TY - JOUR T1 - Anticardiolipin antibodies as a risk factor for venous thromboembolism in a population-based prospective study. JF - Br J Haematol Y1 - 2002 A1 - Runchey, Shauna S A1 - Folsom, Aaron R A1 - Tsai, Michael Y A1 - Cushman, Mary A1 - McGovern, Paul D KW - Aged KW - Aged, 80 and over KW - Antibodies, Anticardiolipin KW - Case-Control Studies KW - Female KW - Humans KW - Immunoglobulin G KW - Immunoglobulin M KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Odds Ratio KW - Prospective Studies KW - Reference Values KW - Risk Factors KW - Thromboembolism KW - Venous Thrombosis AB -

Anticardiolipin antibodies, one of the family of 'antiphospholipid' antibodies, increase the risk of venous thromboembolism in the presence of autoimmune disease. Our objective was to determine prospectively whether there is a positive association between anticardiolipin antibodies and venous thromboembolism in ostensibly healthy adults. We conducted a nested case-control study (n = 317 patients and n = 655 control subjects) in a longitudinal study of over 20 000 participants. Baseline (prediagnosis) anticardiolipin IgG and IgM antibodies were assessed by enzyme-linked immunoassays. Venous thromboembolism was validated using standardized criteria for venous thrombosis and pulmonary embolism. There was no association between anticardiolipin antibodies and subsequent venous thromboembolism occurrence, overall or in any subgroup. For example, the multivariate-adjusted relative risk was 0.88 (95% confidence interval, 0.43, 1.78) for greater than versus less than the 95th percentile of anticardiolipin IgG. In conclusion, in this general population sample, an elevated anticardiolipin antibody level was not a risk factor for venous thromboembolism.

VL - 119 IS - 4 U1 - https://www.ncbi.nlm.nih.gov/pubmed/12472581?dopt=Abstract ER - TY - JOUR T1 - Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. JF - Arch Intern Med Y1 - 2002 A1 - Tsai, Albert W A1 - Cushman, Mary A1 - Rosamond, Wayne D A1 - Heckbert, Susan R A1 - Polak, Joseph F A1 - Folsom, Aaron R KW - Aged KW - Arteriosclerosis KW - Female KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Proportional Hazards Models KW - Prospective Studies KW - Pulmonary Embolism KW - Risk Factors KW - United States KW - Venous Thrombosis AB -

BACKGROUND: The association between traditional cardiovascular risk factors and risk of venous thromboembolism (VTE) has not been extensively examined in prospective studies.

METHODS: To determine whether atherosclerotic risk factors are also associated with increased incidence of VTE, we conducted a prospective study of 19 293 men and women without previous VTE in 6 US communities between 1987 and 1998.

RESULTS: There were 215 validated VTE events (1.45 per 1000 person-years) during a median of 8 years of follow-up. The age-adjusted hazard ratio was 1.4 (95% confidence interval [CI], 1.1-1.9) for men vs women, 1.6 (95% CI, 1.2-2.2) for blacks vs whites, and 1.7 (95% CI, 1.5-2.0) per decade of age. Cigarette smoking, hypertension, dyslipidemia, physical inactivity, and alcohol consumption were not associated with risk of VTE. Age-, race-, and sex-adjusted hazard ratios for body mass index categories (calculated as the weight in kilograms divided by the height in meters squared) of less than 25, 25 to less than 30, 30 to less than 35, 35 to less than 40, and 40 or more were 1.0, 1.5, 2.2, 1.5, and 2.7, respectively (P<.001 for the trend). Diabetes was also associated with an increased risk of VTE (adjusted hazard ratio, 1.5 [95% CI, 1.0-2.1]).

CONCLUSIONS: Our data showing no relationship of some arterial risk factors with VTE corroborate the view that the etiology of VTE differs from atherosclerotic cardiovascular disease. In addition, the findings suggest a hypothesis that avoidance of obesity and diabetes or vigilance in prophylaxis in patients with those conditions may prevent some venous thromboses.

VL - 162 IS - 10 U1 - https://www.ncbi.nlm.nih.gov/pubmed/12020191?dopt=Abstract ER - TY - JOUR T1 - Coagulation factors, inflammation markers, and venous thromboembolism: the longitudinal investigation of thromboembolism etiology (LITE). JF - Am J Med Y1 - 2002 A1 - Tsai, Albert W A1 - Cushman, Mary A1 - Rosamond, Wayne D A1 - Heckbert, Susan R A1 - Tracy, Russell P A1 - Aleksic, Nena A1 - Folsom, Aaron R KW - Aged KW - Biomarkers KW - Blood Coagulation Factors KW - C-Reactive Protein KW - Cohort Studies KW - Confidence Intervals KW - Factor VII KW - Female KW - Fibrinogen KW - Humans KW - Inflammation Mediators KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Prospective Studies KW - Risk Assessment KW - Risk Factors KW - Sensitivity and Specificity KW - Thromboembolism KW - Venous Thrombosis KW - von Willebrand Factor AB -

PURPOSE: We sought to assess prospectively whether higher levels of blood coagulation factors and inflammation markers are risk factors for venous thromboembolism.

SUBJECTS AND METHODS: In two pooled population-based cohort studies, we measured levels of factor VII, factor VIII, von Willebrand factor, fibrinogen, and C-reactive protein, and white blood cell count, in samples obtained from 19,237 adults with no baseline history of venous thromboembolism, cancer, or warfarin use. The endpoint was validated venous thromboembolism during follow-up (median, 7.8 years).

RESULTS: A total of 159 venous thromboembolism events occurred. Factor VIII and von Willebrand factor were linearly associated with increased risk of venous thromboembolism (P for trend <0.0001). As compared with those in the lowest quartile, the multivariate-adjusted hazard ratio (HR) of venous thromboembolism was 2.6 (95% confidence interval [CI]: 1.6 to 4.3) for factor VIII levels in the highest quartile and 3.8 (95% CI: 2.0 to 7.2) for the highest fifth percentile. For von Willebrand factor, the hazard ratios in middle-aged subjects were 4.6 (95% CI: 2.2 to 9.2) for the highest quartile and 7.6 (95% CI: 3.1 to 18) for the highest fifth percentile. Factor VII levels above the 95th percentile, as compared with the lowest quartile, also conveyed a higher risk of venous thromboembolism (HR = 2.4; 95% CI: 1.2 to 4.8). In contrast, there was no association of venous thromboembolism with fibrinogen or C-reactive protein levels, or white cell count.

CONCLUSIONS: In this prospective study, elevated factor VIII and von Willebrand factor levels were common, independent, and dose-dependent risk factors for venous thromboembolism, and an elevated factor VII level was a possible risk factor. Venous thromboembolism, unlike arterial disease, was not related to inflammatory markers.

