1
|
Frederiksen TC, Christiansen MK, Benjamin EJ, Overvad K, Olsen A, Andersen MK, Hansen T, Grarup N, Jensen HK, Dahm CC. Interaction of genetic risk and lifestyle on the incidence of atrial fibrillation. Heart 2024; 110:644-649. [PMID: 38016806 DOI: 10.1136/heartjnl-2023-323333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/03/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The relationship between combined genetic predisposition and lifestyle and the risk of incident atrial fibrillation (AF) is unclear. Therefore, we aimed to assess a possible interaction between lifestyle and genetics on AF risk. METHODS We included AF cases and a randomly drawn subcohort of 4040 participants from the Danish Diet, Cancer and Health cohort. Lifestyle risk factors were assessed, a score was calculated, and participants were categorised as having a poor, intermediate, or ideal lifestyle. We calculated a genetic risk score comprising 142 variants, and categorised participants into low (quintile 1), intermediate (quintiles 2-4) or high (quintile 5) genetic risk of AF. RESULTS 3094 AF cases occurred during a median follow-up of 12.9 years. Regardless of genetic risk, incidence rates per 1000 person-years were gradually higher with worse lifestyle. For participants with high genetic risk, the incidence rates of AF per 1000 person-years were 5.0 (95% CI 3.4 to 7.3) among individuals with ideal lifestyle, 6.6 (95% CI 5.4 to 8.1) among those with intermediate lifestyle and 10.4 (95% CI 9.2 to 11.8) among participants with poor lifestyle. On an additive scale, there was a positive statistically significant interaction between genetic risk and lifestyle (relative excess risk due to interaction=0.86, 95% CI 0.68 to 1.03, p<0.001). CONCLUSIONS The rates of AF increased gradually with worse lifestyle within each category of genetic risk. We found a positive interaction on an additive scale between genetic risk and lifestyle, suggesting that risk factor modification is especially important in individuals with a high genetic risk of AF.
Collapse
Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | | | - Emelia J Benjamin
- Department of Epidemiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Kim Overvad
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anja Olsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Nutrition and Biomarkers, Danish Cancer Society, Copenhagen, Denmark
| | - Mette K Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Kjaerulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Christina C Dahm
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
2
|
Calloe K, Christiansen MK, Henriksen FL, Jensen HK. The loss-of-function variant p.M764R in the cardiac sodium channel Na v1.5 is associated with ventricular arrhythmias and sudden cardiac death in a family without overt Brugada syndrome. HeartRhythm Case Rep 2024; 10:137-141. [PMID: 38404980 PMCID: PMC10885728 DOI: 10.1016/j.hrcr.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Affiliation(s)
- Kirstine Calloe
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | | | - Henrik Kjærulf Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
3
|
Frederiksen TC, Christiansen MK, Benjamin EJ, Overvad K, Olsen A, Dahm CC, Jensen HK. Five-year changes in weight and risk of atrial fibrillation in the Danish Diet, Cancer, and Health Cohort. Eur J Prev Cardiol 2024; 31:244-249. [PMID: 37708406 PMCID: PMC10809168 DOI: 10.1093/eurjpc/zwad300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/09/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
AIMS Obesity is a major risk factor for atrial fibrillation (AF). Compared with stable weight, gaining weight was associated with a higher risk of incident AF in observational studies. The results, however, are conflicting regarding weight loss and risk of AF. This study aimed to assess the association between 5-year weight changes and risk of incident AF. METHODS AND RESULTS The study was based on participants from the Danish Diet, Cancer, and Health Cohort. Body mass index (BMI) was assessed at a baseline examination and at a second examination 5 years later. Diagnoses of AF and co-morbidities were retrieved from the Danish National Patient Registry. In total, 43 758 participants without prior AF were included. The median age was 61 years and 54% were female. During a median follow-up of 15.7 years, 5312 individuals had incident AF (incidence rate 8.6/1000 person-years). Compared with stable weight, weight gain between 2.5 and 5 BMI units (kg/m2) was associated with a higher risk of AF [hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.09-1.41]. Weight gain of 5 or more BMI units (kg/m2) was associated with a HR of 1.95 (95% CI 1.48-2.56) of incident AF. However, there was no statistically significant association between weight loss and risk of AF. CONCLUSION Five-year weight gain was associated with greater risk of AF compared with stable weight in the Danish Diet, Cancer, and Health Cohort. There was no statistically significant association between weight loss and risk of AF.
Collapse
Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Morten Krogh Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kim Overvad
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anja Olsen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Cancer Society Research Center, København Ø, Denmark
| | | | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| |
Collapse
|
4
|
Frederiksen TC, Christiansen MK, Benjamin EJ, Overvad K, Olsen A, Dahm CC, Jensen HK. Five-year changes in alcohol intake and risk of atrial fibrillation: a Danish cohort study. Eur J Prev Cardiol 2023; 30:1046-1053. [PMID: 36508613 PMCID: PMC10442053 DOI: 10.1093/eurjpc/zwac293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
AIMS Alcohol intake is a well-established risk factor for atrial fibrillation (AF). However, evidence on the effects of changes in alcohol intake to primary AF prevention is sparse. The aim of this study was to examine the association between 5-year changes in alcohol intake and the risk of incident AF. METHODS AND RESULTS This study was based on the Danish cohort study Diet, Cancer and Health. Lifestyle factors were assessed using questionnaires at a recruitment research examination and a second examination 5 years later. Diagnoses of AF and comorbidities were retrieved from the Danish National Patient Registry. 43 758 participants without prior AF were included. The median age was 61 (25th-75th percentile 58-66) years and 54% were female. Over a median follow-up time of 15.7 years, 5312 participants had incident AF (incidence rate 8.6/1000 person-years). Compared with stable intake, increases in alcohol intake to ≥21 drinks/week from ≤6.9 drinks/week (HR: 1.38, 95% CI: 1.09-1.72) or 14-20.9 drinks/week (HR: 1.27, 95% CI: 1.01-1.59) at baseline were associated with a higher risk of AF. In contrast, we did not observe a statistically significant association between reductions in alcohol intake and the risk of AF. CONCLUSION A 5-year increase in alcohol intake was associated with a greater risk of AF compared with a stable low/moderate intake.
Collapse
Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
| | - Morten Krogh Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
| | - Emelia J Benjamin
- Sections of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, 725 Albany Street, MA 02118, USA
| | - Kim Overvad
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Anja Olsen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Christina Catherine Dahm
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
| |
Collapse
|
5
|
Calloe K, Magnusson HBD, Lildballe DL, Christiansen MK, Jensen HK. Multifocal ectopic purkinje-related premature contractions and related cardiomyopathy. Front Cardiovasc Med 2023; 10:1179018. [PMID: 37600057 PMCID: PMC10436533 DOI: 10.3389/fcvm.2023.1179018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
In the past 20 years, genetic variants in SCN5A encoding the cardiac voltage-gated sodium channel Nav1.5 have been linked to a range of inherited cardiac arrhythmias: variants resulting in loss-of-function of Nav1.5 have been linked to sick sinus syndrome, atrial stand still, atrial fibrillation (AF) impaired pulse generation, progressive and non-progressive conduction defects, the Brugada Syndrome (BrS), and sudden cardiac death. SCN5A variants causing increased sodium current during the plateau phase of the cardiac action potential is associated with Long QT Syndrome type 3 (LQTS3), Torsade de Pointes ventricular tachycardia and SCD. Recently, gain-of-function variants have been linked to complex electrical phenotypes, such as the Multifocal Ectopic Purkinje-related Premature Contractions (MEPPC) syndrome. MEPPC is a rare condition characterized by a high burden of premature atrial contractions (PACs) and/or premature ventricular contractions (PVCs) often accompanied by dilated cardiomyopathy (DCM). MEPPC is inherited in an autosomal dominant fashion with an almost complete penetrance. The onset is often in childhood. The link between SCN5A variants, MEPPC and DCM is currently not well understood, but amino acid substitutions resulting in gain-of-function of Nav1.5 or introduction of gating pore currents potentially play an important role. DCM patients with a MEPPC phenotype respond relatively poorly to standard heart failure medical therapy and catheter ablation as the PVCs originate from all parts of the fascicular Purkinje fiber network. Class 1c sodium channel inhibitors, notably flecainide, have a remarkable positive effect on the ectopic burden and the associated cardiomyopathy. This highlights the importance of genetic screening of DCM patients to identify patients with SCN5A variants associated with MEPPC. Here we review the MEPPC phenotype, MEPPC-SCN5A associated variants, and pathogenesis as well as treatment options.
