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Murphy BM, Le Grande MR, Rogerson MC, Hesselson S, Iismaa SE, Graham RM, Jackson AC. Prevalence and correlates of anxiety and depressive symptoms after Spontaneous Coronary Artery Dissection (SCAD): a cross-sectional study. Eur J Cardiovasc Nurs 2024:zvae071. [PMID: 38709492 DOI: 10.1093/eurjcn/zvae071] [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: 02/01/2024] [Revised: 04/03/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is recognised as a particularly stressful cause of heart attack. However few studies have documented the prevalence of post-SCAD anxiety and depressive symptoms, or identified patients most at risk. This study documents the prevalence and correlates of post-SCAD anxiety and depressive symptoms. METHOD AND RESULTS 310 (95% women) SCAD survivors were recruited by the Victor Chang Cardiac Research Institute from a database of 433 SCAD survivors. Participants completed an online questionnaire to gather demographic, medical and psychosocial information, including the Generalised Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Bivariate and multivariate analyses were undertaken to identify the significant demographic, psychosocial and medical correlates of post-SCAD anxiety and depressive symptoms. Time between SCAD and questionnaire completion varied from 2 months to 18 years (mean = 5.5 years; SD = 3.5 years). Rates of anxiety and depressive symptoms were 20.7% (GAD-7 ≥ 10) and 20.9% (PHQ-9 ≥ 10) respectively, and did not vary by time since event. In bivariate analyses, correlates (p < .05) of anxiety and depressive symptoms were absence of a close confidante, financial strain, mental health diagnosis pre-SCAD, comorbid obesity, not being in paid employment (anxiety only), younger age (depression only), and not knowing another SCAD survivor (depression only). Variables retained in multivariate models were absence of a close confidante, financial strain, not being in paid employment, mental health diagnosis pre-SCAD (depression only), and younger age (depression only). CONCLUSION This study demonstrated that over one in four SCAD survivors experience either anxiety or depressive symptoms after SCAD, and identified those who may need additional support in their psychological recovery.
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Affiliation(s)
- Barbara M Murphy
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael R Le Grande
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Siiri E Iismaa
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Robert M Graham
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre on Behavioral Health, University of Hong Kong, Pokfulam, Hong Kong
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Tarr I, Hesselson S, Troup M, Young P, Thompson JL, McGrath-Cadell L, Fatkin D, Dunwoodie SL, Muller DWM, Iismaa SE, Kovacic JC, Graham RM, Giannoulatou E. Polygenic Risk in Families With Spontaneous Coronary Artery Dissection. JAMA Cardiol 2024; 9:254-261. [PMID: 38265806 PMCID: PMC10809133 DOI: 10.1001/jamacardio.2023.5194] [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] [Received: 05/09/2023] [Accepted: 11/06/2023] [Indexed: 01/25/2024]
Abstract
Importance Spontaneous coronary artery dissection (SCAD) is a poorly understood cause of acute coronary syndrome that predominantly affects women. Evidence to date suggests a complex genetic architecture, while a family history is reported for a minority of cases. Objective To determine the contribution of rare and common genetic variants to SCAD risk in familial cases, the latter via the comparison of a polygenic risk score (PRS) with those with sporadic SCAD and healthy controls. Design, Setting, and Participants This genetic association study analyzed families with SCAD, individuals with sporadic SCAD, and healthy controls. Genotyping was undertaken for all participants. Participants were recruited between 2017 and 2021. A PRS for SCAD was calculated for all participants. The presence of rare variants in genes associated with connective tissue disorders (CTD) was also assessed. Individuals with SCAD were recruited via social media or from a single medical center. A previously published control database of older healthy individuals was used. Data were analyzed from January 2022 to October 2023. Exposures PRS for SCAD comprised of 7 single-nucleotide variants. Main Outcomes and Measures Disease status (familial SCAD, sporadic SCAD, or healthy control) associated with PRS. Results A total of 13 families with SCAD (27 affected and 12 unaffected individuals), 173 individuals with sporadic SCAD, and 1127 healthy controls were included. A total of 188 individuals with SCAD (94.0%) were female, including 25 of 27 with familial SCAD and 163 of 173 with sporadic SCAD; of 12 unaffected individuals from families with SCAD, 6 (50%) were female; and of 1127 healthy controls, 672 (59.6%) were female. Compared with healthy controls, the odds of being an affected family member or having sporadic SCAD was significantly associated with a SCAD PRS (where the odds ratio [OR] represents an increase in odds per 1-SD increase in PRS) (affected family member: OR, 2.14; 95% CI, 1.78-2.50; adjusted P = 1.96 × 10-4; sporadic SCAD: OR, 1.63; 95% CI, 1.37-1.89; adjusted P = 5.69 × 10-4). This association was not seen for unaffected family members (OR, 1.03; 95% CI, 0.46-1.61; adjusted P = .91) compared with controls. Further, those with familial SCAD were overrepresented in the top quintile of the control PRS distribution (OR, 3.70; 95% CI, 2.93-4.47; adjusted P = .001); those with sporadic SCAD showed a similar pattern (OR, 2.51; 95% CI, 1.98-3.04; adjusted P = .001). Affected individuals within a family did not share any rare deleterious variants in CTD-associated genes. Conclusions and Relevance Extreme aggregation of common genetic risk appears to play a significant role in familial clustering of SCAD as well as in sporadic case predisposition, although further study is required.