VL - 113 IS - 8 U1 - https://www.ncbi.nlm.nih.gov/pubmed/12505113?dopt=Abstract ER - TY - JOUR T1 - Prospective study of the G20210A polymorphism in the prothrombin gene, plasma prothrombin concentration, and incidence of venous thromboembolism. JF - Am J Hematol Y1 - 2002 A1 - Folsom, Aaron R A1 - Cushman, Mary A1 - Tsai, Michael Y A1 - Heckbert, Susan R A1 - Aleksic, Nena KW - African Continental Ancestry Group KW - Age Factors KW - Aged KW - Case-Control Studies KW - European Continental Ancestry Group KW - Genotype KW - Humans KW - Incidence KW - Middle Aged KW - Odds Ratio KW - Polymorphism, Single Nucleotide KW - Prospective Studies KW - Prothrombin KW - Recurrence KW - Research Design KW - Risk Factors KW - Thromboembolism KW - United States AB -

Case-control studies have indicated increased risk of venous thrombosis associated with the prothrombin gene G20210A polymorphism and with elevated plasma prothrombin levels. We sought to confirm these results in a prospective population-based study of 21,690 persons. We measured G20210A and prothrombin antigen on pre-event blood samples of 302 participants who developed venous thromboembolism (VTE) and 626 participants who remained free of VTE. Approximately 4.0% of cases and 2.4% of controls carried the G20210A polymorphism, but only one of 137 African Americans did. The odds ratio in whites was 1.87 (95% CI = 0.85, 4.11)--higher for those who reported a prior history of VTE (OR = 5.44) than those reporting no VTE history (OR = 1.41) and in those with idiopathic VTE (OR = 2.51) than those with secondary VTE (OR = 1.38). There was no association between venous thromboembolism and plasma prothrombin antigen level. We estimated that the G20210A polymorphism may account for approximately 2.5% of venous thromboembolism events in United States whites.

VL - 71 IS - 4 U1 - https://www.ncbi.nlm.nih.gov/pubmed/12447958?dopt=Abstract ER - TY - JOUR T1 - A prospective study of venous thromboembolism in relation to factor V Leiden and related factors. JF - Blood Y1 - 2002 A1 - Folsom, Aaron R A1 - Cushman, Mary A1 - Tsai, Michael Y A1 - Aleksic, Nena A1 - Heckbert, Susan R A1 - Boland, Lori L A1 - Tsai, Albert W A1 - Yanez, N David A1 - Rosamond, Wayne D KW - Activated Protein C Resistance KW - Aged KW - Cohort Studies KW - Continental Population Groups KW - Factor V KW - Genotype KW - Haplotypes KW - Humans KW - Incidence KW - Longitudinal Studies KW - Middle Aged KW - Odds Ratio KW - Prospective Studies KW - Risk Factors KW - Thromboembolism KW - Venous Thrombosis AB -

The aim of this study was to examine the occurrence of venous thromboembolism (VTE) in relation to factor V-related risk factors. Using a nested case-control design combining 2 population-based prospective studies, we measured factor V Leiden, HR2 haplotype, activated protein C (APC) resistance, and plasma factor V antigen in 335 participants who developed VTE during 8 years of follow-up and 688 controls. The overall odds ratio (OR) of VTE was 3.67 (95% CI, 2.20-6.12) in participants carrying factor V Leiden compared with noncarriers. APC resistance measured after predilution with factor V-deficient plasma conferred an OR of 2.58 (95% CI, 1.62-4.10). All 3 participants homozygous for the HR2 haplotype had a VTE, and the OR of VTE for homozygosity was estimated to be 5.5 (95% CI, 2.45-12.5). Carriers of the HR2 haplotype otherwise were not at increased risk of VTE overall (OR = 1.05; 95% CI, 0.64-1.72), but double heterozygotes for HR2 and factor V Leiden carried an OR of idiopathic VTE of 16.3 (95% CI, 1.7-159) compared with noncarriers. Factor V antigen also was not associated with VTE overall, but for participants with the combination of high factor V antigen plus factor V Leiden the OR of idiopathic VTE was 11.5 (95% CI, 4.2-31.4). In the general population, APC resistance and factor V Leiden were important VTE risk factors; homozygosity for the HR2 haplotype may be a risk factor but was rare; otherwise, HR2 haplotype and factor V antigen were not risk factors except in carriers of factor V Leiden.

VL - 99 IS - 8 U1 - https://www.ncbi.nlm.nih.gov/pubmed/11929758?dopt=Abstract ER - TY - JOUR T1 - Protein C, antithrombin, and venous thromboembolism incidence: a prospective population-based study. JF - Arterioscler Thromb Vasc Biol Y1 - 2002 A1 - Folsom, Aaron R A1 - Aleksic, Nena A1 - Wang, Lu A1 - Cushman, Mary A1 - Wu, Kenneth K A1 - White, Richard H KW - Adult KW - Aged KW - Aged, 80 and over KW - Antithrombins KW - Arteriosclerosis KW - Cohort Studies KW - Humans KW - Incidence KW - Longitudinal Studies KW - Middle Aged KW - Odds Ratio KW - Population Surveillance KW - Prospective Studies KW - Protein C KW - Protein C Deficiency KW - Pulmonary Embolism KW - Thromboembolism KW - Venous Thrombosis AB -

Although deficiencies of protein C and antithrombin, 2 natural plasma anticoagulants, are known risk factors for venous thrombosis, population-based prospective incidence data on these associations are lacking. Venous thromboembolic events have been identified in adults in 2 longitudinal cohort studies, the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS). Incidence was examined in relation to prediagnostic plasma levels of protein C (ARIC Study only) and antithrombin. Over a mean of 8.1 years of follow-up, there were 130 incident venous thromboembolic events that were not due to cancer in the ARIC Study. The age-adjusted incidence was elevated 3.36-fold (95% CI 1.24 to 9.11) in the 1.1% of subjects with protein C values <2.0 mg/L compared with subjects with higher values. In contrast, in the ARIC Study and the CHS, there was no association between low plasma antithrombin and venous thromboembolism. In conclusion, in this population-based study, a low protein C, but not antithrombin, level has been determined to be associated with an increased incidence of venous thromboembolism. Attributable risk estimates suggest that low protein C levels account for approximately 2.5% of venous thromboembolic events in the ARIC population.

