Department of Medicine, McGill University, Montreal, Quebec, Canada.
Preventive and Genomic Cardiology, McGill University Health Centre and Research Institute, Montreal, Quebec, Canada.
JAMA Cardiol. 2018 Jan 1;3(1):18-23. doi: 10.1001/jamacardio.2017.4266.
IMPORTANCE: Elevated lipoprotein(a) levels are a risk factor for aortic stenosis (AS). However, a large-scale replication of associations between LPA variants and AS, their interactions with risk factors, and the effect of multiple risk alleles is not well established. OBJECTIVE: To replicate the association between LPA variants with AS and identify subgroups who are at higher risk of developing AS. DESIGN, SETTING, AND PARTICIPANTS: This case-control study of AS included 44 703 individuals (3469 cases) 55 years or older who were enrolled in the Genetic Epidemiology Research on Aging cohort and who were members of the Kaiser Permanente Northern California health care delivery system. The study leveraged the linkage of administrative health data, electronic medical records, genotypes, and self-reported questionnaire data. The 3469 AS cases were diagnosed between January 1996 and December 2015. Individuals with congential valvular heart disease were excluded. EXPOSURES: Two single-nucleotide polymorphisms in the LPA locus, rs10455872 and rs3798220, that are known to associate with circulating plasma lipoprotein(a) levels and an LPA risk score. MAIN OUTCOMES AND MEASURES: Aortic stenosis or aortic valve replacement. RESULTS: The 44 703 participants were of European ancestry,of whom 22 019 (49.3%) were men. The mean (SD) age for the control group was 69.3 (8.3) years and the mean (SD) age for AS cases was 74.6 (8.5) years. Both LPA variants were associated with AS, with a per risk allele odds ratio of 1.34 (95% CI, 1.23-1.47; P = 1.7 × 10-10) for rs10455872 and 1.31 (95% CI, 1.09-1.58; P = 3.6 × 10-3) for rs3798220 after adjusting for age, age2, and sex. The results remained significant after adjusting for risk factors. The estimates were similar for an LPA risk score. Individuals with 2 risk alleles had a 2-fold or greater odds of AS compared with individuals with no risk alleles (for rs10455872, homozygous odds ratio, 2.05; 95% CI, 1.37-3.07; P = 5.3 × 10-4; for rs3798220, homozygous odds ratio, 3.74; 95% CI, 1.03-13.62; P = .05; and for compound heterygotes, odds ratio, 2.00; 95% CI, 1.17-3.44; P = .01). For rs10455872, the odds ratio for AS was greatest in individuals aged 55 to 64 years and declined with age (interaction P = .03). Each rs10455872 risk allele was also associated with AS that was diagnosed 0.71 years earlier (95% CI, -1.42 to 0; P = .05). CONCLUSIONS AND RELEVANCE: We provide a large-scale confirmation of the association between 2 LPA variants and AS, reaching genome-wide significance. In addition, individuals with 2 risk alleles have 2-fold or greater odds of developing AS. Age may modify these associations and identify subgroups who are at greater risk of developing AS.
重要性:脂蛋白(a)水平升高是主动脉瓣狭窄(AS)的一个危险因素。然而,关于 LPA 变体与 AS 之间的关联、它们与风险因素的相互作用,以及多个风险等位基因的影响,尚未得到大规模的复制。
目的:复制 LPA 变体与 AS 之间的关联,并确定发生 AS 风险更高的亚组。
设计、设置和参与者:本研究是一项 AS 的病例对照研究,纳入了 44703 名年龄在 55 岁或以上的个体(3469 例),他们参加了遗传流行病学研究老龄化队列,并且是 Kaiser Permanente 北加利福尼亚医疗保健系统的成员。该研究利用了行政健康数据、电子病历、基因型和自我报告问卷数据的链接。3469 例 AS 病例的诊断时间在 1996 年 1 月至 2015 年 12 月之间。患有先天性瓣膜心脏病的个体被排除在外。
暴露因素:已知与循环血浆脂蛋白(a)水平和 LPA 风险评分相关的 LPA 基因座上的两个单核苷酸多态性(rs10455872 和 rs3798220)。
主要结局和测量指标:主动脉瓣狭窄或主动脉瓣置换。
结果:44703 名参与者为欧洲血统,其中 22019 名(49.3%)为男性。对照组的平均(标准差)年龄为 69.3(8.3)岁,AS 病例的平均(标准差)年龄为 74.6(8.5)岁。两个 LPA 变体均与 AS 相关,每个风险等位基因的比值比为 1.34(95%可信区间,1.23-1.47;P=1.7×10-10),rs10455872 为 1.31(95%可信区间,1.09-1.58;P=3.6×10-3),调整年龄、年龄 2 和性别后。在调整了风险因素后,结果仍然显著。对于 LPA 风险评分,结果相似。与没有风险等位基因的个体相比,具有 2 个风险等位基因的个体发生 AS 的几率增加 2 倍或以上(对于 rs10455872,同型比值比,2.05;95%可信区间,1.37-3.07;P=5.3×10-4;对于 rs3798220,同型比值比,3.74;95%可信区间,1.03-13.62;P=0.05;对于复合杂合子,比值比,2.00;95%可信区间,1.17-3.44;P=0.01)。对于 rs10455872,55 岁至 64 岁的个体发生 AS 的比值比最大,并且随着年龄的增长而下降(交互 P=0.03)。每个 rs10455872 风险等位基因也与提前 0.71 年诊断的 AS 相关(95%可信区间,-1.42 至 0;P=0.05)。
结论和相关性:我们提供了 2 个 LPA 变体与 AS 之间关联的大规模确认,达到了全基因组显著性。此外,具有 2 个风险等位基因的个体发生 AS 的几率增加 2 倍或以上。年龄可能会改变这些关联,并确定发生 AS 风险更高的亚组。
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