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Affiliation(s)
- Ingrid Tarr
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | | | - Michael Troup
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | - Paul Young
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | | | - Lucy McGrath-Cadell
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
- University of New South Wales Sydney, Kensington, Australia
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
- University of New South Wales Sydney, Kensington, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, Australia
| | - Sally L. Dunwoodie
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
- University of New South Wales Sydney, Kensington, Australia
| | - David W. M. Muller
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
- University of New South Wales Sydney, Kensington, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, Australia
| | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
- University of New South Wales Sydney, Kensington, Australia
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
- University of New South Wales Sydney, Kensington, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, Australia
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
- University of New South Wales Sydney, Kensington, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, Australia
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
- University of New South Wales Sydney, Kensington, Australia
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Murphy BM, Rogerson MC, Le Grande MR, Hesselson S, Iismaa SE, Graham RM, Jackson AC. Psychosocial and lifestyle impacts of spontaneous coronary artery dissection: A quantitative study. PLoS One 2024; 19:e0296224. [PMID: 38181032 PMCID: PMC10769080 DOI: 10.1371/journal.pone.0296224] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION Recent studies suggest that acute myocardial infarction due to spontaneous coronary artery dissection (SCAD) carries significant psychosocial burden. This survey-based quantitative study builds on our earlier qualitative investigation of the psychosocial impacts of SCAD in Australian SCAD survivors. The study aimed to document the prevalence and predictors of a broad range of psychosocial and lifestyle impacts of SCAD. METHOD Australian SCAD survivors currently enrolled in the Victor Chang Cardiac Research Institute genetics study were invited to participate in an online survey to assess the psychosocial impacts of SCAD. Participants completed a questionnaire, developed using findings from our earlier qualitative research, which assessed 48 psychosocial and five lifestyle impacts of SCAD. Participants also provided demographic and medical data and completed validated measures of anxiety and depression. RESULTS Of 433 SCAD survivors invited to participate, 310 (72%) completed the questionnaire. The most common psychosocial impacts were 'shock about having a heart attack' (experienced by 87% respondents), 'worry about having another SCAD' (81%), 'concern about triggering another SCAD' (77%), 'uncertainty about exercise and physical activity' (73%) and 'confusion about safe levels of activity and exertion' (73.0%) and 'being overly aware of bodily sensations' (73%). In terms of lifestyle impacts, the SCAD had impacted on work capacity for almost two thirds of participants, while one in ten had sought financial assistance. The key predictors of psychosocial impacts were being under 50, current financial strain, and trade-level education. The key predictors of lifestyle impacts were being over 50, SCAD recurrence, trade-level education, and current financial strain. All psychosocial impacts and some lifestyle impacts were associated with increased risk of anxiety and/or depression. CONCLUSION AND IMPLICATIONS This quantitative study extends our previous qualitative investigation by documenting the prevalence of each of 48 psychosocial and five lifestyle impacts identified in our earlier focus group research, and by providing risk factors for greater SCAD impacts. The findings suggest the need for supports to address initial experiences of shock, as well as fears and uncertainties regarding the future, including SCAD recurrence and exercise resumption. Support could be targeted to those with identified risk factors. Strategies to enable SCAD survivors to remain in or return to the paid workforce are also indicated.
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Affiliation(s)
- Barbara M. Murphy
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michael R. Le Grande
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Alun C. Jackson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre on Behavioral Health, University of Hong Kong, Pokfulam, Hong Kong
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Bax M, Junday K, Iismaa SE, Kaidonis X, Muller D, Hesselson S, Graham RM. Generation of induced pluripotent stem cell lines from a sister pair who suffered post-partum or recurrent Spontaneous Coronary Artery Dissections. Stem Cell Res 2023; 73:103238. [PMID: 37939621 DOI: 10.1016/j.scr.2023.103238] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
Spontaneous Coronary Artery Dissection (SCAD) results from a bleed within a coronary artery wall that impairs blood flow as it expands. It is the most common cause of myocardial infarction in pregnant women. Here, peripheral blood mononuclear cells from two sisters who had suffered SCADs were reprogrammed using Sendai Virus. Expression of pluripotency markers, capability to differentiate to the three germ layers, and cellular integrity were confirmed. This is the first report of a SCAD family induced pluripotent stem cell (iPSC) cohort, including a sister who suffered post-partum SCAD, and one who suffered from multiple recurrences.
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Affiliation(s)
- Monique Bax
- Victor Chang Cardiac Research Institute, Darlinghurst 2010, Australia; University of New South Wales Sydney, Kensington, New South Wales 2052, Australia
| | - Keerat Junday
- Victor Chang Cardiac Research Institute, Darlinghurst 2010, Australia
| | - Siiri E Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst 2010, Australia; University of New South Wales Sydney, Kensington, New South Wales 2052, Australia
| | - Xenia Kaidonis
- Victor Chang Cardiac Research Institute, Darlinghurst 2010, Australia; University of New South Wales Sydney, Kensington, New South Wales 2052, Australia
| | - David Muller
- Victor Chang Cardiac Research Institute, Darlinghurst 2010, Australia; St Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia; University of New South Wales Sydney, Kensington, New South Wales 2052, Australia
| | | | - Robert M Graham
- Victor Chang Cardiac Research Institute, Darlinghurst 2010, Australia; St Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia; University of New South Wales Sydney, Kensington, New South Wales 2052, Australia.