VL - 22 IS - 6 U1 - https://www.ncbi.nlm.nih.gov/pubmed/12067914?dopt=Abstract ER - TY - JOUR T1 - Fibrin fragment D-dimer and the risk of future venous thrombosis. JF - Blood Y1 - 2003 A1 - Cushman, Mary A1 - Folsom, Aaron R A1 - Wang, Lu A1 - Aleksic, Nena A1 - Rosamond, Wayne D A1 - Tracy, Russell P A1 - Heckbert, Susan R KW - Aged KW - Body Mass Index KW - Cohort Studies KW - Continental Population Groups KW - Factor V KW - Factor VIII KW - Female KW - Fibrin Fibrinogen Degradation Products KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Odds Ratio KW - Prospective Studies KW - Prothrombin KW - Risk Factors KW - Venous Thrombosis AB -

Plasma D-dimer concentration rises more than 100-fold during acute deep vein thrombosis, but there are no prospective data concerning D-dimer as a risk factor for incident venous thrombosis in a general population. Incident venous thrombosis was ascertained in 2 prospective observational studies, the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. Of 21 690 participants enrolled between 1987 and 1993, after 8 years of follow-up, D-dimer was measured using baseline stored plasma of 307 participants who developed venous thrombosis and 616 who did not. Relative to the first quintile of the distribution of D-dimer, the age-adjusted odds ratios for future venous thrombosis for the second to fifth quintiles of D-dimer were 1.6, 2.3, 2.3, and 4.2, respectively (P for trend <.0001). Following added adjustment for sex, race, body mass index, factor V Leiden, prothrombin 20210A, and elevated factor VIII coagulant activity (factor VIII:c), these odds ratios were 1.5, 2.1, 1.9, and 3.0, respectively (P for trend <.0001). Among those with idiopathic thrombosis or secondary thrombosis unrelated to cancer, the adjusted fifth quintile odds ratios were 3.5 and 4.8, respectively. By contrast, D-dimer in the fifth versus first quintile was not related to occurrence of cancer-associated thrombosis (odds ratio, 1.1). Odds ratios for elevated D-dimer were consistently elevated in subgroups defined by age, sex, race, duration of follow-up, and thrombosis type (deep vein thrombosis or pulmonary embolus). D-dimer is strongly and positively related to the occurrence of future venous thrombosis.

VL - 101 IS - 4 U1 - https://www.ncbi.nlm.nih.gov/pubmed/12393393?dopt=Abstract ER - TY - JOUR T1 - Prospective study of fibrinolytic markers and venous thromboembolism. JF - J Clin Epidemiol Y1 - 2003 A1 - Folsom, Aaron R A1 - Cushman, Mary A1 - Heckbert, Susan R A1 - Rosamond, Wayne D A1 - Aleksic, Nena KW - Aged KW - alpha-2-Antiplasmin KW - Antifibrinolytic Agents KW - Biomarkers KW - Caenorhabditis elegans Proteins KW - Case-Control Studies KW - Female KW - Fibrinolysin KW - Fibrinolysis KW - Humans KW - Male KW - Middle Aged KW - Odds Ratio KW - Plasminogen Activator Inhibitor 1 KW - Prognosis KW - Prospective Studies KW - Protein-Tyrosine Kinases KW - Risk Factors KW - Thromboembolism KW - Venous Thrombosis AB -

Prior research has conflicted on whether increased levels of plasma fibrinolytic factors may identify patients at risk of venous thromboembolism (VTE). We therefore performed a nested case-control study of VTE within two prospective population-based studies. In 308 participants who developed VTE and 640 controls, we measured PAI-1 antigen, tPA/PAI-1 complex, plasmin-alpha 2-antiplasmin (PAP), and the PAI-1 -675 4G/5G promoter polymorphism on pre-event blood samples. There was no overall association between any of these fibrinolytic variables and VTE, after adjustment for age or for multiple VTE risk factors. There was weak evidence for an interaction of PAP with elevated factor VIIIc and elevated D-dimer in augmenting VTE risk. We conclude that, for the most part, these fibrinolytic markers do not identify healthy subjects at risk for VTE.

VL - 56 IS - 6 U1 - https://www.ncbi.nlm.nih.gov/pubmed/12873656?dopt=Abstract ER - TY - JOUR T1 - Serum homocysteine, thermolabile variant of methylene tetrahydrofolate reductase (MTHFR), and venous thromboembolism: Longitudinal Investigation of Thromboembolism Etiology (LITE). JF - Am J Hematol Y1 - 2003 A1 - Tsai, Albert W A1 - Cushman, Mary A1 - Tsai, Michael Y A1 - Heckbert, Susan R A1 - Rosamond, Wayne D A1 - Aleksic, Nena A1 - Yanez, N David A1 - Psaty, Bruce M A1 - Folsom, Aaron R KW - Aged KW - Aging KW - Animals KW - Case-Control Studies KW - Cohort Studies KW - Factor V KW - Female KW - Genotype KW - Homocysteine KW - Humans KW - Longitudinal Studies KW - Male KW - Methylenetetrahydrofolate Reductase (NADPH2) KW - Middle Aged KW - Odds Ratio KW - Oxidoreductases Acting on CH-NH Group Donors KW - Polymorphism, Genetic KW - Prospective Studies KW - Risk Factors KW - Venous Thrombosis AB -

We sought to examine prospectively the association of serum homocysteine and the methylene tetrahydrofolate reductase (MTHFR) C677T gene polymorphism with risk of venous thromboembolism (VTE). We studied these relationships in a nested case-control study of 303 VTE cases and 635 matched controls from a population-based cohort of 21,680 adults from six U.S. communities. The highest quintile of serum homocysteine carried a non-statistically significant adjusted odds ratio of 1.55 (95% CI, 0.93-2.58) compared to the lowest quintile in the overall cohort but a significant association among adults aged 45-64 years (OR = 2.05, 95% CI, 1.10-3.83) and an inverse association in those > or = 65 years of age. Carriers of the MTHFR C677T polymorphism were not at higher risk for VTE than those with normal genotype (OR = 0.74, 95% CI = 0.56-0.98). Our prospective data showed, at most, a weak relationship between homocysteine and VTE risk, with associations larger among younger participants. MTHFR C677T was not a risk factor for VTE.

VL - 72 IS - 3 U1 - https://www.ncbi.nlm.nih.gov/pubmed/12605391?dopt=Abstract ER - TY - JOUR T1 - Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. JF - Am J Med Y1 - 2004 A1 - Cushman, Mary A1 - Tsai, Albert W A1 - White, Richard H A1 - Heckbert, Susan R A1 - Rosamond, Wayne D A1 - Enright, Paul A1 - Folsom, Aaron R KW - Aged KW - Case-Control Studies KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Neoplasms KW - Population Surveillance KW - Pulmonary Embolism KW - Recurrence KW - Risk Factors KW - Survival Rate KW - Venous Thrombosis AB -

PURPOSE: To determine the incidence of deep vein thrombosis and pulmonary embolism in two cohorts representing regions of the United States.

METHODS: The sample comprised 21,680 participants of the Atherosclerosis Risk in Communities study and the Cardiovascular Health Study. Subjects were aged >/=45 years, resided in six communities, and were followed for 7.6 years. All hospitalizations were identified and thromboses were validated by chart review.

RESULTS: The age-standardized incidence of first-time venous thromboembolism was 1.92 per 1000 person-years. Rates were higher in men than women, and increased with age in both sexes. There was no antecedent trauma, surgery, immobilization, or diagnosis of cancer for 48% (175/366) of events. The 28-day case-fatality rate was 11% (29/265) after a first venous thromboembolism and 25% (17/67) for cancer-associated thrombosis. The recurrence rate 2 years after a first venous thromboembolism was 7.7% per year (95% confidence interval [CI]: 4.5% to 10.9% per year). Cancer was the only factor independently associated with 28-day fatality (relative risk [RR] = 5.2; 95% CI: 1.4 to 19.9) or recurrent thrombosis (RR = 9.2; 95% CI: 2.0 to 41.7).

