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Jensson BO, Arnadottir GA, Katrinardottir H, Fridriksdottir R, Helgason H, Oddsson A, Sveinbjornsson G, Eggertsson HP, Halldorsson GH, Atlason BA, Jonsson H, Oskarsson GR, Sturluson A, Gudjonsson SA, Thorisson GA, Zink F, Moore KHS, Palsson G, Sigurdsson A, Jonasdottir A, Jonasdottir A, Magnusson MK, Helgadottir A, Steinthorsdottir V, Gudmundsson J, Stacey SN, Hilmarsson R, Olafsson I, Johannsson OT, Arnar DO, Saemundsdottir J, Magnusson OT, Masson G, Halldorsson BV, Helgason A, Stefansson H, Jonsdottir I, Holm H, Rafnar T, Thorsteinsdottir U, Gudbjartsson DF, Stefansson K, Sulem P. Actionable Genotypes and Their Association with Life Span in Iceland. N Engl J Med 2023; 389:1741-1752. [PMID: 37937776 DOI: 10.1056/nejmoa2300792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/09/2023]
Abstract
BACKGROUND In 2021, the American College of Medical Genetics and Genomics (ACMG) recommended reporting actionable genotypes in 73 genes associated with diseases for which preventive or therapeutic measures are available. Evaluations of the association of actionable genotypes in these genes with life span are currently lacking. METHODS We assessed the prevalence of coding and splice variants in genes on the ACMG Secondary Findings, version 3.0 (ACMG SF v3.0), list in the genomes of 57,933 Icelanders. We assigned pathogenicity to all reviewed variants using reported evidence in the ClinVar database, the frequency of variants, and their associations with disease to create a manually curated set of actionable genotypes (variants). We assessed the relationship between these genotypes and life span and further examined the specific causes of death among carriers. RESULTS Through manual curation of 4405 sequence variants in the ACMG SF v3.0 genes, we identified 235 actionable genotypes in 53 genes. Of the 57,933 participants, 2306 (4.0%) carried at least one actionable genotype. We found shorter median survival among persons carrying actionable genotypes than among noncarriers. Specifically, we found that carrying an actionable genotype in a cancer gene was associated with survival that was 3 years shorter than that among noncarriers, with causes of death among carriers attributed primarily to cancer-related conditions. Furthermore, we found evidence of association between carrying an actionable genotype in certain genes in the cardiovascular disease group and a reduced life span. CONCLUSIONS On the basis of the ACMG SF v3.0 guidelines, we found that approximately 1 in 25 Icelanders carried an actionable genotype and that carrying such a genotype was associated with a reduced life span. (Funded by deCODE Genetics-Amgen.).
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Affiliation(s)
- Brynjar O Jensson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Gudny A Arnadottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Hildigunnur Katrinardottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Run Fridriksdottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Hannes Helgason
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Asmundur Oddsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Gardar Sveinbjornsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Hannes P Eggertsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Gisli H Halldorsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Bjarni A Atlason
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Hakon Jonsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Gudjon R Oskarsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Arni Sturluson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Sigurjon A Gudjonsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Gudmundur A Thorisson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Florian Zink
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Kristjan H S Moore
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Gunnar Palsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Asgeir Sigurdsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Adalbjorg Jonasdottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Aslaug Jonasdottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Magnus K Magnusson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Anna Helgadottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Valgerdur Steinthorsdottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Julius Gudmundsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Simon N Stacey
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Rafn Hilmarsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Isleifur Olafsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Oskar T Johannsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - David O Arnar
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Jona Saemundsdottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Olafur T Magnusson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Gisli Masson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Bjarni V Halldorsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Agnar Helgason
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Hreinn Stefansson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Ingileif Jonsdottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Hilma Holm
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Thorunn Rafnar
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Daniel F Gudbjartsson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Kari Stefansson
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
| | - Patrick Sulem
- From deCODE Genetics-Amgen (B.O.J., G.A.A., H.K., R.F., H. Helgason, A.O., G.S., H.P.E., G.H.H., B.A.A., H.J., G.R.O., A. Sturluson, S.A.G., G.A.T., F.Z., K.H.S.M., G.P., A. Sigurdsson, Adalbjorg Jonasdottir, Aslaug Jonasdottir, M.K.M., A. Helgadottir, V.S., J.G., S.N.S., D.O.A., J.S., O.T.M., G.M., B.V.H., A. Helgason, H.S., I.J., H. Holm, T.R., U.T., D.F.G., K.S., P.S.), the Faculty of Medicine, School of Health Sciences (G.A.A., M.K.M., R.H., D.O.A., I.J., U.T., K.S.), the Department of Anthropology (K.H.S.M., A. Helgason), and the School of Engineering and Natural Sciences (H. Helgason, G.H.H., D.F.G.), University of Iceland, the Departments of Urology (R.H.), Clinical Biochemistry (I.O.), Oncology (O.T.J.), Medicine (D.O.A.), and Immunology (I.J.), Landspitali-the National University Hospital of Iceland, and the School of Science and Engineering, Reykjavik University (B.V.H.) - all in Reykjavik, Iceland