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Murphy BM, Rogerson MC, Hesselson S, Iismaa SE, Hoover V, Le Grande M, Graham RM, Jackson AC. Prevalence of Anxiety, Depression, and Distress in SCAD and Non-SCAD AMI Patients: A Comparative Study. J Cardiopulm Rehabil Prev 2023; 43:338-345. [PMID: 36892564 PMCID: PMC10467813 DOI: 10.1097/hcr.0000000000000782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 03/10/2023]
Abstract
PURPOSE Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction (AMI), particularly in younger women without classic cardiac risk factors. Spontaneous coronary artery dissection is considered to be particularly stressful; however, few studies have quantified SCAD survivor stress levels. This study compared anxiety, depression, and distress levels in SCAD and non-SCAD AMI patients. METHOD A sample of 162 AMI (35 [22%] SCAD) patients was recruited from hospitals and via social media, in Australia and the United States. All had had their AMI in the past 6 mo. Participants completed an online questionnaire comprising the Generalized Anxiety Disorder-2 (GAD2), Patient Health Questionnaire-2 (PHQ2), Kessler-6 (K6), and Cardiac Distress Inventory (CDI). T-tests, χ 2 tests, Mann-Whitney tests, and analysis of covariance were used to compare SCAD and non-SCAD samples. Logistic regression was used to identify the unique predictors of anxiety, depression, and distress, controlling for relevant confounders. RESULTS Patients with SCAD were more commonly female and significantly younger than non-SCAD patients. Patients with SCAD scored significantly higher on the GAD2, PHQ2, K6, and CDI and a significantly larger proportion was classified as anxious, depressed, or distressed using these instruments. In logistic regression, together with mental health history, having had a SCAD-AMI predicted anxiety, depression, and distress, after controlling for female sex, younger age, and other confounding variables. CONCLUSION This study supports the view that anxiety, depression, and distress are more common after SCAD-AMI than after traditional AMI. These findings highlight the psychosocial impacts of SCAD and suggest that psychological support should be an important component of cardiac rehabilitation for these patients.
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Affiliation(s)
- Barbara M. Murphy
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Michelle C. Rogerson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Stephanie Hesselson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Siiri E. Iismaa
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Valerie Hoover
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Michael Le Grande
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Robert M. Graham
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
| | - Alun C. Jackson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia (Drs Murphy, Rogerson, and Jackson and Mr Le Grande); Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia (Drs Murphy and Jackson and Mr Le Grande); Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia (Drs Hesselson, Iismaa, and Graham); St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Drs Iismaa and Graham); Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California (Dr Hoover); and Centre on Behavioral Health, University of Hong Kong, Pokfulam, HongKong, China (Dr Jackson)
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Murphy BM, Rogerson MC, Hesselson S, Iismaa SE, Graham RM, Jackson AC. Psychosocial impacts of spontaneous coronary artery dissection: A qualitative study. PLoS One 2022; 17:e0273978. [PMID: 36067201 PMCID: PMC9447895 DOI: 10.1371/journal.pone.0273978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/18/2022] [Indexed: 12/17/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of acute myocardial infarction, particularly in younger women without classic cardiac risk factors. While recent quantitative studies have noted high anxiety and depression in SCAD survivors, the full range and extent of psychosocial impacts of SCAD is unknown. The present study used a qualitative approach to investigate the psychosocial impacts of SCAD in Australian SCAD survivors. Focus group participants were recruited as part of a larger study of SCAD survivors currently being undertaken by the Victor Chang Cardiac Research Institute. Thirty SCAD survivors participated in one of seven online focus groups, conducted using a semi-structured format. Focus group duration was 1.5 hours. Each was digitally recorded and transcribed. Data were analyzed thematically according to recommended guidelines. One over-arching theme, five main themes and 26 sub-themes were identified. The over-arching theme related to lack of information, while the five main themes related to emotional impacts, issues with self-management, issues with family, impacts on work life, and the need for psychosocial support. The ‘emotional impacts’ theme comprised 11 sub-themes, namely shock and disbelief, confusion and uncertainty, unfairness, fear and anxiety, loss and grief, isolation and loneliness, guilt, invalidation and embarrassment, depression, vulnerability, and frustration. Findings are discussed in light of relevant psychological theories. This qualitative study extends previous quantitative investigations of SCAD survivors by providing an in-depth understanding of the complex, inter-related and highly distressing impacts of SCAD. The findings point to the urgent need for a coherent approach to information provision, the development and delivery of SCAD-specific cardiac rehabilitation programs, and the provision of psychosocial support programs for SCAD survivors.
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Affiliation(s)
- Barbara M. Murphy
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | | | | | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Alun C. Jackson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia
- Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Center on Behavioral Health, University of Hong Kong, Pokfulam, Hong Kong
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Tarr I, Hesselson S, Iismaa SE, Rath E, Monger S, Troup M, Mishra K, Wong CM, Hsu PC, Junday K, Humphreys DT, Adlam D, Webb TR, Baranowska-Clarke AA, Hamby SE, Carss KJ, Samani NJ, Bax M, McGrath-Cadell L, Kovacic JC, Dunwoodie SL, Fatkin D, Muller DW, Graham RM, Giannoulatou E. Exploring the Genetic Architecture of Spontaneous Coronary Artery Dissection Using Whole-Genome Sequencing. Circ Genom Precis Med 2022; 15:e003527. [PMID: 35583931 PMCID: PMC9388555 DOI: 10.1161/circgen.121.003527] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome that predominantly affects women. Its pathophysiology remains unclear but connective tissue disorders (CTD) and other vasculopathies have been observed in many SCAD patients. A genetic component for SCAD is increasingly appreciated, although few genes have been robustly implicated. We sought to clarify the genetic cause of SCAD using targeted and genome-wide methods in a cohort of sporadic cases to identify both common and rare disease-associated variants.
Methods:
A cohort of 91 unrelated sporadic SCAD cases was investigated for rare, deleterious variants in genes associated with either SCAD or CTD, while new candidate genes were sought using rare variant collapsing analysis and identification of novel loss-of-function variants in genes intolerant to such variation. Finally, 2 SCAD polygenic risk scores were applied to assess the contribution of common variants.
Results:
We identified 10 cases with at least one rare, likely disease-causing variant in CTD-associated genes, although only one had a CTD phenotype. No genes were significantly associated with SCAD from genome-wide collapsing analysis, however, enrichment for TGF (transforming growth factor)-β signaling pathway genes was found with analysis of 24 genes harboring novel loss-of-function variants. Both polygenic risk scores demonstrated that sporadic SCAD cases have a significantly elevated genetic SCAD risk compared with controls.