CONCLUSION: The incidence of venous thromboembolism in this cohort of middle- and older-aged subjects was similar to that observed in more geographically homogeneous samples. Half of cases were idiopathic. Short-term mortality and 2-year recurrence rates were appreciable, especially among subjects with cancer. Based on this study we estimate that 187,000 cases of first-time venous thromboembolism are diagnosed yearly in the United States among those aged 45 years or older.

VL - 117 IS - 1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/15210384?dopt=Abstract ER - TY - JOUR T1 - The association of alpha-fibrinogen Thr312Ala polymorphism and venous thromboembolism in the LITE study. JF - Thromb Res Y1 - 2007 A1 - Rasmussen-Torvik, Laura J A1 - Cushman, Mary A1 - Tsai, Michael Y A1 - Zhang, Yan A1 - Heckbert, Susan R A1 - Rosamond, Wayne D A1 - Folsom, Aaron R KW - African Continental Ancestry Group KW - Aged KW - Case-Control Studies KW - European Continental Ancestry Group KW - Female KW - Fibrinogen KW - Genotype KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Mutation, Missense KW - Polymorphism, Genetic KW - Venous Thromboembolism AB -

INTRODUCTION: The alpha-fibrinogen Thr312Ala variant has been shown to influence clot structure through increased factor XIII cross-linking and formation of thicker fibrin fibers. However, the effect of this common variant on risk of venous thromboembolism (VTE) is unclear. This paper reports the association between the Thr312Ala variant and VTE in the LITE study.

MATERIALS AND METHODS: 506 cases and 1014 controls frequency matched on age, sex, race, and study were drawn from two prospective studies and included in the analysis. Logistic regression was used to examine the association between Thr312Ala and VTE.

RESULTS: In a logistic regression model minimally adjusted for the matching variables, the Thr312Ala TA and AA genotypes were associated with a significantly higher risk of VTE than the TT genotype (TA OR and 95% confidence interval 1.27 [1.01-1.60], AA OR 1.49 [1.00-2.22]). Associations were similar in analyses of PE and DVT considered separately and across racial and study subgroups. The association between alpha-fibrinogen Thr312Ala and VTE was modified by both BMI and the FXIII Val34Leu variant; the combination of elevated BMI or FXIII Val34Leu with alpha-fibrinogen Thr312Ala conveyed lower odds of VTE than would be expected by an additive or multiplicative model of individual risk factors.

CONCLUSIONS: These results suggest that alpha-fibrinogen Thr312Ala is involved in the pathogenesis of VTE and that its action may be modified by other VTE risk factors.

VL - 121 IS - 1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/17433418?dopt=Abstract ER - TY - JOUR T1 - Frailty and risk of venous thromboembolism in older adults. JF - J Gerontol A Biol Sci Med Sci Y1 - 2007 A1 - Folsom, Aaron R A1 - Boland, Lori L A1 - Cushman, Mary A1 - Heckbert, Susan R A1 - Rosamond, Wayne D A1 - Walston, Jeremy D KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Female KW - Follow-Up Studies KW - Frail Elderly KW - Humans KW - Male KW - Morbidity KW - Motor Activity KW - Prospective Studies KW - Risk Factors KW - Thromboembolism KW - United States KW - Venous Thrombosis AB -

BACKGROUND: Frailty is a common risk factor for morbidity and mortality in elderly persons. Recent evidence links frailty to activation of coagulation and inflammatory pathways. We aimed to determine whether frailty in community-dwelling older adults is a risk factor for venous thromboembolism (VTE).

METHODS: We conducted a prospective cohort study in four U.S. communities involving 4859 participants 65 years old and older. At baseline, in 1989-1993, we assessed frailty based on weight loss, grip strength, feelings of exhaustion, walk time, and physical activity. Incident VTE (deep vein thrombosis or pulmonary embolus) through 2002 was identified by review of hospital records.

RESULTS: Fifty-two percent of the sample was classified as having intermediate or definite frailty. After adjustment for age, race, sex, body mass index, and diabetes, the relative risk of total VTE (n = 150) for people who were frail compared with no frailty was 1.31 (95% confidence interval [CI], 0.93-1.84). The comparably adjusted relative risk for idiopathic VTE (n = 58) was 1.79 (95% CI, 1.02-3.13).

CONCLUSIONS: The incidence rates of idiopathic VTE was higher in community-dwelling older adults with baseline frailty compared with no frailty. Further studies of the clotting process in frailty may allow the development of an improved strategy to determine VTE risk in this vulnerable subset of older adults.

VL - 62 IS - 1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/17301042?dopt=Abstract ER - TY - JOUR T1 - Risk factors for intracerebral hemorrhage in a pooled prospective study. JF - Stroke Y1 - 2007 A1 - Sturgeon, Jared D A1 - Folsom, Aaron R A1 - Longstreth, W T A1 - Shahar, Eyal A1 - Rosamond, Wayne D A1 - Cushman, Mary KW - African Americans KW - Age Distribution KW - Cerebral Hemorrhage KW - Cholesterol, LDL KW - Female KW - Follow-Up Studies KW - Humans KW - Hypertension KW - Incidence KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Predictive Value of Tests KW - Prevalence KW - Prospective Studies KW - Risk Factors KW - Stroke KW - Triglycerides AB -

BACKGROUND AND PURPOSE: Few prospective studies have reported risk factors for intracerebral hemorrhage (ICH), and results are inconsistent. We studied risk factors for ICH in a pooled cohort of the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS).

METHODS: The ARIC cohort was recruited in 1987 to 1989 and involves 15 792 men and women, aged 45 to 64 years at baseline, sampled from 4 US communities. The CHS cohort was recruited in 1989 to 1993 and involves 5888 men and women, aged 65 or over at baseline, sampled from 4 US communities. Baseline measurements included many potential vascular risk factors. The cohorts were followed for incident stroke events.

RESULTS: Over 263 489 person-years of follow-up, 135 incident ICH events occurred. In a multivariable model, age, African-American ethnicity (versus Whites), and hypertension were positively associated with incident ICH, whereas low-density lipoprotein cholesterol and triglycerides were inversely related to incident ICH. Participants with systolic blood pressure >or=160 mm Hg or diastolic blood pressure >/=110 mm Hg had 5.55 (95% CI 3.07 to 10.0) times the rate of ICH as nonhypertensives. Sex, smoking, alcohol intake, body mass index, waist-to-hip ratio, waist circumference, and diabetes were not related to ICH.

CONCLUSIONS: In this pooled cohort the risk factors for ICH were older age, African-American ethnicity, hypertension, lower LDL-C, and lower triglycerides.

