020.08.26.20182709] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Early epidemiological studies report associations of diverse cardiometabolic conditions especially body mass index (BMI), with COVID-19 susceptibility and severity, but causality has not been established. Identifying causal risk factors is critical to inform preventive strategies aimed at modifying disease risk. OBJECTIVE We sought to evaluate the causal associations of cardiometabolic conditions with COVID-19 susceptibility and severity. DESIGN Two-sample Mendelian Randomization (MR) Study. SETTING Population-based cohorts that contributed to the genome-wide association study (GWAS) meta-analysis by the COVID-19 Host Genetics Initiative. PARTICIPANTS Patients hospitalized with COVID-19 diagnosed by RNA PCR, serologic testing, or clinician diagnosis. Population controls defined as anyone who was not a case in the cohorts. Exposures: Selected genetic variants associated with 17 cardiometabolic diseases, including diabetes, coronary artery disease, stroke, chronic kidney disease, and BMI, at p<5 x 10-8 from published largescale GWAS. MAIN OUTCOMES We performed an inverse-variance weighted averages of variant-specific causal estimates for susceptibility, defined as people who tested positive for COVID-19 vs. population controls, and severity, defined as patients hospitalized with COVID-19 vs. population controls, and repeated the analysis for BMI using effect estimates from UKBB. To estimate direct and indirect causal effects of BMI through obesity-related cardiometabolic diseases, we performed pairwise multivariable MR. We used p<0.05/17 exposure/2 outcomes=0.0015 to declare statistical significance. RESULTS Genetically increased BMI was causally associated with testing positive for COVID-19 [6,696 cases / 1,073,072 controls; p=6.7 x 10-4, odds ratio and 95% confidence interval 1.08 (1.03, 1.13) per kg/m2] and a higher risk of COVID-19 hospitalization [3,199 cases/897,488 controls; p=8.7 x 10-4, 1.12 (1.04, 1.21) per kg/m2]. In the multivariable MR, the direct effect of BMI was abolished upon conditioning on the effect on type 2 diabetes but persisted when conditioning on the effects on coronary artery disease, stroke, chronic kidney disease, and c-reactive protein. No other cardiometabolic exposures tested were associated with a higher risk of poorer COVID-19 outcomes. CONCLUSIONS AND RELEVANCE Genetic evidence supports BMI as a causal risk factor for COVID-19 susceptibility and severity. This relationship may be mediated via type 2 diabetes. Obesity may have amplified the disease burden of the COVID-19 pandemic either single-handedly or through its metabolic consequences.
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