Conclusions:
SCAD shares some genetic overlap with CTD, even in the absence of any major CTD phenotype. Consistent with a complex genetic architecture, SCAD patients also have a higher burden of common variants than controls.
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Affiliation(s)
- Ingrid Tarr
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Stephanie Hesselson
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Emma Rath
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Steven Monger
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Michael Troup
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Ketan Mishra
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Claire M.Y. Wong
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Pei-Chen Hsu
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Keerat Junday
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - David T. Humphreys
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - David Adlam
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Tom R. Webb
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Anna A. Baranowska-Clarke
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Stephen E. Hamby
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Keren J. Carss
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, United Kingdom (K.J.C.)
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Monique Bax
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Lucy McGrath-Cadell
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C.K.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - Sally L. Dunwoodie
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - David W.M. Muller
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
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8
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Bax M, Junday K, Iismaa S, Hesselson S, Tarr I, McGrath-Cadell L, Dunwoodie S, Giannoulatou E, Graham R. Induced Pluripotent Stem Cell-Derived Models of Spontaneous Coronary Artery Dissection. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.097] [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: 11/25/2022]
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9
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McGrath-Cadell L, Hesselson S, Tarr I, Iismaa SE, Bax M, Junday K, Dunwoodie SE, Fatkin D, Kovacic J, Muller DWM, Giannoulatou E, Graham RM. Spontaneous Coronary Artery Dissection (SCAD) and a family history of aortic artery dissection, a case series. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2787] [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/Introduction
SCAD typically affects women in their fifth or sixth decade with a paucity of cardiovascular risk factors.(1) It is caused by a coronary artery intramural haematoma with or without intimal tear. Resultant luminal occlusion manifests as myocardial ischaemia/infarction or death.
There are two published sporadic cases of SCAD who developed iatrogenic aortic dissection with coronary angiography.(2, 3) We are not aware of any SCAD cases with intercurrent or historical spontaneous aortic dissection. There is a published SCAD case with a familial history of aortic dissection, in her mother.(4) None of these cases reported a connective tissue disorder.
Methods
We searched our database of 338 SCAD cases, recruited via social media or cardiologist referral, for cases with a family history of aortic dissection. SCAD diagnosis was confirmed by review of coronary angiogram images by an expert interventional cardiologist blinded to the genetic analysis.
Genomic DNA was extracted from buccal cells collected using a cheek swab or mouthwash sample. Whole genome sequencing was performed using the Illumina HiSeq X Ten platform with 30x coverage.
These data are being analysed for rare variants in genes associated with familial aortopathies or connective tissue disorders (e.g. FBN1, COL3A1, TGFbR-1/2, SMAD3), as well as for novel gene associations with aortic dissection and/or SCAD.
Results
We identified 12 cases with a first- or second-degree relative with aortic dissection. Of these SCAD cases, 11 were female whereas 10 of 12 relatives with aortic dissection were male. In one instance, a maternal uncle, but not the index SCAD case, had Marfan's syndrome.
Whole genome sequencing has been performed on the 12 SCAD cases, 2 living relatives with aortic dissection and 2 relatives linking the SCAD and aortic dissection cases.
Conclusions
Coronary and aortic dissections have serious consequences and in some families there may be a genetic association between the two conditions. Early identification of variant carriers is critical for disease prevention.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This work was supported in part by grants from the Cardiac Society of Australia and New Zealand, the National Health and Medical Research Council, Australia (APP1161200), the St Vincent's Clinic Foundation, the Catholic Archdiocese of Sydney, Perpetual Philanthropy, NSW Health and SCAD Research Inc. LMC is funded by a University Postgraduate Scholarship through University of NSW and a grant from the Avant Foundation.
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Affiliation(s)
| | - S Hesselson
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - I Tarr
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - S E Iismaa
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - M Bax
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - K Junday
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - S E Dunwoodie
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - D Fatkin
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - J Kovacic
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - D W M Muller
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - E Giannoulatou
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - R M Graham
- Victor Chang Cardiac Research Institute, Sydney, Australia
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10
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McGrath-Cadell L, Hesselson S, Tarr I, Iismaa S, Bax M, Junday K, Dunwoodie S, Fatkin D, Kovacic J, Muller D, Giannoulatou E, Graham B. Spontaneous Coronary Artery Dissection (SCAD) and a Family History of Aortic Artery Dissection—A Case Series. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.350] [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: 10/20/2022]
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11
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Bax M, Junday K, Hesselson S, Iismaa S, Tarr I, McGrath-Cadell L, Dunwoodie S, Fatkin D, Kovacic J, Muller D, Giannoulatou E, Graham R. Modelling Spontaneous Coronary Artery Dissection With iPSC-Derived Vascular Cells. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.089] [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: 10/20/2022]
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12
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Carss KJ, Baranowska AA, Armisen J, Webb TR, Hamby SE, Premawardhana D, Al-Hussaini A, Wood A, Wang Q, Deevi SVV, Vitsios D, Lewis SH, Kotecha D, Bouatia-Naji N, Hesselson S, Iismaa SE, Tarr I, McGrath-Cadell L, Muller DW, Dunwoodie SL, Fatkin D, Graham RM, Giannoulatou E, Samani NJ, Petrovski S, Haefliger C, Adlam D. Spontaneous Coronary Artery Dissection: Insights on Rare Genetic Variation From Genome Sequencing. Circ Genom Precis Med 2020; 13:e003030. [PMID: 33125268 PMCID: PMC7748045 DOI: 10.1161/circgen.120.003030] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Spontaneous coronary artery dissection (SCAD) occurs when an epicardial coronary artery is narrowed or occluded by an intramural hematoma. SCAD mainly affects women and is associated with pregnancy and systemic arteriopathies, particularly fibromuscular dysplasia. Variants in several genes, such as those causing connective tissue disorders, have been implicated; however, the genetic architecture is poorly understood. Here, we aim to better understand the diagnostic yield of rare variant genetic testing among a cohort of SCAD survivors and to identify genes or gene sets that have a significant enrichment of rare variants.