VL - 38 IS - 10 U1 - https://www.ncbi.nlm.nih.gov/pubmed/17761915?dopt=Abstract ER - TY - JOUR T1 - Chronic kidney disease increases risk for venous thromboembolism. JF - J Am Soc Nephrol Y1 - 2008 A1 - Wattanakit, Keattiyoat A1 - Cushman, Mary A1 - Stehman-Breen, Catherine A1 - Heckbert, Susan R A1 - Folsom, Aaron R KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Diabetic Nephropathies KW - Factor VIII KW - Female KW - Glomerular Filtration Rate KW - Humans KW - Hypertension KW - Kidney Failure, Chronic KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Risk Factors KW - Thromboembolism KW - Venous Thrombosis AB -

Chronic kidney disease (CKD) is associated with increased risk for cardiovascular disease morbidity and mortality, but its association with incident venous thromboembolism (VTE) in non-dialysis-dependent patients has not been evaluated in a community-based population. With the use of data from the Longitudinal Investigation of Thromboembolism Etiology (LITE) study, 19,073 middle-aged and elderly adults were categorized on the basis of estimated GFR, and cystatin C (available in 4734 participants) was divided into quintiles. During a mean follow-up time of 11.8 yr, 413 participants developed VTE. Compared with participants with normal kidney function, relative risk for VTE was 1.28 (95% confidence interval [CI] 1.02 to 1.59) for those with mildly decreased kidney function and 2.09 (95% CI 1.47 to 2.96) for those with stage 3/4 CKD, when adjusted for age, gender, race, and center. After additional adjustment for cardiovascular disease risk factors, an increased risk for VTE was still observed in participants with stage 3/4 CKD, with a multivariable adjusted relative risk of 1.71 (95% CI 1.18 to 2.49). There was no significant association between cystatin C and VTE. In conclusion, middle-aged and elderly patients with CKD (stages 3 through 4) are at increased risk for incident VTE, suggesting that VTE prophylaxis may be particularly important in this population.

VL - 19 IS - 1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18032796?dopt=Abstract ER - TY - JOUR T1 - Hemostatic and inflammatory risk factors for intracerebral hemorrhage in a pooled cohort. JF - Stroke Y1 - 2008 A1 - Sturgeon, Jared D A1 - Folsom, Aaron R A1 - Longstreth, W T A1 - Shahar, Eyal A1 - Rosamond, Wayne D A1 - Cushman, Mary KW - Age Distribution KW - Aged KW - Biomarkers KW - C-Reactive Protein KW - Cerebral Hemorrhage KW - Cohort Studies KW - Factor VIII KW - Female KW - Fibrinogen KW - Follow-Up Studies KW - Humans KW - Leukocyte Count KW - Lipoprotein(a) KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Prevalence KW - Risk Factors KW - Stroke KW - United States KW - Vasculitis KW - von Willebrand Factor AB -

BACKGROUND AND PURPOSE: The purpose of this study was to identify novel risk factors for intracerebral hemorrhagic stroke (ICH).

METHODS: Risk factors were assessed at baseline in a pooled cohort of the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS) involving 21,680 adults aged 45 or over. Over 263,489 person-years of follow-up, we identified 135 incident ICH events.

RESULTS: In multivariable models, for each SD higher baseline level of fibrinogen, the relative rate of incident ICH increased 35% (95% CI, 17% to 55%). Fibrinogen was more strongly related to ICH in ARIC than in CHS. In multivariable models, those with von Willebrand factor levels above the median were 1.72 (95% CI, 0.97 to 3.03) times more likely to have an incident ICH as those below the median. Factor VIII was significantly positively related to ICH in ARIC (relative rate per standard deviation of 1.31; 95% CI, 1.07 to 1.62), but not in CHS. There was no relation in multivariable models between lipoprotein (a), Factor VII, white blood cell count, or C-reactive protein and ICH.

CONCLUSIONS: Greater plasma fibrinogen and, to some degree, von Willebrand factor were associated with increased rates of ICH in these prospective studies, whereas Factor VIII was related to ICH in younger ARIC study participants only.

VL - 39 IS - 8 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18535282?dopt=Abstract ER - TY - JOUR T1 - High-density lipoprotein cholesterol and venous thromboembolism in the Longitudinal Investigation of Thromboembolism Etiology (LITE). JF - Blood Y1 - 2008 A1 - Chamberlain, Alanna M A1 - Folsom, Aaron R A1 - Heckbert, Susan R A1 - Rosamond, Wayne D A1 - Cushman, Mary KW - Aged KW - Apolipoprotein A-I KW - Cholesterol, HDL KW - Female KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - United States KW - Venous Thromboembolism AB -

We determined prospectively the risk of venous thromboembolism (VTE) in relation to baseline high-density lipoprotein cholesterol (HDL-c) in 19 049 participants of the Longitudinal Investigation of Thromboembolism Etiology (LITE), which was composed of 14 490 participants of the Atherosclerosis Risk in Communities (ARIC) study and 4559 participants of the Cardiovascular Health Study (CHS). In addition, we determined the risk of VTE in relation to baseline subfractions of HDL (HDL(2) and HDL(3)) and apolipoprotein A-I (apoA-I) in 14 488 participants of the ARIC study. Age-adjusted incidence rates of VTE by HDL-c quartile ranged from 1.64 to 1.91 per 1000 person-years in men and 1.40 to 1.94 per 1000 person-years in women; however, there was no apparent trend of VTE incidence across HDL-c quartiles for either sex. The multivariate adjusted hazard ratios of VTE by HDL-c quartiles (with quartile 4 as the reference) were nonsignificant for both sexes and ranged between 0.91 and 0.99 for men and 0.78 and 1.22 for women. Results did not differ in separate evaluations of idiopathic and secondary VTE. In the ARIC study, there was no trend of VTE hazard ratios across quartiles of HDL(2), HDL(3), or apoA-I. Low HDL-c does not appear to be an important VTE risk factor.

VL - 112 IS - 7 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18614761?dopt=Abstract ER - TY - JOUR T1 - Lipoprotein-associated phospholipase A2 and risk of venous thrombosis in older adults. JF - Am J Hematol Y1 - 2008 A1 - Olson, Nels A1 - O'Meara, Ellen S A1 - Jenny, Nancy S A1 - Folsom, Aaron R A1 - Bovill, Edwin G A1 - Furberg, Curt D A1 - Heckbert, Susan R A1 - Psaty, Bruce M A1 - Cushman, Mary KW - 1-Alkyl-2-acetylglycerophosphocholine Esterase KW - Aged KW - Female KW - Humans KW - Male KW - Risk Factors KW - Venous Thrombosis AB -

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an enzyme involved in inflammation and platelet function. Inherited deficiency and elevated levels are associated with atherosclerosis. Given potential common etiologies of atherosclerosis and venous thrombosis (VT), we hypothesized that low and high Lp-PLA2 would be associated with VT risk. Lp-PLA(2) mass and activity were measured in baseline samples of Cardiovascular Health Study participants (5,888 men and women age > or =65), excluding 354 reporting pre-baseline VT. The study endpoint was VT unrelated to cancer after 11.6 years follow-up. Hazard ratios were estimated using Cox proportional hazard models, adjusting for age, race, sex, and body-mass index. With 129 cases of VT, there was no association of Lp-PLA2 activity with risk. Adjusted hazard ratios were 1.19 (CI 0.62, 2.29) and 0.87 (CI 0.43, 1.76) for the lowest and highest decile, respectively, compared to the 10-25th percentile. Corresponding hazard ratios for Lp-PLA2 mass were 1.63 (CI 0.79, 3.34) and 1.33 (CI 0.61, 2.87). Results were robust to several definitions of low or high Lp-PLA2. While the association of Lp-PLA(2) levels with arterial disease events implies a role for this enzyme in atherogenesis, our findings suggest that it is not prothrombotic.