Collapse
Affiliation(s)
- Kirstine Calloe
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Helena B. D. Magnusson
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | | | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
6
|
Christiansen MK, Kjær-Sørensen K, Clavsen NC, Dittmann S, Jensen MF, Guldbrandsen HØ, Pedersen LN, Sørensen RH, Lildballe DL, Müller K, Müller P, Vogel K, Rudic B, Borggrefe M, Oxvig C, Aalkjær C, Schulze-Bahr E, Matchkov V, Bundgaard H, Jensen HK. Genetic analysis identifies the SLC4A3 anion exchanger as a major gene for short QT syndrome. Heart Rhythm 2023:S1547-5271(23)00148-0. [PMID: 36806574 DOI: 10.1016/j.hrthm.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND A variant in the SLC4A3 anion exchanger has been identified as a novel cause of short QT syndrome (SQTS), but the clinical importance of SLC4A3as a cause of SQTS or sudden cardiac death remains unknown. OBJECTIVE The purpose of this study was to investigate the prevalence of potential disease-causing variants using gene panels including SLC4A3. METHODS In this multicenter study, genetic testing was performed in 34 index patients with SQTS. The pathogenicity of novel SLC4A3variants was validated in a zebrafish embryo heart model. RESULTS Potentially disease-causing variants were identified in 9 (26%) patients and were mainly (15%) located in SLC4A3: 4 patients heterozygous for novel nonsynonymous SLC4A3 variants-p.Arg600Cys, p.Arg621Trp, p.Glu852Asp, and p.Arg952His-and 1 patient with the known p.Arg370His variant. In other SQTS genes, potentially disease-causing variants were less frequent (2× in KCNQ1, 1× in KCNJ2, and CACNA1C each). SLC4A3 variant carriers (n = 5) had a similar heart rate but shorter QT and J point to T wave peak intervals than did noncarriers (n = 29). Knockdown of slc4a3 in zebrafish resulted in shortened heart rate-corrected QT intervals (calculated using the Bazett interval) that could be rescued by overexpression of the native human SLC4A3-encoded protein (AE3), but neither by the mutated AE3 variants p.Arg600Cys, p.Arg621Trp, p.Glu852Asp nor by p.Arg952His, suggesting the pathogenicity of these variants. Dysfunction in slc4a3/AE3 was associated with alkaline cytosol and shortened action potential of cardiomyocytes. CONCLUSION In about a quarter of patients with SQTS, a potentially disease-causing variant can be identified. Nonsynonymous variants in SLC4A3 represent the most common cause of SQTS, underscoring the importance of including SLC4A3in the genetic screening of patients with SQTS or sudden cardiac death.
Collapse
Affiliation(s)
| | - Kasper Kjær-Sørensen
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus C, Denmark
| | - Natacha C Clavsen
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus C, Denmark
| | - Sven Dittmann
- Institut für Genetik von Herzerkrankungen (IfGH), Universitätsklinikum Münster, Münster, Germany
| | - Maja Fuhlendorff Jensen
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus C, Denmark; Department of Biomedicine, Aarhus University, Aarhus C, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | | | | | | | | | - Klara Müller
- Institut für Genetik von Herzerkrankungen (IfGH), Universitätsklinikum Münster, Münster, Germany
| | - Patrick Müller
- Institut für Genetik von Herzerkrankungen (IfGH), Universitätsklinikum Münster, Münster, Germany
| | - Kira Vogel
- Institut für Genetik von Herzerkrankungen (IfGH), Universitätsklinikum Münster, Münster, Germany
| | - Boris Rudic
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Claus Oxvig
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus C, Denmark
| | | | - Eric Schulze-Bahr
- Institut für Genetik von Herzerkrankungen (IfGH), Universitätsklinikum Münster, Münster, Germany; ERN Reference Center GUARD-Heart, Münster, Germany
| | | | - Henning Bundgaard
- Unit for Inherited Cardiovascular Diseases, The Heart Centre, National University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark; ERN Reference Center GUARD-Heart, Aarhus, Denmark
| |
Collapse
|
7
|
Guldfeldt MLB, Frederiksen TC, Broendberg AK, Christiansen MK, Jensen HK. Outcome after out-of-hospital cardiac arrest in patients with ischaemic and non-ischaemic heart disease: A Danish tertiary-center cohort study. IJC Heart & Vasculature 2022; 41:101059. [PMID: 35663621 PMCID: PMC9157222 DOI: 10.1016/j.ijcha.2022.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
Approximately half of patients with out-of-hospital cardiac arrest had died within five years. Most working patients returned to work within five years. No significant difference in all-cause mortality, cardiac death, and return to work. A non-significant trend toward a higher mortality was shown in patients with non-ischaemic heart disease driven by non-cardiac causes; suggesting ischaemic heart disease may be a favourable cause of cardiac arrest compared with other causes.
Background Mortality following out-of-hospital cardiac arrest (OHCA) is high, and studies on return to work show varying results. It remains uncertain whether mortality and return to work differs between patients with ischaemic heart disease (IHD) and non-ischaemic heart disease (non-IHD). Aim To investigate all-cause mortality, cardiac death, and return to work among patients admitted after OHCA with IHD and non-IHD. Methods We included 234 consecutive patients admitted to Aarhus University Hospital with OHCA, who were not declared dead in the prehospital setting or upon arrival. Patients were divided into an IHD and a non-IHD group based on history of myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery, or signs of obstructive IHD on the admission coronary angiography. Outcome in terms of all-cause mortality, cardiac death, and return to work was evaluated. Results All-cause mortality after one month, one year, and five years was 41.9%, 49.1%, and 54.3%. There was no difference in all-cause mortality or cardiac death between IHD and non-IHD patients (all-cause mortality: adjusted HR 0.78, 95% CI, 0.53–1.14; P = 0.19) and cardiac death: adjusted HR 0.93, 95% CI, 0.60–1.43; P = 0.73). Among patients working prior to OHCA the cumulative incidence of patients returning to work was 62.3% after five years with no statistically significant difference between groups. Conclusion A favourable outcome was observed in patients admitted after OHCA with a non-significant trend toward a higher mortality in non-IHD patients, possibly indicating that IHD is a favourable cause of cardiac arrest.
Collapse
|
8
|
Resdal Dyssekilde J, Frederiksen TC, Christiansen MK, Hasle Sørensen R, Pedersen LN, Loof Møller P, Christensen LS, Larsen JM, Thomsen KK, Lindhardt TB, Böttcher M, Molsted S, Havndrup O, Fischer T, Møller DS, Henriksen FL, Johansen JB, Nielsen JC, Bundgaard H, Nygaard M, Jensen HK. Diagnostic Yield of Genetic Testing in Young Patients With Atrioventricular Block of Unknown Cause. J Am Heart Assoc 2022; 11:e025643. [PMID: 35470684 PMCID: PMC9238593 DOI: 10.1161/jaha.121.025643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background The cause of atrioventricular block (AVB) remains unknown in approximately half of young patients with the diagnosis. Although variants in several genes associated with cardiac conduction diseases have been identified, the contribution of genetic variants in younger patients with AVB is unknown. Methods and Results Using the Danish Pacemaker and Implantable Cardioverter Defibrillator (ICD) Registry, we identified all patients younger than 50 years receiving a pacemaker because of AVB in Denmark in the period from January 1, 1996 to December 31, 2015. From medical records, we identified patients with unknown cause of AVB at time of pacemaker implantation. These patients were invited to a genetic screening using a panel of 102 genes associated with inherited cardiac diseases. We identified 471 living patients with AVB of unknown cause, of whom 226 (48%) accepted participation. Median age at the time of pacemaker implantation was 39 years (interquartile range, 32–45 years), and 123 (54%) were men. We found pathogenic or likely pathogenic variants in genes associated with or possibly associated with AVB in 12 patients (5%). Most variants were found in the LMNA gene (n=5). LMNA variant carriers all had a family history of either AVB and/or sudden cardiac death. Conclusions In young patients with AVB of unknown cause, we found a possible genetic cause in 1 out of 20 participating patients. Variants in the LMNA gene were most common and associated with a family history of AVB and/or sudden cardiac death, suggesting that genetic testing should be a part of the diagnostic workup in these patients to stratify risk and screen family members.