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Affiliation(s)
- Keren J Carss
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca (K.J.C., J.A., Q.W., S.V.V.D., D.V., S.H.L., S.P., C.H.)
| | - Anna A Baranowska
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (A.A.B., T.R.W., S.E.H., D.P., A.A.-H., A.W., D.K., N.J.S., D.A.)
| | - Javier Armisen
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca (K.J.C., J.A., Q.W., S.V.V.D., D.V., S.H.L., S.P., C.H.)
| | - Tom R Webb
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (A.A.B., T.R.W., S.E.H., D.P., A.A.-H., A.W., D.K., N.J.S., D.A.)
| | - Stephen E Hamby
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (A.A.B., T.R.W., S.E.H., D.P., A.A.-H., A.W., D.K., N.J.S., D.A.)
| | - Diluka Premawardhana
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (A.A.B., T.R.W., S.E.H., D.P., A.A.-H., A.W., D.K., N.J.S., D.A.)
| | - Abtehale Al-Hussaini
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (A.A.B., T.R.W., S.E.H., D.P., A.A.-H., A.W., D.K., N.J.S., D.A.)
| | - Alice Wood
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (A.A.B., T.R.W., S.E.H., D.P., A.A.-H., A.W., D.K., N.J.S., D.A.)
| | - Quanli Wang
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca (K.J.C., J.A., Q.W., S.V.V.D., D.V., S.H.L., S.P., C.H.)
| | - Sri V V Deevi
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca (K.J.C., J.A., Q.W., S.V.V.D., D.V., S.H.L., S.P., C.H.)
| | - Dimitrios Vitsios
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca (K.J.C., J.A., Q.W., S.V.V.D., D.V., S.H.L., S.P., C.H.)
| | - Samuel H Lewis
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca (K.J.C., J.A., Q.W., S.V.V.D., D.V., S.H.L., S.P., C.H.)
| | - Deevia Kotecha
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (A.A.B., T.R.W., S.E.H., D.P., A.A.-H., A.W., D.K., N.J.S., D.A.)
| | - Nabila Bouatia-Naji
- Université de Paris, Inserm UMR 970 - Paris, Centre de Recherche Cardiovasculaire, France (N.B.-N)
| | - Stephanie Hesselson
- Victor Chang Cardiac Research Institute, Darlinghurst (S.H., S.E.I., I.T., D.W.M., S.L.D., D.F., R.M.G., E.G.)
| | - Siiri E Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst (S.H., S.E.I., I.T., D.W.M., S.L.D., D.F., R.M.G., E.G.).,St Vincent's Clinical School, University of NSW Sydney, Kensington (S.E.I., L.M.-C., D.W.M., S.L.D., D.F., R.M.G., E.G.)
| | - Ingrid Tarr
- Victor Chang Cardiac Research Institute, Darlinghurst (S.H., S.E.I., I.T., D.W.M., S.L.D., D.F., R.M.G., E.G.)
| | - Lucy McGrath-Cadell
- St Vincent's Clinical School, University of NSW Sydney, Kensington (S.E.I., L.M.-C., D.W.M., S.L.D., D.F., R.M.G., E.G.)
| | - David W Muller
- Victor Chang Cardiac Research Institute, Darlinghurst (S.H., S.E.I., I.T., D.W.M., S.L.D., D.F., R.M.G., E.G.).,St Vincent's Clinical School, University of NSW Sydney, Kensington (S.E.I., L.M.-C., D.W.M., S.L.D., D.F., R.M.G., E.G.)
| | - Sally L Dunwoodie
- Victor Chang Cardiac Research Institute, Darlinghurst (S.H., S.E.I., I.T., D.W.M., S.L.D., D.F., R.M.G., E.G.).,St Vincent's Clinical School, University of NSW Sydney, Kensington (S.E.I., L.M.-C., D.W.M., S.L.D., D.F., R.M.G., E.G.)
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst (S.H., S.E.I., I.T., D.W.M., S.L.D., D.F., R.M.G., E.G.).,St Vincent's Clinical School, University of NSW Sydney, Kensington (S.E.I., L.M.-C., D.W.M., S.L.D., D.F., R.M.G., E.G.).,Cardiology Department, St Vincent's Hospital, Darlinghurst, NSW, Australia (D.F.)
| | - Robert M Graham
- Victor Chang Cardiac Research Institute, Darlinghurst (S.H., S.E.I., I.T., D.W.M., S.L.D., D.F., R.M.G., E.G.).,St Vincent's Clinical School, University of NSW Sydney, Kensington (S.E.I., L.M.-C., D.W.M., S.L.D., D.F., R.M.G., E.G.)
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst (S.H., S.E.I., I.T., D.W.M., S.L.D., D.F., R.M.G., E.G.).,St Vincent's Clinical School, University of NSW Sydney, Kensington (S.E.I., L.M.-C., D.W.M., S.L.D., D.F., R.M.G., E.G.)
| | - Nilesh J Samani
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (A.A.B., T.R.W., S.E.H., D.P., A.A.-H., A.W., D.K., N.J.S., D.A.)
| | - Slavé Petrovski
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca (K.J.C., J.A., Q.W., S.V.V.D., D.V., S.H.L., S.P., C.H.)
| | - Carolina Haefliger
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca (K.J.C., J.A., Q.W., S.V.V.D., D.V., S.H.L., S.P., C.H.)
| | - David Adlam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (A.A.B., T.R.W., S.E.H., D.P., A.A.-H., A.W., D.K., N.J.S., D.A.)