VL - 83 IS - 7 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18383322?dopt=Abstract ER - TY - JOUR T1 - The relationship between exercise and risk of venous thrombosis in elderly people. JF - J Am Geriatr Soc Y1 - 2008 A1 - van Stralen, Karlijn J A1 - Doggen, Carine J M A1 - Lumley, Thomas A1 - Cushman, Mary A1 - Folsom, Aaron R A1 - Psaty, Bruce M A1 - Siscovick, David A1 - Rosendaal, Frits R A1 - Heckbert, Susan R KW - Aged KW - Aged, 80 and over KW - Case-Control Studies KW - Cohort Studies KW - Energy Metabolism KW - Exercise KW - Female KW - Humans KW - Male KW - Prevalence KW - Risk Factors KW - United States KW - Venous Thrombosis AB -

OBJECTIVES: To study whether exercise is associated with the risk of venous thrombosis in elderly people.

DESIGN: Observational study with a median follow-up of 11.6 years.

SETTING: The Cardiovascular Health Study in four U.S. communities.

PARTICIPANTS: People aged 65 and older without prior venous thrombosis (deep venous thrombosis or pulmonary embolism).

MEASUREMENTS: Self-reported exercise was measured two or three times during follow-up and was defined as expending more than 500 kcal/wk on exercise, including walking for exercise. Venous thrombosis cases were verified using medical record review.

RESULTS: Of 5,534 participants, 171 developed a first venous thrombosis. Self-reported exercise at baseline was not related to the risk of venous thrombosis after adjustment for sex, age, race, self-reported health, and body mass index (adjusted hazard ratio (HR(adj))=1.16, 95% confidence interval (CI)=0.84-1.61), although with exercise modeled as a time-varying exposure, overall results were in the direction of greater risk of venous thrombosis (HR(adj)=1.38, 95% CI=0.99-1.91). For mild-intensity exercise, such as walking, there was a nonsignificant finding in the direction of benefit (HR(adj)=0.75, 95% CI=0.49-1.16), but strenuous exercise, such as jogging, was associated with greater risk of venous thrombosis (HR(adj)=1.75, 95% CI=1.08-2.83) than no exercise at all.

CONCLUSION: In elderly people, strenuous exercise was associated with a higher risk of venous thrombosis than no exercise at all. Future studies are needed to explain this unexpected higher risk.

VL - 56 IS - 3 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18179500?dopt=Abstract ER - TY - JOUR T1 - Association of novel genetic Loci with circulating fibrinogen levels: a genome-wide association study in 6 population-based cohorts. JF - Circ Cardiovasc Genet Y1 - 2009 A1 - Dehghan, Abbas A1 - Yang, Qiong A1 - Peters, Annette A1 - Basu, Saonli A1 - Bis, Joshua C A1 - Rudnicka, Alicja R A1 - Kavousi, Maryam A1 - Chen, Ming-Huei A1 - Baumert, Jens A1 - Lowe, Gordon D O A1 - McKnight, Barbara A1 - Tang, Weihong A1 - de Maat, Moniek A1 - Larson, Martin G A1 - Eyhermendy, Susana A1 - McArdle, Wendy L A1 - Lumley, Thomas A1 - Pankow, James S A1 - Hofman, Albert A1 - Massaro, Joseph M A1 - Rivadeneira, Fernando A1 - Kolz, Melanie A1 - Taylor, Kent D A1 - van Duijn, Cornelia M A1 - Kathiresan, Sekar A1 - Illig, Thomas A1 - Aulchenko, Yurii S A1 - Volcik, Kelly A A1 - Johnson, Andrew D A1 - Uitterlinden, André G A1 - Tofler, Geoffrey H A1 - Gieger, Christian A1 - Psaty, Bruce M A1 - Couper, David J A1 - Boerwinkle, Eric A1 - Koenig, Wolfgang A1 - O'Donnell, Christopher J A1 - Witteman, Jacqueline C A1 - Strachan, David P A1 - Smith, Nicholas L A1 - Folsom, Aaron R KW - Adult KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Fibrinogen KW - Genetic Loci KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Pedigree KW - Polymorphism, Single Nucleotide KW - Young Adult AB -

BACKGROUND: Fibrinogen is both central to blood coagulation and an acute-phase reactant. We aimed to identify common variants influencing circulation fibrinogen levels.

METHODS AND RESULTS: We conducted a genome-wide association analysis on 6 population-based studies, the Rotterdam Study, the Framingham Heart Study, the Cardiovascular Health Study, the Atherosclerosis Risk in Communities Study, the Monitoring of Trends and Determinants in Cardiovascular Disease/KORA Augsburg Study, and the British 1958 Birth Cohort Study, including 22 096 participants of European ancestry. Four loci were marked by 1 or more single-nucleotide polymorphisms that demonstrated genome-wide significance (P<5.0 x 10(-8)). These included a single-nucleotide polymorphism located in the fibrinogen beta chain (FGB) gene and 3 single-nucleotide polymorphisms representing newly identified loci. The high-signal single-nucleotide polymorphisms were rs1800789 in exon 7 of FGB (P=1.8 x 10(-30)), rs2522056 downstream from the interferon regulatory factor 1 (IRF1) gene (P=1.3 x 10(-15)), rs511154 within intron 1 of the propionyl coenzyme A carboxylase (PCCB) gene (P=5.9 x 10(-10)), and rs1539019 on the NLR family pyrin domain containing 3 isoforms (NLRP3) gene (P=1.04 x 10(-8)).

CONCLUSIONS: Our findings highlight biological pathways that may be important in regulation of inflammation underlying cardiovascular disease.