Collapse
Affiliation(s)
| | - Tanja Charlotte Frederiksen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark.,Department of Clinical Medicine Health Aarhus University Aarhus Denmark
| | | | | | | | | | | | | | | | - Tommi Bo Lindhardt
- Department of Cardiology Copenhagen University HospitalHerlev and Gentofte Hospital Hellerup Denmark
| | - Morten Böttcher
- Department of Cardiology Regional Hospital Herning Herning Denmark
| | - Stig Molsted
- Department of Clinical Research North Zealand Hospital Hillerød Denmark
| | - Ole Havndrup
- Department of Cardiology Zealand University Hospital Roskilde Denmark
| | | | | | | | | | - Jens Cosedis Nielsen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark.,Department of Clinical Medicine Health Aarhus University Aarhus Denmark
| | - Henning Bundgaard
- Department of Cardiology The Heart Center Rigshospitalet Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Denmark
| | - Mette Nygaard
- Department of Biomedicine Health Aarhus University Aarhus Denmark.,Department of Health Science and Technology Aalborg Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark.,Department of Clinical Medicine Health Aarhus University Aarhus Denmark
| |
Collapse
|
9
|
Dyssekilde JR, Christiansen MK, Johansen JB, Nielsen JC, Bundgaard H, Jensen HK. Familial risk of atrioventricular block in first-degree relatives. Heart 2022; 108:1194-1199. [PMID: 35246466 PMCID: PMC9279841 DOI: 10.1136/heartjnl-2021-320411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/28/2022] [Indexed: 12/30/2022]
Abstract
Objective Rare cases of genetically inherited atrioventricular block (AVB) have been reported; however, the heredity of AVB remains unknown. We aimed to assess the heredity of AVB. Design, setting and participants Using data from the Danish Civil Registration Registry, we established a nationwide cohort of individuals with parental links. Data were merged with information from the Danish Pacemaker and Implantable Cardioverter Defibrillator Registry, containing information on all pacemaker implantations performed in Denmark during the study period, to identify patients who received a first-time pacemaker because of AVB. Results A total of 4 648 204 individuals had parental links and a total of 26 880 consecutive patients received a first-time pacemaker due to AVB. Overall, the adjusted rate ratio (RR) of pacemaker implantation due to AVB was 2.1 (95% CI 1.8 to 2.5) if a father, mother or sibling had AVB compared with the risk in the general population. The adjusted RR was 2.2 (1.7–2.9) for offspring of mothers with AVB, 1.9 (1.5–2.4) for offspring of fathers with AVB and 3.5 (2.3–5.4) for siblings to a patient with AVB. The risk increased inversely proportionally with the age of the index case at the time of pacemaker implantation. The corresponding adjusted RRs were 15.8 (4.8–52.3) and 10.0 (3.3–30.4) if a mother or father, respectively, had a pacemaker implantation before 50 years. Conclusion and relevance First-degree relatives to a patient with AVB carry an increased risk of AVB with the risk being strongly inversely associated with the age of the index case at pacemaker implantation. These findings indicate a genetic component in the development of AVB in families with an early-onset disease.
Collapse
Affiliation(s)
| | | | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | | | - Henrik Kjaerulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark .,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
10
|
Frederiksen TC, Krogh Christiansen M, Clausen L, Kjaerulf Jensen H. Early repolarization pattern in adult females with eating disorders. Ann Noninvasive Electrocardiol 2021; 26:e12865. [PMID: 34114301 PMCID: PMC8411689 DOI: 10.1111/anec.12865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The risk of cardiovascular death is increased in patients with eating disorders (ED), but the background for this is unknown. Early repolarization pattern (ERP) on the electrocardiogram (ECG) has been associated with increased risk of sudden cardiac death. METHODS We investigated the prevalence of ERP in 233 female patients with anorexia nervosa (AN) and bulimia nervosa (BN) (age 18-35 years) compared with 123 healthy female controls. RESULTS Early repolarization pattern was present in 52 (22%) of ED patients (16 (15%) AN patients and 36 (29%) BN patients) and 17 (14%) of healthy controls. When adjusting for age, BMI, heart rate, use of selective serotonin reuptake inhibitors (SSRI), and potassium level, the odds ratio (OR) for ERP was 2.1 (95% CI 1.1-4.2, p = .03). There was an increased prevalence of inferolateral ERP in patients with ED compared with healthy controls (OR = 4.3, 95% CI 1.7-11.3, p = .003) as well as ERP with a downward/horizontal sloping ST segment (OR = 3.1, 95% CI 1.3-7.6, p = .01). Additionally, J-point elevation >0.2 mV was more prevalent in patients with ED (OR = 3.3, 95% CI 1.1-9.7, p = .03). CONCLUSION The prevalence of ERP was increased in patients with ED compared with healthy controls. This finding may provide a possible explanation for the increased cardiovascular mortality in ED patients.
Collapse
Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
| | | | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark.,Research Unit, Department of Child- and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Kjaerulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Health, Aarhus, Denmark
| |
Collapse
|
11
|
Christiansen MK, Winther S, Nissen L, Vilhjálmsson BJ, Frost L, Johansen JK, Møller PL, Schmidt SE, Westra J, Holm NR, Jensen HK, Christiansen EH, Guðbjartsson DF, Hólm H, Stefánsson K, Bøtker HE, Bøttcher M, Nyegaard M. Polygenic Risk Score-Enhanced Risk Stratification of Coronary Artery Disease in Patients With Stable Chest Pain. Circ Genom Precis Med 2021; 14:e003298. [PMID: 34032468 DOI: 10.1161/circgen.120.003298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Polygenic risk scores (PRSs) are associated with coronary artery disease (CAD), but the clinical potential of using PRSs at the single-patient level for risk stratification has yet to be established. We investigated whether adding a PRS to clinical risk factors (CRFs) improves risk stratification in patients referred to coronary computed tomography angiography on a suspicion of obstructive CAD. METHODS In this prespecified diagnostic substudy of the Dan-NICAD trial (Danish study of Non-Invasive testing in Coronary Artery Disease), we included 1617 consecutive patients with stable chest symptoms and no history of CAD referred for coronary computed tomography angiography. CRFs used for risk stratification were age, sex, symptoms, prior or active smoking, antihypertensive treatment, lipid-lowering treatment, and diabetes. In addition, patients were genotyped, and their PRSs were calculated. All patients underwent coronary computed tomography angiography. Patients with a suspected ≥50% stenosis also underwent invasive coronary angiography with fractional flow reserve. A combined end point of obstructive CAD was defined as a visual invasive coronary angiography stenosis >90%, fractional flow reserve <0.80, or a quantitative coronary analysis stenosis >50% if fractional flow reserve measurements were not feasible. RESULTS The PRS was associated with obstructive CAD independent of CRFs (adjusted odds ratio, 1.8 [95% CI, 1.5-2.2] per SD). The PRS had an area under the curve of 0.63 (0.59-0.68), which was similar to that for age and sex. Combining the PRS with CRFs led to a CRF+PRS model with area under the curve of 0.75 (0.71-0.79), which was 0.04 more than the CRF model (P=0.0029). By using pretest probability (pretest probability) cutoffs at 5% and 15%, a net reclassification improvement of 15.8% (P=3.1×10-4) was obtained, with a down-classification of risk in 24% of patients (211 of 862) in whom the pretest probability was 5% to 15% based on CRFs alone. CONCLUSIONS Adding a PRS improved risk stratification of obstructive CAD beyond CRFs, suggesting a modest clinical potential of using PRSs to guide diagnostic testing in the contemporary clinical setting. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02264717.