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13
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Iismaa SE, Hesselson S, McGrath-Cadell L, Muller DW, Fatkin D, Giannoulatou E, Kovacic J, Graham RM. Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia: Vasculopathies With a Predilection for Women. Heart Lung Circ 2020; 30:27-35. [PMID: 32713767 DOI: 10.1016/j.hlc.2020.05.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/23/2020] [Revised: 05/12/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
The burden of cardiovascular disease in women is being increasingly appreciated. Nevertheless, both clinicians and the general public are largely unaware that cardiovascular disease is the leading cause of death worldwide in women in all countries and that outcomes after a heart attack are worse for women than men. Of note, certain types of cardiovascular disease have a predilection for women, including spontaneous coronary artery dissection (SCAD) and fibromuscular dysplasia (FMD). Although uncommon, SCAD is being increasingly recognised as the cause of an acute coronary syndrome (ACS) and can recur. It is a potentially fatal, under-diagnosed condition that affects relatively young women, who often have few traditional risk factors, and is the commonest cause of a myocardial infarction associated with pregnancy. In contrast, FMD often remains silent but when manifested can also cause major sequelae, including renal infarction, stroke, cervical artery dissection and gut infarction. Here we provide an update on the diagnosis, aetiology and management of these important disorders that overwhelmingly affect women.
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Affiliation(s)
- Siiri E Iismaa
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; St Vincent's Clinical School, St Vincent's Hospital, Sydney, NSW, Australia
| | - Stephanie Hesselson
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Lucy McGrath-Cadell
- St Vincent's Clinical School, St Vincent's Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - David W Muller
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; St Vincent's Clinical School, St Vincent's Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Diane Fatkin
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; St Vincent's Clinical School, St Vincent's Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Eleni Giannoulatou
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Jason Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert M Graham
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; St Vincent's Clinical School, St Vincent's Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of NSW, Sydney, NSW, Australia.
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14
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McGrath-Cadell L, Hesselson S, Iismaa SE, Mishra K, Wong CMY, Fatkin D, Dunwoodie SL, Harvey R, Holloway CJ, Muller DWM, Giannoulatou E, Graham RM. P5540Familial clustering of spontaneous coronary artery dissection. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/13/2022] Open
Abstract
Abstract
Background
There is increasing evidence that patients with spontaneous coronary artery dissection (SCAD) have an underlying genetic susceptibility (Goel et al JAMA Intern Med175:821–826, 2015). Moreover, in a collaborative study involving 1,055 SCAD cases and 7,190 controls, we recently reported the first risk allele for SCAD, a variant (rs9349379-A) in the PHACTR1/EDN1 genetic locus (Adlam et al J Amer Coll Cardiol73:58–66, 2019).
Purpose
We sought to determine the clinical characteristics and initial genetic data for 11 families, in which more than one member has had an episode of SCAD.
Methods
Participants were recruited largely via a social media platform. Informed consent was obtained in all cases for analysis of genetic information using whole genome sequencing, as well as collection of clinical information. SCAD was confirmed by review of coronary angiogram images and clinical data collected by phone interview, as well as review of specialist letters and hospital records.
Results
Of 235 participants recruited to date, 23 cases showed familial clustering involving sister-sister pairs in six families, three first-degree cousins in one family (picture), two first-degree cousins in two families, a mother-son pair, and a family with concordant monozygotic twins, that is both twins having had SCAD. In an additional family, SCAD is discordant in monozygotic twins. A comparison of symptoms, age at SCAD, clinical syndrome, cardiovascular risk factors, SCAD risk factors, environmental triggers, SCAD location, acute management, left ventricular function and recurrent SCAD events in these families versus isolated cases, will be presented. Three sister-sister pairs have undergone whole genome sequencing and these data sets are undergoing segregation analysis to identify rare variants that are present exclusively in affected family members.
Family E Pedigree. Shaded circles represent first cousins affected with SCAD. The top number represents age (in years) of the SCAD event and the bottom number represents current age (in years).
Conclusions
To our knowledge, this is the largest assembly of SCAD cases with familial clustering reported to date. It provides strong evidence supporting an underlying genetic basis for SCAD, which most likely is a multi-genic disorder that also involves important gene-environment interactions.
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Affiliation(s)
| | - S Hesselson
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - S E Iismaa
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - K Mishra
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - C M Y Wong
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - D Fatkin
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - S L Dunwoodie
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - R Harvey
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | | | - E Giannoulatou
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - R M Graham
- Victor Chang Cardiac Research Institute, Sydney, Australia
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15
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McGrath-Cadell L, Hesselson S, Iismaa S, Mishra K, Wong C, Fatkin D, Dunwoodie S, Harvey R, Holloway C, Muller D, Giannoulatou E, Graham R. Familial Clustering of Spontaneous Coronary Artery Dissection. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.454] [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: 11/16/2022]
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16
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Lawrence GM, Shulman S, Friedlander Y, Sitlani CM, Burger A, Savitsky B, Granot-Hershkovitz E, Lumley T, Kwok PY, Hesselson S, Enquobahrie D, Wander PL, Manor O, Siscovick DS, Hochner H. Associations of maternal pre-pregnancy and gestational body size with offspring longitudinal change in BMI. Obesity (Silver Spring) 2014; 22:1165-71. [PMID: 24124160 PMCID: PMC3968220 DOI: 10.1002/oby.20643] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/06/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Studies demonstrate associations between changes in obesity-related phenotypes and cardiovascular risk. Although maternal pre-pregnancy BMI (mppBMI) and gestational weight gain (GWG) may be associated with adult offspring adiposity, no study has examined associations with obesity changes. Associations of mppBMI and GWG with longitudinal change in offspring's BMI (ΔBMI) were examined, and whether associations are explained by offspring genetics was assessed. METHODS A birth cohort of 1400 adults, with data at birth, age 17 and 32 years was used. After genotyping offspring, genetic scores, predictive of exposures and outcome were created, and linear regression models with and without scores were fit to examine the associations of mppBMI and GWG with ΔBMI. RESULTS A one SD change in mppBMI and GWG was associated with a 0.83 and a 0.75 kg/m² increase in ΔBMI, respectively. The association between mppBMI and offspring ΔBMI was slightly attenuated (12%) with the addition of genetic scores. In the GWG model, a significant substantial 28.2% decrease in the coefficient was observed. CONCLUSIONS This study points to an association between maternal excess weight in pregnancy and offspring BMI change from adolescence to adulthood. Genetic factors may account, in part, for GWG/ΔBMI association. These findings broaden observations that maternal obesity-related phenotypes have long-term consequences for offspring health.