VL - 2 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20031576?dopt=Abstract ER - TY - JOUR T1 - Coagulation factors IX through XIII and the risk of future venous thrombosis: the Longitudinal Investigation of Thromboembolism Etiology. JF - Blood Y1 - 2009 A1 - Cushman, Mary A1 - O'Meara, Ellen S A1 - Folsom, Aaron R A1 - Heckbert, Susan R KW - Aged KW - Aged, 80 and over KW - Case-Control Studies KW - Factor IX KW - Factor X KW - Factor XI KW - Factor XII KW - Factor XIII KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Odds Ratio KW - Prospective Studies KW - Risk Factors KW - Venous Thromboembolism AB -

Higher levels of procoagulant factors and factor XII deficiency may be risk factors for first venous thromboembolism (VTE). We studied associations of coagulation factors IX through XIII with risk of future VTE in 2 general population samples. Using a nested case-control study combining the 21 860 participants of the Atherosclerosis Risk in Communities study and the Cardiovascular Health Study, we determined antigenic levels of these coagulation factors in primarily pre-event blood samples from 462 participants who subsequently developed VTE and 1047 participants who remained free of VTE. Only elevated levels of factors IX and XI were associated with increased risk of VTE after adjustment for age, sex, race, and study. For factor IX, the odds ratio (OR) was 1.4 (95% confidence interval [CI], 1.0-2.0) comparing the top to bottom quintile. The OR for factor XI was higher: 2.0 (95% CI, 1.4-2.9). With further adjustment for body mass index and diabetes, only elevated factor XI remained associated with VTE risk: OR 1.8 (95% CI, 1.3-2.7). Associations were similar by study and whether the thrombosis was idiopathic or secondary. Factor XII deficiency was not related to VTE risk. Among these procoagulant factors, only elevated factor XI was a risk factor for VTE.

VL - 114 IS - 14 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19617576?dopt=Abstract ER - TY - JOUR T1 - Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium: Design of prospective meta-analyses of genome-wide association studies from 5 cohorts. JF - Circ Cardiovasc Genet Y1 - 2009 A1 - Psaty, Bruce M A1 - O'Donnell, Christopher J A1 - Gudnason, Vilmundur A1 - Lunetta, Kathryn L A1 - Folsom, Aaron R A1 - Rotter, Jerome I A1 - Uitterlinden, André G A1 - Harris, Tamara B A1 - Witteman, Jacqueline C M A1 - Boerwinkle, Eric KW - Adult KW - Aged KW - Aging KW - Cohort Studies KW - Female KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Genotype KW - Heart Diseases KW - Humans KW - Male KW - Meta-Analysis as Topic KW - Middle Aged KW - Phenotype KW - Research Design KW - Risk Factors AB -

BACKGROUND: The primary aim of genome-wide association studies is to identify novel genetic loci associated with interindividual variation in the levels of risk factors, the degree of subclinical disease, or the risk of clinical disease. The requirement for large sample sizes and the importance of replication have served as powerful incentives for scientific collaboration. Methods- The Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium was formed to facilitate genome-wide association studies meta-analyses and replication opportunities among multiple large population-based cohort studies, which collect data in a standardized fashion and represent the preferred method for estimating disease incidence. The design of the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium includes 5 prospective cohort studies from the United States and Europe: the Age, Gene/Environment Susceptibility-Reykjavik Study, the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, the Framingham Heart Study, and the Rotterdam Study. With genome-wide data on a total of about 38 000 individuals, these cohort studies have a large number of health-related phenotypes measured in similar ways. For each harmonized trait, within-cohort genome-wide association study analyses are combined by meta-analysis. A prospective meta-analysis of data from all 5 cohorts, with a properly selected level of genome-wide statistical significance, is a powerful approach to finding genuine phenotypic associations with novel genetic loci.

CONCLUSIONS: The Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium and collaborating non-member studies or consortia provide an excellent framework for the identification of the genetic determinants of risk factors, subclinical-disease measures, and clinical events.

VL - 2 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20031568?dopt=Abstract ER - TY - JOUR T1 - Genomewide association studies of stroke. JF - N Engl J Med Y1 - 2009 A1 - Ikram, M Arfan A1 - Seshadri, Sudha A1 - Bis, Joshua C A1 - Fornage, Myriam A1 - DeStefano, Anita L A1 - Aulchenko, Yurii S A1 - Debette, Stephanie A1 - Lumley, Thomas A1 - Folsom, Aaron R A1 - van den Herik, Evita G A1 - Bos, Michiel J A1 - Beiser, Alexa A1 - Cushman, Mary A1 - Launer, Lenore J A1 - Shahar, Eyal A1 - Struchalin, Maksim A1 - Du, Yangchun A1 - Glazer, Nicole L A1 - Rosamond, Wayne D A1 - Rivadeneira, Fernando A1 - Kelly-Hayes, Margaret A1 - Lopez, Oscar L A1 - Coresh, Josef A1 - Hofman, Albert A1 - DeCarli, Charles A1 - Heckbert, Susan R A1 - Koudstaal, Peter J A1 - Yang, Qiong A1 - Smith, Nicholas L A1 - Kase, Carlos S A1 - Rice, Kenneth A1 - Haritunians, Talin A1 - Roks, Gerwin A1 - de Kort, Paul L M A1 - Taylor, Kent D A1 - de Lau, Lonneke M A1 - Oostra, Ben A A1 - Uitterlinden, André G A1 - Rotter, Jerome I A1 - Boerwinkle, Eric A1 - Psaty, Bruce M A1 - Mosley, Thomas H A1 - van Duijn, Cornelia M A1 - Breteler, Monique M B A1 - Longstreth, W T A1 - Wolf, Philip A KW - African Continental Ancestry Group KW - Aged KW - Chromosomes, Human, Pair 12 KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Genetic Markers KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Proportional Hazards Models KW - Risk Factors KW - Stroke AB -

BACKGROUND: The genes underlying the risk of stroke in the general population remain undetermined.

METHODS: We carried out an analysis of genomewide association data generated from four large cohorts composing the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium, including 19,602 white persons (mean [+/-SD] age, 63+/-8 years) in whom 1544 incident strokes (1164 ischemic strokes) developed over an average follow-up of 11 years. We tested the markers most strongly associated with stroke in a replication cohort of 2430 black persons with 215 incident strokes (191 ischemic strokes), another cohort of 574 black persons with 85 incident strokes (68 ischemic strokes), and 652 Dutch persons with ischemic stroke and 3613 unaffected persons.

RESULTS: Two intergenic single-nucleotide polymorphisms on chromosome 12p13 and within 11 kb of the gene NINJ2 were associated with stroke (P<5x10(-8)). NINJ2 encodes an adhesion molecule expressed in glia and shows increased expression after nerve injury. Direct genotyping showed that rs12425791 was associated with an increased risk of total (i.e., all types) and ischemic stroke, with hazard ratios of 1.30 (95% confidence interval [CI], 1.19 to 1.42) and 1.33 (95% CI, 1.21 to 1.47), respectively, yielding population attributable risks of 11% and 12% in the discovery cohorts. Corresponding hazard ratios were 1.35 (95% CI, 1.01 to 1.79; P=0.04) and 1.42 (95% CI, 1.06 to 1.91; P=0.02) in the large cohort of black persons and 1.17 (95% CI, 1.01 to 1.37; P=0.03) and 1.19 (95% CI, 1.01 to 1.41; P=0.04) in the Dutch sample; the results of an underpowered analysis of the smaller black cohort were nonsignificant.

CONCLUSIONS: A genetic locus on chromosome 12p13 is associated with an increased risk of stroke.