Collapse
Affiliation(s)
- Morten Krogh Christiansen
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark.,Department of Internal Medicine, Horsens Regional Hospital, Denmark (M.K.C.)
| | - Simon Winther
- Department of Cardiology (S.W., M.B.), Hospital Unit West, Herning, Denmark
| | - Louise Nissen
- Department of Radiology (L.N.), Hospital Unit West, Herning, Denmark
| | | | - Lars Frost
- Department of Cardiology, Silkeborg Regional Hospital, Denmark (L.F., J.K.J.)
| | - Jane Kirk Johansen
- Department of Cardiology, Silkeborg Regional Hospital, Denmark (L.F., J.K.J.)
| | - Peter Loof Møller
- Department of Biomedicine (P.L.M., M.N.), Aarhus University, Denmark
| | - Samuel Emil Schmidt
- Department of Health Science and Technology, Aalborg University, Denmark (S.E.S., M.N.)
| | - Jelmer Westra
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark
| | - Niels Ramsing Holm
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health (H.K.J., H.E.B.), Aarhus University, Denmark
| | - Evald Høj Christiansen
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark
| | | | - Hilma Hólm
- deCODE Genetics/Amgen, Inc, Reykjavik, Iceland (D.F.G., H.H., K.S.)
| | - Kári Stefánsson
- deCODE Genetics/Amgen, Inc, Reykjavik, Iceland (D.F.G., H.H., K.S.)
| | - Hans Erik Bøtker
- Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health (H.K.J., H.E.B.), Aarhus University, Denmark
| | - Morten Bøttcher
- Department of Cardiology (S.W., M.B.), Hospital Unit West, Herning, Denmark
| | - Mette Nyegaard
- Department of Clinical Genetics (M.N.), Aarhus University Hospital, Denmark.,Department of Biomedicine (P.L.M., M.N.), Aarhus University, Denmark.,Department of Health Science and Technology, Aalborg University, Denmark (S.E.S., M.N.)
| |
Collapse
|
12
|
Smedegaard SB, Riis AL, Christiansen MK, Linde JKS. Subclinical hyperthyroidism and the risk of developing cardiovascular disease - a systematic review. Dan Med J 2020; 67:A12190701. [PMID: 33215608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION It is debated whether the presence of subclinical hyperthyroidism (SH) constitutes an increased risk of cardiovascular disease. This review presents a summary of the literature examining the association between SH and atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI) and cardiovascular mortality. METHODS A systematic literature search of the PubMed database was performed. Studies were included if they were of observational design, about SH in humans, and had AF, HF, MI and/or cardiovascular mortality as outcome, were published in either Danish or English language and included euthyroid controls. RESULTS A total of 33 papers were suitable for inclusion. Thus, 13 papers on AF and five papers on HF were included for review and supported an association between SH and AF and HF, respectively. In all, 14 papers on MI and 15 papers on cardiovascular mortality were included for review; but, overall, they did not support an association between SH and MI or cardiovascular mortality. CONCLUSIONS Based on our review, current literature supports an association between SH and AF and HF, respectively; but not between SH and MI or cardiovascular mortality.
Collapse
|
13
|
Winther-Larsen A, Christiansen MK, Larsen SB, Nyegaard M, Neergaard-Petersen S, Ajjan RA, Würtz M, Grove EL, Jensen HK, Kristensen SD, Hvas AM. The ABO Locus is Associated with Increased Fibrin Network Formation in Patients with Stable Coronary Artery Disease. Thromb Haemost 2020; 120:1248-1256. [PMID: 32604426 DOI: 10.1055/s-0040-1713753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The ABO locus has been associated with increased risk of myocardial infarction (MI) in patients with coronary artery disease (CAD), but the underlying mechanisms are unknown. As altered fibrin clot structure has been demonstrated to predict MI in CAD patients, we examined the association between the ABO risk variant and fibrin clot properties, and investigated the effects of other CAD-associated risk variants. METHODS We included 773 stable CAD patients. Patients were genotyped for 45 genome-wide CAD risk variants, including rs495828 at the ABO locus. We used a genetic risk score (GRS) for CAD calculated as the weighted sum of the number of risk alleles based on all 45 variants. Fibrin clot properties were evaluated using a turbidimetric assay. We studied clot maximum absorbance, a measure of clot density and fiber thickness, together with clot lysis time, an indicator of fibrinolysis potential. RESULTS The rs495828 risk allele was present in 13.2% of patients and associated with higher clot maximum absorbance (adjusted effect size per risk allele: 1.05 [1.01 - 1.09], p = 0.01) but not with clot lysis time (p = 0.97). The rs12936587 (p = 0.04), rs4773144 (p = 0.02), and rs501120 (p = 0.04) were associated with clot lysis time; however, after Bonferroni correction, no significant associations were found between any of the remaining 44 CAD-associated variants and fibrin clot properties. The GRS was not associated with fibrin clot properties (p-values > 0.05). CONCLUSION The ABO risk allele was associated with a more compact fibrin network in stable CAD patients, which may represent a mechanism for increased MI risk in ABO risk variant carriers.
Collapse
Affiliation(s)
- Anne Winther-Larsen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Biochemistry, Viborg Regional Hospital, Viborg, Denmark
| | | | | | - Mette Nyegaard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Morten Würtz
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
14
|
Christiansen MK, Nissen L, Winther S, Møller PL, Frost L, Johansen JK, Jensen HK, Guðbjartsson D, Holm H, Stefánsson K, Bøtker HE, Bøttcher M, Nyegaard M. Genetic Risk of Coronary Artery Disease, Features of Atherosclerosis, and Coronary Plaque Burden. J Am Heart Assoc 2020; 9:e014795. [PMID: 31983321 PMCID: PMC7033858 DOI: 10.1161/jaha.119.014795] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Polygenic risk scores (PRSs) based on risk variants from genome‐wide association studies predict coronary artery disease (CAD) risk. However, it is unknown whether the PRS is associated with specific CAD characteristics. Methods and Results We consecutively included 1645 patients with suspected stable CAD undergoing coronary computed tomography angiography. A multilocus PRS was calculated as the weighted sum of CAD risk variants. Plaques were evaluated using an 18‐segment model and characterized by stenosis severity and composition (soft [0%‐19% calcified], mixed‐soft [20%‐49% calcified], mixed‐calcified [50%‐79% calcified], or calcified [≥80% calcified]). Coronary artery calcium score and segment stenosis score were used to characterize plaque burden. For each standard deviation increase in the PRS, coronary artery calcium score increased by 78% (P=4.1e‐26) and segment stenosis score increased by 16% (P=2.4e‐29) in the fully adjusted model. The PRS was associated with a higher prevalence of obstructive plaques (odds ratio [OR]: 1.78, P=5.6e‐16), calcified (OR: 1.69, P=6.5e‐17), mixed‐calcified (OR: 1.67, P=7.3e‐9), mixed‐soft (OR: 1.45, P=1.6e‐6), and soft plaques (OR: 1.49, P=2.5e‐6), and a higher prevalence of plaque in each coronary vessel (all P<1.0e‐4). However, when analyzing data on a plaque level (3007 segments with plaque in 849 patients) the PRS was not associated with stenosis severity, plaque composition, or localization (all P>0.05). Conclusions Our results suggest that polygenic risk based on large genome‐wide association studies increases CAD risk through an increased burden of coronary atherosclerosis rather than promoting specific plaque features. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02264717.