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Affiliation(s)
- Gabriella M Lawrence
- Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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17
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Wander PL, Hochner H, Sitlani CM, Enquobahrie DA, Lumley T, Lawrence GM, Burger A, Savitsky B, Manor O, Meiner V, Hesselson S, Kwok PY, Siscovick DS, Friedlander Y. Maternal genetic variation accounts in part for the associations of maternal size during pregnancy with offspring cardiometabolic risk in adulthood. PLoS One 2014; 9:e91835. [PMID: 24670385 PMCID: PMC3966761 DOI: 10.1371/journal.pone.0091835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 07/30/2013] [Accepted: 02/12/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Maternal pre-pregnancy body-mass index (ppBMI) and gestational weight gain (GWG) are associated with cardiometabolic risk (CMR) traits in the offspring. The extent to which maternal genetic variation accounts for these associations is unknown. METHODS/RESULTS In 1249 mother-offspring pairs recruited from the Jerusalem Perinatal Study, we used archival data to characterize ppBMI and GWG and follow-up data from offspring to assess CMR, including body mass index (BMI), waist circumference, glucose, insulin, blood pressure, and lipid levels, at an average age of 32. Maternal genetic risk scores (GRS) were created using a subset of SNPs most predictive of ppBMI, GWG, and each CMR trait, selected among 1384 single-nucleotide polymorphisms (SNPs) characterizing variation in 170 candidate genes potentially related to fetal development and/or metabolic risk. We fit linear regression models to examine the associations of ppBMI and GWG with CMR traits with and without adjustment for GRS. Compared to unadjusted models, the coefficient for the association of a one-standard-deviation (SD) difference in GWG and offspring BMI decreased by 41% (95%CI -81%, -11%) from 0.847 to 0.503 and the coefficient for a 1SD difference in GWG and WC decreased by 63% (95%CI -318%, -11%) from 1.196 to 0.443. For other traits, there were no statistically significant changes in the coefficients for GWG with adjustment for GRS. None of the associations of ppBMI with CMR traits were significantly altered by adjustment for GRS. CONCLUSIONS Maternal genetic variation may account in part for associations of GWG with offspring BMI and WC in young adults.
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Affiliation(s)
- Pandora L. Wander
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Hagit Hochner
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Colleen M. Sitlani
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
| | - Daniel A. Enquobahrie
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Gabriela M. Lawrence
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ayala Burger
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Bella Savitsky
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Vardiella Meiner
- Department of Human Genetics, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Stephanie Hesselson
- Institute of Human Genetics, University of California San Francisco, San Francisco, California, United States of America
| | - Pui Y. Kwok
- Institute of Human Genetics, University of California San Francisco, San Francisco, California, United States of America
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, California, United States of America
- Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America
| | - David S. Siscovick
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
| | - Yechiel Friedlander
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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18
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Johnson CO, Lemaitre RN, Fahrenbruch CE, Hesselson S, Sotoodehnia N, McKnight B, Rice KM, Kwok PY, Siscovick DS, Rea TD. Common variation in fatty acid genes and resuscitation from sudden cardiac arrest. ACTA ACUST UNITED AC 2012; 5:422-9. [PMID: 22661490 DOI: 10.1161/circgenetics.111.961912] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fatty acids provide energy and structural substrates for the heart and brain and may influence resuscitation from sudden cardiac arrest (SCA). We investigated whether genetic variation in fatty acid metabolism pathways was associated with SCA survival. METHODS AND RESULTS Subjects (mean age, 67 years; 80% male, white) were out-of-hospital SCA patients found in ventricular fibrillation in King County, WA. We compared subjects who survived to hospital admission (n=664) with those who did not (n=689), and subjects who survived to hospital discharge (n=334) with those who did not (n=1019). Associations between survival and genetic variants were assessed using logistic regression adjusting for age, sex, location, time to arrival of paramedics, whether the event was witnessed, and receipt of bystander cardiopulmonary resuscitation. Within-gene permutation tests were used to correct for multiple comparisons. Variants in 5 genes were significantly associated with SCA survival. After correction for multiple comparisons, single-nucleotide polymorphisms in ACSL1 and ACSL3 were significantly associated with survival to hospital admission. Single-nucleotide polymorphisms in ACSL3, AGPAT3, MLYCD, and SLC27A6 were significantly associated with survival to hospital discharge. CONCLUSIONS Our findings indicate that variants in genes important in fatty acid metabolism are associated with SCA survival in this population.
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Affiliation(s)
- Catherine O Johnson
- Department of Medicine, University of Washington CHRU, 1730 Minor Ave, Seattle, WA 98101, USA.