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Björnsson E, Thorgeirsson G, Helgadóttir A, Thorleifsson G, Sveinbjörnsson G, Kristmundsdóttir S, Jónsson H, Jónasdóttir A, Jónasdóttir Á, Sigurðsson Á, Guðnason T, Ólafsson Í, Sigurðsson EL, Sigurðardóttir Ó, Viðarsson B, Baldvinsson M, Bjarnason R, Danielsen R, Matthíasson SE, Thórarinsson BL, Grétarsdóttir S, Steinthórsdóttir V, Halldórsson BV, Andersen K, Arnar DO, Jónsdóttir I, Guðbjartsson DF, Hólm H, Thorsteinsdóttir U, Sulem P, Stefánsson K. Large-Scale Screening for Monogenic and Clinically Defined Familial Hypercholesterolemia in Iceland. Arterioscler Thromb Vasc Biol 2021; 41:2616-2628. [PMID: 34407635 PMCID: PMC8454500 DOI: 10.1161/atvbaha.120.315904] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/02/2021] [Indexed: 01/07/2023]
Abstract
Objective: Familial hypercholesterolemia (FH) is traditionally defined as a monogenic disease characterized by severely elevated LDL-C (low-density lipoprotein cholesterol) levels. In practice, FH is commonly a clinical diagnosis without confirmation of a causative mutation. In this study, we sought to characterize and compare monogenic and clinically defined FH in a large sample of Icelanders. Approach and Results: We whole-genome sequenced 49 962 Icelanders and imputed the identified variants into an overall sample of 166 281 chip-genotyped Icelanders. We identified 20 FH mutations in LDLR, APOB, and PCSK9 with combined prevalence of 1 in 836. Monogenic FH was associated with severely elevated LDL-C levels and increased risk of premature coronary disease, aortic valve stenosis, and high burden of coronary atherosclerosis. We used a modified version of the Dutch Lipid Clinic Network criteria to screen for the clinical FH phenotype among living adult participants (N=79 058). Clinical FH was found in 2.2% of participants, of whom only 5.2% had monogenic FH. Mutation-negative clinical FH has a strong polygenic basis. Both individuals with monogenic FH and individuals with mutation-negative clinical FH were markedly undertreated with cholesterol-lowering medications and only a minority attained an LDL-C target of <2.6 mmol/L (<100 mg/dL; 11.0% and 24.9%, respectively) or <1.8 mmol/L (<70 mg/dL; 0.0% and 5.2%, respectively), as recommended for primary prevention by European Society of Cardiology/European Atherosclerosis Society cholesterol guidelines. Conclusions: Clinically defined FH is a relatively common phenotype that is explained by monogenic FH in only a minority of cases. Both monogenic and clinical FH confer high cardiovascular risk but are markedly undertreated.
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Affiliation(s)
- Eythór Björnsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Department of Internal Medicine (E.B.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Guðmundur Thorgeirsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Division of Cardiology, Department of Internal Medicine (G. Thorgeirsson, R.D., K.A., D.O.A.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Anna Helgadóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Guðmar Thorleifsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Garðar Sveinbjörnsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Snaedís Kristmundsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Hákon Jónsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Aðalbjörg Jónasdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Áslaug Jónasdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Ásgeir Sigurðsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | | | - Ísleifur Ólafsson
- Department of Clinical Biochemistry (I.O.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Emil L. Sigurðsson
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Development Centre for the Primary Care, Reykjavík, Iceland (E.L.S.)
| | | | - Brynjar Viðarsson
- Department of Hematology (B.V.), Landspítali-The National University Hospital of Iceland, Reykjavík
- The Laboratory in Mjódd, Reykjavík, Iceland (B.V.)
| | | | - Ragnar Bjarnason
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Children’s Medical Center (R.B.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Ragnar Danielsen
- Division of Cardiology, Department of Internal Medicine (G. Thorgeirsson, R.D., K.A., D.O.A.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | | | - Björn L. Thórarinsson
- Department of Neurology (B.L.T.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Sólveig Grétarsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Valgerður Steinthórsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Bjarni V. Halldórsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Karl Andersen
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Division of Cardiology, Department of Internal Medicine (G. Thorgeirsson, R.D., K.A., D.O.A.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Davíð O. Arnar
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Division of Cardiology, Department of Internal Medicine (G. Thorgeirsson, R.D., K.A., D.O.A.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Ingileif Jónsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
| | - Daníel F. Guðbjartsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- School of Engineering and Natural Sciences, University of Iceland, Reykjavík (D.F.G.)
| | - Hilma Hólm
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Unnur Thorsteinsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
| | - Patrick Sulem
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Kári Stefánsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
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