Collapse
Affiliation(s)
- Morten Krogh Christiansen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark.,Department of Internal Medicine Horsens Regional Hospital Horsens Denmark
| | - Louise Nissen
- Department of Cardiology Hospital Unit West Herning Denmark
| | - Simon Winther
- Department of Cardiology Aarhus University Hospital Aarhus Denmark.,Department of Cardiology Hospital Unit West Herning Denmark
| | | | - Lars Frost
- Department of Cardiology Silkeborg Regional Hospital Silkeborg Denmark
| | | | | | | | - Hilma Holm
- deCODE Genetics/Amgen, Inc. Reykjavik Iceland
| | | | - Hans Erik Bøtker
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | | | - Mette Nyegaard
- Department of Biomedicine Aarhus University Aarhus Denmark
| |
Collapse
|
15
|
Baturova MA, Haugaa KH, Jensen HK, Svensson A, Gilljam T, Bundgaard H, Madsen T, Hansen J, Chivulescu M, Christiansen MK, Carlson J, Edvardsen T, Svendsen JH, Platonov PG. Atrial fibrillation as a clinical characteristic of arrhythmogenic right ventricular cardiomyopathy: Experience from the Nordic ARVC Registry. Int J Cardiol 2020; 298:39-43. [DOI: 10.1016/j.ijcard.2019.07.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/15/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
|
16
|
Christiansen MK, Nissen L, Winther S, Frost L, Johansen JK, Jensen HK, Botker HE, Bottcher M, Nyegaard M. P870A genetic risk score is associated with increased coronary plaque burden but not specific plaque features: a coronary computed tomography study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Genetic risk scores (GRSs) based on risk variants identified from genome-wide association studies (GWASs) predict coronary artery disease (CAD) risk. However, it is unknown whether the GRS is associated with coronary plaque burden or specific high-risk plaque features responsible for the clinical disease onset.
Purpose
To investigate if a GRS is associated with coronary plaque burden and specific plaque characteristics, in patients with suspected stable CAD referred for coronary computed tomography angiography (CTA).
Methods
We consecutively included and genotyped 1645 patients undergoing coronary CTA. Using LDPred, a previously validated GRS was calculated as the weighted sum of the number of CAD risk variants identified from the CARDIoGRAMplusC4D GWAS meta-analysis. Plaques were evaluated using an 18-segment model and characterized by stenosis severity (0%, 1–49%, 50–69%, 70–100%) and composition (calcified (>80% calcified), mixed-calcified (50–80% calcified), mixed-soft (20–50% calcified), or soft (<20% calcified)). The segment stenosis score and the coronary artery calcium score (CACS) were used as measures of plaque burden. Multivariate regression models were used to assess the effect per standard deviation (SD) of the GRS with adjustment for age, sex, hypertension, hypercholesterolemia, BMI, chest pain symptoms, and active smoking.
Results
For each SD increase in the GRS, the segment stenosis score increased with 49% (p=8.6e-27) and CACS increased with 110% (p=2.3e-24). The GRS was associated with a higher risk of plaque stenosis >50% (OR: 1.74, p=3.2e-15), calcified (OR: 1.65, p=3.0e-16), mixed-calcified (OR: 1.64, p=1.5e-8), mixed-soft (OR: 1.44, p=1.6e-6), and soft plaques (OR: 1.40, p=3.0e-6), and all coronary vessels were more often affected with plaques (all p-values <1.0e-4).
When analyzing the plaque characteristics (3007 plaques in 849 patients), the GRS was associated with stenosis severity (OR per severity category: 1.15 (p=0.005), but not with extent of calcification, proximal location, or presence in any of the major coronary vessels (all p-values >0.05).
GRS and Plaque burden
Conclusion
The GRS was strongly associated with the extent and severity of CAD at coronary CTA, but not any specific plaque characteristics per se. The results may suggest that polygenic risk based on large CAD-GWAS increases CAD risk through increased coronary plaque burden rather than specific plaque features.
Collapse
Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Nissen
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - S Winther
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - J K Johansen
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Bottcher
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - M Nyegaard
- Aarhus University, Department of Biomedicine, Aarhus, Denmark
| |
Collapse
|
17
|
Christiansen MK, Winther S, Nissen L, Johansen JK, Westra JS, Holm NR, Frost L, Botker HE, Christiansen EH, Bottcher M, Nyegaard M. P2713A genetic risk score improves discrimination of hemodynamically obstructive coronary artery disease (CAD) beyond the CAD Consortium scores in patients at low-to-intermediate risk of CAD. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Genetic risk scores (GRSs), based on variants identified in genome-wide association studies (GWAS), have been shown to predict risk of coronary artery disease (CAD). However, the clinical potential remains unknown.
Purpose
To investigate whether a GRS improves discrimination of hemodynamically obstructive CAD beyond the CAD Consortium scores and coronary artery calcium score (CACS) in patients referred for coronary computed tomography angiography (CTA).
Methods
We consecutively included and genotyped 1645 patients undergoing CACS scoring and coronary CTA on a suspicion of CAD. Using LDPred, a recently validated GRS was calculated as the weighted sum of the number of CAD risk variants identified from the CARDIoGRAMplusC4D GWAS meta-analysis. Patients with a ≥50% stenosis on CTA further underwent invasive coronary angiography (ICA) with fractional flow reserve (FFR). Hemodynamically obstructive CAD was defined as a visual ICA stenosis >90%, FFR <0.80, or a quantitative coronary analysis stenosis >50% if FFR was not feasible. Discrimination was evaluated by receiver-operating characteristics.
Results
Median age was 57 (interquartile range 50–64) years and 799 (49%) were males. Hemodynamically obstructive CAD was present in 14 (4%) with a low GRS (<20th percentile), 91 (9%) with an intermediate GRS (20th–80th percentile) and 53 (16%) with a high GRS (>80th percentile) (p<0.0001). Adding the GRS improved the area under the receiver-operating curve (AUC) on top of the CAD Consortium basic score (from 0.67 to 0.72, p=0.0052), and the CAD Consortium clinical score (0.70 to 0.74, p=0.0084), but not on top of the CAD Consortium clinical score + CACS (0.85 to 0.86, p=0.30). Improvement in discrimination on top of the CAD Consortium scores was predominantly driven by females ≤57 years (CAD Consortium basic score ± GRS: 0.60 to 0.78, p=0.0004; CAD Consortium clinical score ± GRS: 0.63 to 0.78, p=0.0007). The GRS did not improve discrimination in any subgroups including CACS (CAD Consortium clinical score + CACS ± GRS: all p-values >0.05).
Conclusion
A GRS improves discrimination of hemodynamically obstructive CAD beyond CAD consortium scores, particularly in young women. However, the additive discriminative value is attenuated in models including CACS.
Collapse
Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S Winther
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Nissen
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - J K Johansen
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - J S Westra
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - N R Holm
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - H E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - E H Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Bottcher
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - M Nyegaard
- Aarhus University, Department of Biomedicine, Aarhus, Denmark
| |
Collapse
|
18
|
Platonov PG, Carlson J, Castrini I, Svensson A, Christiansen MK, Gilljam T, Madsen T, Hansen J, Astrom MA, Haagua K, Jensen HK, Edvardsen T, Svendsen JH. P2247Pregnancies and childbirth in women with arrhythmogenic right ventricular cardiomyopathy are associated with low risk of ventricular arrhythmias. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a risk of ventricular arrhythmias (VA) and sudden cardiac death (SCD). Even though female patients with ARVC are considered to be at lower risk of VA, the impact of pregnancy and child birth on the arrhythmic risk and development of arrhythmic substrate in the context of ARVC remains insufficiently studied.
Objective
To assess the risk of VA in relation to childbirth in women with ARVC and the impact of multiple pregnancies on progression of arrhythmic manifestations of the disease.
Methods
The study included 186 females with definite ARVC (n=107, 70 probands) or unaffected mutation-carriers (n=79) with median age at the end of follow up of 48 (IQR 34–60) years. Seventeen women had 1, 59 had 2 and 29 had ≥3 child births by the age of 40 years. VA was defined as ventricular tachycardia, appropriate ICD therapy, aborted cardiac arrest or SCD. Proportions of patients who experienced VA by the age of 40 years were compared between nulliparous women (n=81) and those with reported child births (n=105). VA-free survival after accomplished pregnancies was assessed for women ≥40 years of age (n=119). Cumulative probability of VA for each pregnancy (n=230) was assessed from conception through 2 years after child birth and compared between those that occurred before ARVC diagnosis (Pre-Ds, n=164), after it (Post-Ds, n=11) and in unaffected mutation carriers (No-Ds, n=55).