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19
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Chen Y, Teranishi K, Li S, Yee SW, Hesselson S, Stryke D, Johns SJ, Ferrin TE, Kwok P, Giacomini KM. Genetic variants in multidrug and toxic compound extrusion-1, hMATE1, alter transport function. Pharmacogenomics J 2009; 9:127-36. [PMID: 19172157 DOI: 10.1038/tpj.2008.19] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
hMATE1 (human multidrug and toxin compound extrusion-1; encoded by SLC47A1) is thought to have an important function in the renal and hepatic elimination of drugs, endogenous compounds and environmental toxins. The goals of this study were to identify genetic variants of hMATE1 and to determine their effects on hMATE1 transport function. We identified four synonymous and six nonsynonymous, coding region variants in DNA samples from 272 individuals (68 Caucasians, 68 African Americans, 68 Asian Americans and 68 Mexican Americans). The overall prevalence of hMATE1 nonsynonymous variants was relatively low with three singleton variants and three variants having allele frequencies > or =2% in a specific ethnic group. The nonsynonymous hMATE1 variants were constructed and stably transfected into HEK-293 cells. Uptake studies using four known hMATE1 substrates (paraquat, metformin, tetraethylammonium and oxaliplatin) were performed in cells transfected with hMATE1 reference or variants. We found that two singleton variants, G64D and V480M, produced a complete loss of function for all four tested substrates whereas three polymorphic variants (allele frequencies > or =2%), L125F, V338I and C497S, significantly altered the transport function in a substrate-dependent manner. Confocal microscopy studies were consistent with functional studies suggesting that the altered function of the variants was due to altered localization to the plasma membrane. These data suggest that nonsynonymous variants in hMATE1 may alter drug disposition and ultimately affect clinical drug response.
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Affiliation(s)
- Ying Chen
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Biopharmaceutical Sciences, University of California at San Francisco, San Francisco, CA 94158, USA
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20
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Tahara H, Yee SW, Urban TJ, Hesselson S, Castro RA, Kawamoto M, Stryke D, Johns SJ, Ferrin TE, Kwok PY, Giacomini KM. Functional genetic variation in the basal promoter of the organic cation/carnitine transporters OCTN1 (SLC22A4) and OCTN2 (SLC22A5). J Pharmacol Exp Ther 2009; 329:262-71. [PMID: 19141711 DOI: 10.1124/jpet.108.146449] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The organic cation/ergothioneine transporter OCTN1 (SLC22A4) and the high-affinity carnitine transporter OCTN2 (SLC22A5), play an important role in the disposition of xenobiotics and endogenous compounds. Here, we analyzed the sequence of the proximal promoter regions of OCTN1 and OCTN2 in four ethnic groups and determined the effects of the identified genetic variants on transcriptional activities and mRNA expression. Six variants were found in the proximal promoter of OCTN1, one of which showed high allele frequency ranging from 13 to 34% in samples from individuals with ancestries in Africa, Europe, China, and Mexico. OCTN1 haplotypes had similar activities as the reference in luciferase reporter assays. For OCTN2, three of the seven variants identified in the proximal promoter showed allele frequencies greater than 29.5% in all populations, with the exception of -207C>G (rs2631367) that was monomorphic in Asian Americans. OCTN2 haplotypes containing -207G, present in all populations, were associated with a gain of function in luciferase reporter assays. Consistent with reporter assays, OCTN2 mRNA expression levels in lymphoblastoid cell lines (LCLs) from gene expression analysis were greater in samples carrying a marker for -207G. This SNP seems to contribute to racial differences in OCTN2 mRNA expression levels in LCLs. Our study with healthy subjects (n = 16) homozygous for either -207C or -207G, showed no appreciable effect of this SNP on carnitine disposition. However, there were significant effects of gender on carnitine plasma levels (p < 0.01). Further in vivo studies of OCTN2 promoter variants on carnitine disposition and variation in drug response are warranted.
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Affiliation(s)
- Harunobu Tahara
- Department of Biopharmaceutical Sciences, University of California, San Francisco, San Francisco, CA 94158-2911, USA
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21
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Yee SW, Shima JE, Hesselson S, Nguyen L, De Val S, Lafond RJ, Kawamoto M, Johns SJ, Stryke D, Kwok PY, Ferrin TE, Black BL, Gurwitz D, Ahituv N, Giacomini KM. Identification and characterization of proximal promoter polymorphisms in the human concentrative nucleoside transporter 2 (SLC28A2). J Pharmacol Exp Ther 2008; 328:699-707. [PMID: 19098160 DOI: 10.1124/jpet.108.147207] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The human concentrative nucleoside transporter 2 (CNT2) plays an important role in the absorption, disposition, and biological effects of endogenous nucleosides and nucleoside analog drugs. We identified genetic variation in the basal promoter region of CNT2 and characterized the function of the variants. We screened DNA from an ethnically diverse population and identified five basal promoter variants in CNT2. Three major haplotypes in the CNT2 basal promoter region were identified and were found at different allele frequencies in various ethnic groups. The common promoter variants and haplotypes were constructed and characterized for their promoter activity using luciferase reporter assays. One polymorphic variant, rs2413775 (-146T>A), with an allele frequency >20% in all populations, showed a gain of function in luciferase activity. Furthermore, in vivo mouse promoter assays of these nucleotide variants using the hydrodynamic tail vein injection, leading to their expression in the liver, demonstrated similar results. Transcription factor binding site (TFBS) analysis indicated this variant alters a hepatic nuclear factor (HNF) 1 TFBS. Electrophoretic mobility shift assay demonstrated stronger binding of HNF1alpha and weaker binding of HNF1beta to the -146T and -146A regions, whereas the single nucleotide polymorphism (SNP), -146A, exhibited enhanced binding to both HNF1alpha and HNF1beta, consistent with its greater activity in reporter assays. The data collectively suggest that the common variant, -146T>A, in the proximal promoter of CNT2 may result in an enhanced transcription rate of the gene and, thus, expression levels of CNT2. This SNP may play a role in variation in the pharmacokinetics and pharmacological effects of nucleoside analogs.
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Affiliation(s)
- Sook Wah Yee
- Department of Biopharmaceutical Sciences, University of California, 1550 4th Street, RH584, Box 2911, San Francisco, CA 94158-2911, USA
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