Results
The nulliparous women had lower age at ARVC diagnosis (37 vs 44, p=0.023) and more often had VA before the age of 40 (31% vs 13%, p=0.003) while the number of child births was not related to the prevalence of VA (18% among women with 1 childbirth, 12% in those with 2 and 14% in those with 3 or more, ns). Three women suffered SCD before the age of 40. VA-free survival after 40 years did not differ between nulliparous and those who gave birth (Figure A). Only four pregnancy-related events were documented (Figure B): 1 in the Post-Ds group and three in the Pre-Ds group. No pregnancy-related events were reported in the unaffected mutation carriers.
Conclusion
In this Scandinavian cohort of women with ARVC we observed no indication of an increased VA risk either associated with pregnancies or during long-term follow up after the last child birth.
Collapse
Affiliation(s)
| | - J Carlson
- Lund University, Department of Cardiology, Clinical Sciences, Lund, Sweden
| | | | | | | | - T Gilljam
- Sahlgrenska Academy, Gothenburg, Sweden
| | - T Madsen
- Aalborg University Hospital, Aalborg, Denmark
| | - J Hansen
- Gentofte University Hospital, Gentofte, Denmark
| | | | - K Haagua
- University of Oslo, Oslo, Norway
| | - H K Jensen
- Aarhus University Hospital, Aarhus, Denmark
| | | | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
19
|
Christiansen MK, Haugaa K, Svensson A, Gilljam T, Madsen T, Hansen J, Holst A, Bundgaard H, Edvardsen T, Svendsen JH, Platonov P, Jensen HK. P992Incidence, predictors, and success of ventricular tachycardia catheter ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC): A long-term cohort study from the Nordic ARVC registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Catheter ablation may reduce ventricular tachycardia (VT) burden in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. However, little is known about factors predicting need for ablation and various outcomes have been reported.
Purpose
We sought to investigate predictors and use of VT ablation and to evaluate the post-procedural outcome in ARVC patients.
Methods
We studied 435 patients from the Nordic ARVC registry including 220 probands with definite ARVC according to the 2010 task force criteria and 215 mutation-carrying relatives identified through cascade screening. Patients were followed until first-time VT ablation, death, heart transplantation, or January 1st 2018. Additionally, patients undergoing VT ablation were further followed from the time of ablation for recurrent ventricular arrhythmias.
Results
Cumulative use of VT ablation was 4% (95% CI 3%-6%) and 11% (95% CI 8%-15%) after 1 and 10 years. All procedures were performed in probands in whom the cumulative use was 8% (95% CI 5%-12%) and 20% (95% CI 15%-26%). In adjusted analyses restricted to probands, only young age predicted need for ablation. In patients undergoing ablation, risk of recurrent arrhythmias was 59% (95% CI 44%-71%) and 74% (95% CI 59%-84%) 1 and 5 years after the procedure. Despite high recurrence rates, the burden of ventricular arrhythmias was reduced after ablation (p=0.0042). Young age, use of several antiarrhythmic drugs and inducibility to VT immediately after ablation were associated with an unfavorable outcome.
Conclusions
Twenty percent of ARVC probands developed a clinical indication for VT ablation within 10 years after diagnosis whereas mutation-carrying relatives were without such need. Although the burden of ventricular arrhythmias decreased after ablation, risk of recurrence was substantial.
Collapse
Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K Haugaa
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - A Svensson
- Linkoping University, Department of Cardiology, Linkoping, Sweden
| | - T Gilljam
- Sahlgrenska Academy, Department of Cardiology, Gothenburg, Sweden
| | - T Madsen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J Hansen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - A Holst
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Edvardsen
- Oslo University Hospital, Department of cardiology, Oslo, Norway
| | - J H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P Platonov
- Lund University, Department of Cardiology, Lund, Sweden
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| |
Collapse
|
20
|
Frederiksen TC, Krogh Christiansen M, Charmoth Østergaard P, Hove Thomsen P, Graff C, Clausen L, Kjærulf Jensen H. QTc Interval and Risk of Cardiac Events in Adults With Anorexia Nervosa: A Long-Term Follow-Up Study. Circ Arrhythm Electrophysiol 2019; 11:e005995. [PMID: 30030265 DOI: 10.1161/circep.117.005995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/17/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The literature contains several cases of anorexia nervosa (AN) patients with prolonged QTc interval. However, the risk of prolonged QTc interval is controversial and the risk of cardiac events in AN patients has yet to be investigated. METHODS We estimated the difference in mean QTc interval and relative risk of borderline prolonged QTc (>440 ms) and prolonged QTc (>460 ms) between 430 adult women AN patients and 123 healthy controls using 3 correction formulas. In a follow-up study, we estimated the risk of a primary end point (a composite of ventricular tachycardia, aborted cardiac arrest, and cardiac arrest) in AN patients compared with a population-based cohort derived from the Danish Civil Register. RESULTS Mean QTc for AN patients was 408 ms (Hodges), 402 ms (Fridericia), and 399 ms (Bazett). Hodges' found a slightly increased mean QTc (6.8 ms, 95% confidence interval, 1.6-12.0; P=0.01) and percentage with QTc >440 ms in AN patients (relative risk, 3.7, 95% confidence interval, 1.4-10.3; P=0.01), not observed with Fridericia's and Bazett's formulas. There was no difference in the risk of QTc >460 ms between AN patients and healthy controls. During a median follow-up of 10.1 years, AN patients had an increased risk of the primary end point compared with the population-based cohort (hazard ratio, 10.4, 95% confidence interval, 2.6-41.6; P=0.001). However, absolute numbers were small with cumulative incidences of 0.5% and 0.07%, respectively, after 10 years. No events occurred in any AN patient with QTc >440 ms. All-cause mortality was also significantly increased in AN patients compared with the population-based cohort (hazard ratio, 11.2, 95% confidence interval, 5.1-24.5; P<0.001). CONCLUSIONS Overall, there was no difference in mean QTc interval or risk of prolonged QTc between AN patients and healthy controls. However, AN patients had a notably increased all-cause mortality, as well as an increased risk of cardiac events, which was not related to the baseline QTc interval.
Collapse
Affiliation(s)
| | - Morten Krogh Christiansen
- Department of Cardiology (T.C.F., M.K.C., H.K.J.).,and Centre for Child and Adolescent Psychiatry (P.C.O., P.H.T., L.C.)
| | - Pernille Charmoth Østergaard
- and Centre for Child and Adolescent Psychiatry (P.C.O., P.H.T., L.C.).,Department of Public Health Medicine and Rehabilitation, Western Hospital Unit, Herning, Denmark (P.C.O.)
| | - Per Hove Thomsen
- and Centre for Child and Adolescent Psychiatry (P.C.O., P.H.T., L.C.)
| | - Claus Graff
- Aarhus University, Denmark. Department of Health Science and Technology, Aalborg University, Denmark (C.G.)
| | - Loa Clausen
- and Centre for Child and Adolescent Psychiatry (P.C.O., P.H.T., L.C.).,Department of Public Health (L.C.).,Department of Psychology and Behavioral Sciences (L.C.)
| | - Henrik Kjærulf Jensen
- Department of Cardiology (T.C.F., M.K.C., H.K.J.).,and Department of Clinical Medicine (H.K.J.)
| |
Collapse
|
21
|
Christiansen MK, Larsen SB, Nyegaard M, Neergaard-Petersen S, Würtz M, Grove EL, Hvas AM, Jensen HK, Kristensen SD. The ABO locus is associated with increased platelet aggregation in patients with stable coronary artery disease. Int J Cardiol 2019; 286:152-158. [PMID: 30837090 DOI: 10.1016/j.ijcard.2019.01.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/13/2019] [Accepted: 01/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Genome-wide association studies of patients with coronary artery disease (CAD) suggest that several risk loci increase the risk of CAD and myocardial infarction (MI) equally. In contrast, the ABO locus is stronger associated with MI than with CAD, but the underlying mechanisms are unknown. PURPOSE To investigate the association between the ABO risk variant and platelet activation and aggregation. Moreover, to explore the effects of other CAD-associated risk variants. METHODS We included 879 stable CAD patients receiving low-dose aspirin. All patients were genotyped for 45 genome-wide significant CAD risk variants, including rs495828 at the ABO locus. A genetic risk score (GRS) was calculated to assess the combined risk of all genetic variants. Serum soluble P-selectin (sP-selectin) and thromboxane B2 were used as measures of platelet activation, and platelet aggregation was assessed by multiple electrode aggregometry (MEA) using arachidonic acid and collagen as agonists and VerifyNow. RESULTS The rs495828 CAD risk allele was associated with higher MEA platelet aggregation; arachidonic acid: 14.9% (6.7-23.7%, p = 0.0002) higher AUC (Area Under aggregation Curve) per risk allele, and collagen: 13.1% (5.8%-20.9%, p = 0.0003). Conversely, sP-selectin levels were 7.5% (3.1%-11.7%, p = 0.001) lower per risk allele. Rs495828 genotypes were not associated with aggregation assessed by VerifyNow (p = 0.30) or S-thromboxane B2 levels (p = 0.98). None of the remaining variants or the GRS were associated with platelet activation or aggregation. CONCLUSIONS The ABO risk allele was associated with increased platelet aggregation as assessed by MEA. This finding may contribute to explain the increased MI risk in ABO risk variant carriers.
Collapse
Affiliation(s)
| | | | - Mette Nyegaard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Søs Neergaard-Petersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Würtz
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
22
|
Christiansen MK, Larsen SB, Nyegaard M, Neergaard-Petersen S, Wurtz M, Grove EL, Hvas AM, Jensen HK, Kristensen SD. P804The AB0 gene locus is associated with increased platelet aggregation in stable coronary artery disease patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S B Larsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Nyegaard
- Aarhus University, Department of Biomedicine, Aarhus, Denmark
| | | | - M Wurtz
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - E L Grove
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - A.-M Hvas
- Aarhus University Hospital, Department of Clinical Biochemistry, Aarhus, Denmark
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| |
Collapse
|
23
|
Dideriksen JTR, Christiansen MK, Johansen JB, Bundgaard H, Nielsen JC, Jensen HK. 111Aetiologies of atrioventricular block in patients younger than 50 years at time of first pacemaker implantation -A nationwide Danish study. Europace 2018. [DOI: 10.1093/europace/euy015.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J T R Dideriksen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J B Johansen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| |
Collapse
|
24
|
Broendberg AK, Christiansen MK, Nielsen JC, Pedersen LN, Jensen HK. Targeted next generation sequencing in a young population with suspected inherited malignant cardiac arrhythmias. Eur J Hum Genet 2018; 26:303-313. [PMID: 29343803 PMCID: PMC5838968 DOI: 10.1038/s41431-017-0060-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/19/2017] [Accepted: 11/18/2017] [Indexed: 12/19/2022] Open
Abstract
Aborted sudden cardiac death in the young often is due to inherited heart disease. However, the clinical phenotype in these patients is not always evident. The aim of this study was to identify pathogenic molecular genetic variants in a population with suspected inherited cardiac arrhythmias. Eligible patients were admitted to Aarhus University Hospital, Denmark during the period 1999–2013 with arrhythmias assumed caused by a hereditary heart disease, and in whom no genotype had been established. We used the Danish national pacemaker and ICD registry to identify this cohort. One third (24/80) of the study population had first-line genetic testing with a targeted next-generation sequencing (NGS) panel, and two-third (56/80) of the study population had second-line genetic testing with NGS where prior Sanger sequencing did not reveal a causative variant. Variants were assessed according to the American College of Medical Genetics and Genomics (ACMG) guidelines. We included 80 patients. Median age (IQR) was 38 (28–43) years, 54 (68%) were males. First-line genetic testing identified a genetic variant in 33% (8/24) of the cases and second-line genetic testing revealed a variant in 20% (11/56) of the cases. Eleven variants were considered pathogenic, three likely pathogenic and 10 were variants of unknown significance (VUS). Seventeen variants were very rare with a minor allele frequency (MAF) ≤0.02% in all population databases used in the study. Molecular genetic testing of patients with suspected inherited cardiac arrhythmias with NGS identifies a molecular-genetic cause in a significant proportion of patients.
Collapse
Affiliation(s)
- Anders Krogh Broendberg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. .,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
| | - Morten Krogh Christiansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | | | - Henrik Kjaerulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
25
|
Christiansen MK. Early-onset Coronary Artery Disease Clinical and Hereditary Aspects. Dan Med J 2017; 64:B5406. [PMID: 28874246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A family history of coronary artery disease (CAD) is an important risk factor for adverse coronary events, in particular if the disease has an early onset. The risk of CAD is influenced by genetic and environmental factors with a greater genetic contribution earlier in life. Through recent years the advances in genetic techniques has led to an increased understanding of the genetic background of CAD, which may potentially be translated into clinical use. The studies of this thesis aimed to investigate the burden of conventional risk factors and control in early-onset CAD (i.e. < 40 years), and to characterize and quantify subclinical atherosclerosis in their relatives. Furthermore, the aim was to explore the impact of common genetic risk variants on the age of onset, familial clustering and disease severity. In study I, 143 patients with early-onset CAD were recruited from the Western Denmark Heart Registry and risk factor control was evaluated. The study revealed that risk factors are common in early-onset CAD and that a large room for risk factor improvement remains. In study II, we used coronary computed tomography angiography to compare the coronary plaque burden and characteristics between 88 first-degree relatives of patients with early-onset CAD and 88 controls with no familial predisposition. Relatives had a significantly increased coronary plaque burden, which displayed characteristics associated with myocardial ischemia and adverse coronary events. In study III, 134 patients with early-onset CAD, a cohort of 446 late-onset CAD patients (onset > 55/65 years in males/females), and 89 healthy controls were genotyped for 45 common genetic risk variants and a genetic risk score was calculated as a measure of the polygenetic burden. Early-onset CAD patients had a modestly increased genetic burden compared with late-onset CAD patients and healthy controls; however, the burden did not associate with familial clustering of CAD. Additionally, familial clustering seemed to be stronger associated with CAD disease severity than the polygenetic burden. Our findings emphasize the hereditary component of coronary atherosclerosis and underpin the need for risk factor optimization in early-onset CAD. Furthermore, our data support that yet identified common risk variants may have little clinical relevance in the clinical setting of early-onset CAD.
Collapse
|
26
|
Christiansen MK, Larsen SB, Nyegaard M, Neergaard-Petersen S, Ajjan R, Würtz M, Grove EL, Hvas AM, Jensen HK, Kristensen SD. Coronary artery disease-associated genetic variants and biomarkers of inflammation. PLoS One 2017; 12:e0180365. [PMID: 28686695 PMCID: PMC5501546 DOI: 10.1371/journal.pone.0180365] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/14/2017] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Genetic constitution and inflammation both contribute to development of coronary artery disease (CAD). Several CAD-associated single-nucleotide polymorphisms (SNPs) have recently been identified, but their functions are largely unknown. We investigated the associations between CAD-associated SNPs and five CAD-related inflammatory biomarkers. METHODS We genotyped 45 CAD-associated SNPs in 701 stable CAD patients in whom levels of high-sensitivity C-reactive protein (hsRCP), interleukin-6, calprotectin, fibrinogen and complement component 3 levels had previously been measured. A genetic risk score was calculated to assess the combined risk associated with all the genetic variants. A multiple linear regression model was used to assess associations between the genetic risk score, single SNPs, and the five inflammatory biomarkers. RESULTS The minor allele (G) (CAD risk allele) of rs2075650 (TOMM40/APOE) was associated with lower levels of high-sensitivity C-reactive protein (effect per risk allele: -0.37 mg/l [95%CI -0.56 to -0.18 mg/l]). The inflammatory markers tested showed no association with the remaining 44 SNPs or with the genetic risk score. CONCLUSIONS In stable CAD patients, the risk allele of a common CAD-associated marker at the TOMM40/APOE locus was associated with lower hsCRP levels. No other genetic variants or the combined effect of all variants were associated with the five inflammatory biomarkers.
Collapse
Affiliation(s)
- Morten Krogh Christiansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- * E-mail:
| | - Sanne Bøjet Larsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Nyegaard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Ramzi Ajjan
- Leeds Institute for Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom
| | - Morten Würtz
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne-Mette Hvas
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
27
|
Kjærgaard KA, Christiansen MK, Schmidt M, Olsen MS, Jensen HK. Long-Term Cardiovascular Risk in Heterozygous Familial Hypercholesterolemia Relatives Identified by Cascade Screening. J Am Heart Assoc 2017; 6:JAHA.116.005435. [PMID: 28652386 PMCID: PMC5669167 DOI: 10.1161/jaha.116.005435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Heterozygous familial hypercholesterolemia increases the risk of adverse cardiovascular events. Whether affected relatives of probands are at increased risk remains unknown. We aimed to evaluate the long‐term cardiovascular risk in heterozygous familial hypercholesterolemia relatives with a low‐density lipoprotein receptor (LDLR) mutation who were all recommended statin therapy. Methods and Results Participants were identified by cascade screening at Aarhus University Hospital during 1992–1994. A comparison cohort from the Danish general population was matched 10:1 to relatives by birth year and sex. Using medical registries, participants were followed until the event of interest, migration, death, or end of follow‐up on December 31, 2014. The primary end point was all‐cause mortality and major adverse cardiovascular events comprising myocardial infarction, ischemic stroke, transient ischemic attack, peripheral artery disease, and coronary revascularization. We included 220 relatives. Median age was 37 years (interquartile range: 27–52 years) of which 118 (54%) had an LDLR mutation. By 2004, when prescription data became available, 89% of mutation‐carrying participants were taking statins during their follow‐up period. Despite frequent use of lipid‐lowering medication, the adjusted hazard ratio of the primary end point was 1.65 (95% confidence interval, 1.17–2.33) in mutation‐carrying relatives compared with the general population cohort. The risk in non–mutation‐carrying relatives was not different from that of the general population cohort (adjusted hazard ratio: 0.85; 95% confidence interval, 0.56–1.29). Comparing mutation‐carrying relatives with non–mutation‐carrying relatives, the adjusted hazard ratio was 1.94 (95% confidence interval, 1.14–3.31). Results were driven by nonfatal events. Conclusion Heterozygous familial hypercholesterolemia relatives with an LDLR mutation had an increased long‐term risk of adverse cardiovascular events.
Collapse
Affiliation(s)
- Kasper Aalbæk Kjærgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Morten Smærup Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | | |
Collapse
|
28
|
Christiansen MK, Nyegaard M, Larsen SB, Grove EL, Würtz M, Neergaard-Petersen S, Hvas AM, Jensen HK, Kristensen SD. A genetic risk score predicts cardiovascular events in patients with stable coronary artery disease. Int J Cardiol 2017; 241:411-416. [PMID: 28442232 DOI: 10.1016/j.ijcard.2017.04.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Genetic risk scores (GRSs) may predict cardiovascular risk in community-based populations. However, studies investigating the association with recurrent cardiovascular events in patients with established coronary artery disease (CAD) are conflicting. METHODS We genotyped 879 patients with high-risk stable CAD and created a GRS based on 45 single nucleotide polymorphisms previously reported to be associated with CAD in genome-wide association studies. Patients were categorised into high or low GRS according to the median GRS and followed for recurrent cardiovascular events using national Danish registries. The primary endpoint was a composite of myocardial infarction, coronary revascularisation, and cardiovascular death. RESULTS Median (interquartile range) follow-up time was 2.8 (2.4-3.8)years. The cumulative incidence proportions of the primary endpoint at 1 and 3years were 6.4% and 11.5% in high-GRS patients vs. 2.5% and 7.3% in low-GRS patients. The corresponding relative risks were 2.56 (95% confidence interval (CI) 1.29-5.07), and 1.57 (95% CI 1.02-2.44). The adjusted hazard ratio (HR) of the primary endpoint was 1.50 (95% CI 1.00-2.25). The most pronounced effect of a high GRS was observed on coronary revascularisations (adjusted HR 2.10 [95% CI 1.08-4.07]). Risks of cardiovascular death (adjusted HR 1.07 [95% CI 0.46-2.48]) and all-cause death (adjusted HR 1.15 [95% CI 0.65-2.03]) were unaffected. CONCLUSIONS A GRS predicts recurrent cardiovascular events in high-risk stable CAD patients. The observed effect was mainly driven by coronary revascularisations.
Collapse
Affiliation(s)
- Morten Krogh Christiansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Mette Nyegaard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Würtz
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
29
|
Broendberg AK, Christiansen MK, Pedersen LN, Thorsen K, Jensen HK. 216-58: Next-generation sequencing increases the diagnostic yield in aborted sudden cardiac death caused by non-ischemic hereditary heart disease. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
30
|
Christiansen MK, Jensen JM, Brøndberg AK, Bøtker HE, Jensen HK. Cardiovascular risk factor control is insufficient in young patients with coronary artery disease. Vasc Health Risk Manag 2016; 12:219-27. [PMID: 27307744 PMCID: PMC4888858 DOI: 10.2147/vhrm.s106436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Control of cardiovascular risk factor is important in secondary prevention of coronary artery disease (CAD) but it is unknown whether treatment targets are achieved in young patients. We aimed to examine the prevalence and control of risk factors in this subset of patients. Methods We performed a cross-sectional, single-center study on patients with documented CAD before age 40. All patients treated between 2002 and 2014 were invited to participate at least 6 months after the last coronary intervention. We included 143 patients and recorded the family history of cardiovascular disease, physical activity level, smoking status, body mass index, waist circumference, blood pressure, cholesterol levels, metabolic status, and current medical therapy. Risk factor control and treatment targets were evaluated according to the shared guidelines from the European Society of Cardiology. Results The most common insufficiently controlled risk factors were overweight (113 [79.0%]), low-density lipoprotein cholesterol above target (77 [57.9%]), low physical activity level (78 [54.6%]), hypertriglyceridemia (67 [46.9%]), and current smoking (53 [37.1%]). Almost one-half of the patients fulfilled the criteria of metabolic syndrome. The median (interquartile range) number of uncontrolled modifiable risk factors was 2 (2;4) and only seven (4.9%) patients fulfilled all modifiable health measure targets. Conclusion Among the youngest patients with CAD, there remains a potential to improve the cardiovascular risk profile.
Collapse
Affiliation(s)
| | | | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | |
Collapse
|
31
|
Christiansen MK, Jensen HK. [Inhibition of the protein PCSK9 is a promising target in the prevention of cardiovascular disease]. Ugeskr Laeger 2015; 177:V11140582. [PMID: 25786699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recent research in genetics has revealed that PCSK9 - which codes for proprotein convertase subtilisin/kexin type 9 (PCSK9) - plays a major role in cholesterol regulatory pathways. Normal genetic variations in PCSK9 have a great impact on low-density lipoprotein cholesterol levels and hence the risk of cardio-vascular disease. This has led to huge efforts in inhibiting PCSK9. Recent clinical phase II trials with monoclonal antibodies against PCSK9 have shown great results for lowering low-density lipoprotein cholesterol levels making the inhibition of PCSK9 a promising target in the prevention of cardiovascular disease.
Collapse
|
32
|
Hjorth Madsen E, Christiansen MK, Schmidt EB, Poulsen TS, Kristensen SR. Effect of exercise on platelet activation during aspirin or clopidogrel intake in healthy men. Platelets 2009; 20:177-82. [PMID: 19437335 DOI: 10.1080/09537100902795484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sudden strenuous exercise increases the risk of ischemic cardiac events in patients with coronary artery disease. The exact mechanism behind this observation is unknown, but platelet activation induced by exercise may be of importance. We hypothesized that brief strenuous exercise would activate platelets in healthy men, assessed by the Platelet Function Analyzer 100 and light transmittance aggregometry. Nearly all participants exhibited increased platelet reactivity after exercise measured by the Platelet Function Analyzer 100, whereas only minor changes were detected by light transmittance aggregometry. A significant increase in plasma von Willebrand Factor was also found in response to exercise. In conclusion, platelet activation occurs during exercise in healthy individuals. This activation is not prevented by use of aspirin or clopidogrel, and may partly be explained by an increase in plasma von Willebrand Factor.
Collapse
Affiliation(s)
- Esben Hjorth Madsen
- Department of Clinical Biochemistry, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
| | | | | | | | | |
Collapse
|