VL - 360 IS - 17 U1 - https://www.ncbi.nlm.nih.gov/pubmed/19369658?dopt=Abstract ER - TY - JOUR T1 - Lack of association of soluble endothelial protein C receptor and PROCR 6936A/G polymorphism with the risk of venous thromboembolism in a prospective study. JF - Br J Haematol Y1 - 2009 A1 - Yamagishi, Kazumasa A1 - Cushman, Mary A1 - Heckbert, Susan R A1 - Tsai, Michael Y A1 - Folsom, Aaron R KW - Antigens, CD KW - Case-Control Studies KW - Endothelial Protein C Receptor KW - Female KW - Genotype KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Odds Ratio KW - Polymorphism, Genetic KW - Prospective Studies KW - Receptors, Cell Surface KW - Risk KW - Venous Thromboembolism AB -

Prior case-control studies reported that levels of the soluble form of the endothelial protein C receptor (sEPCR) were strongly controlled by the PROCR 6963A/G polymorphism and higher levels were a risk factor for venous thromboembolism (VTE). We sought to prospectively examine the association of sEPCR and the 6963A/G polymorphism with the incidence of VTE. The Longitudinal Investigation of Thromboembolism Etiology (LITE) pooled data from the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) Study on men and women aged > or =45 years. A nested case-control study of 458 incident VTE and 1038 controls was performed. sEPCR levels were distributed trimodally according to 6963A/G polymorphism. Adjusting for age, sex and race, there was no overall association between sEPCR level and VTE: odds ratio (OR) [95% confidence interval] for highest versus lowest quartile = 1.17[0.86-1.59]. However, higher sEPCR was associated with VTE in non-whites (OR = 1.84[1.05-3.22]) and women (OR = 1.51[1.01-2.26]). The 6963A/G polymorphism was not associated with VTE risk (OR = 0.93[0.70-1.25]). In conclusion, sEPCR levels and the PROCR 6963A/G polymorphism were not associated overall with increased risk of VTE.

VL - 145 IS - 2 U1 - https://www.ncbi.nlm.nih.gov/pubmed/19222470?dopt=Abstract ER - TY - JOUR T1 - Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index. JF - Nat Genet Y1 - 2010 A1 - Speliotes, Elizabeth K A1 - Willer, Cristen J A1 - Berndt, Sonja I A1 - Monda, Keri L A1 - Thorleifsson, Gudmar A1 - Jackson, Anne U A1 - Lango Allen, Hana A1 - Lindgren, Cecilia M A1 - Luan, Jian'an A1 - Mägi, Reedik A1 - Randall, Joshua C A1 - Vedantam, Sailaja A1 - Winkler, Thomas W A1 - Qi, Lu A1 - Workalemahu, Tsegaselassie A1 - Heid, Iris M A1 - Steinthorsdottir, Valgerdur A1 - Stringham, Heather M A1 - Weedon, Michael N A1 - Wheeler, Eleanor A1 - Wood, Andrew R A1 - Ferreira, Teresa A1 - Weyant, Robert J A1 - Segrè, Ayellet V A1 - Estrada, Karol A1 - Liang, Liming A1 - Nemesh, James A1 - Park, Ju-Hyun A1 - Gustafsson, Stefan A1 - Kilpeläinen, Tuomas O A1 - Yang, Jian A1 - Bouatia-Naji, Nabila A1 - Esko, Tõnu A1 - Feitosa, Mary F A1 - Kutalik, Zoltán A1 - Mangino, Massimo A1 - Raychaudhuri, Soumya A1 - Scherag, Andre A1 - Smith, Albert Vernon A1 - Welch, Ryan A1 - Zhao, Jing Hua A1 - Aben, Katja K A1 - Absher, Devin M A1 - Amin, Najaf A1 - Dixon, Anna L A1 - Fisher, Eva A1 - Glazer, Nicole L A1 - Goddard, Michael E A1 - Heard-Costa, Nancy L A1 - Hoesel, Volker A1 - Hottenga, Jouke-Jan A1 - Johansson, Asa A1 - Johnson, Toby A1 - Ketkar, Shamika A1 - Lamina, Claudia A1 - Li, Shengxu A1 - Moffatt, Miriam F A1 - Myers, Richard H A1 - Narisu, Narisu A1 - Perry, John R B A1 - Peters, Marjolein J A1 - Preuss, Michael A1 - Ripatti, Samuli A1 - Rivadeneira, Fernando A1 - Sandholt, Camilla A1 - Scott, Laura J A1 - Timpson, Nicholas J A1 - Tyrer, Jonathan P A1 - van Wingerden, Sophie A1 - Watanabe, Richard M A1 - White, Charles C A1 - Wiklund, Fredrik A1 - Barlassina, Christina A1 - Chasman, Daniel I A1 - Cooper, Matthew N A1 - Jansson, John-Olov A1 - Lawrence, Robert W A1 - Pellikka, Niina A1 - Prokopenko, Inga A1 - Shi, Jianxin A1 - Thiering, Elisabeth A1 - Alavere, Helene A1 - Alibrandi, Maria T S A1 - Almgren, Peter A1 - Arnold, Alice M A1 - Aspelund, Thor A1 - Atwood, Larry D A1 - Balkau, Beverley A1 - Balmforth, Anthony J A1 - Bennett, Amanda J A1 - Ben-Shlomo, Yoav A1 - Bergman, Richard N A1 - Bergmann, Sven A1 - Biebermann, Heike A1 - Blakemore, Alexandra I F A1 - Boes, Tanja A1 - Bonnycastle, Lori L A1 - Bornstein, Stefan R A1 - Brown, Morris J A1 - Buchanan, Thomas A A1 - Busonero, Fabio A1 - Campbell, Harry A1 - Cappuccio, Francesco P A1 - Cavalcanti-Proença, Christine A1 - Chen, Yii-Der Ida A1 - Chen, Chih-Mei A1 - Chines, Peter S A1 - Clarke, Robert A1 - Coin, Lachlan A1 - Connell, John A1 - Day, Ian N M A1 - den Heijer, Martin A1 - Duan, Jubao A1 - Ebrahim, Shah A1 - Elliott, Paul A1 - Elosua, Roberto A1 - Eiriksdottir, Gudny A1 - Erdos, Michael R A1 - Eriksson, Johan G A1 - Facheris, Maurizio F A1 - Felix, Stephan B A1 - Fischer-Posovszky, Pamela A1 - Folsom, Aaron R A1 - Friedrich, Nele A1 - Freimer, Nelson B A1 - Fu, Mao A1 - Gaget, Stefan A1 - Gejman, Pablo V A1 - Geus, Eco J C A1 - Gieger, Christian A1 - Gjesing, Anette P A1 - Goel, Anuj A1 - Goyette, Philippe A1 - Grallert, Harald A1 - Grässler, Jürgen A1 - Greenawalt, Danielle M A1 - Groves, Christopher J A1 - Gudnason, Vilmundur A1 - Guiducci, Candace A1 - Hartikainen, Anna-Liisa A1 - Hassanali, Neelam A1 - Hall, Alistair S A1 - Havulinna, Aki S A1 - Hayward, Caroline A1 - Heath, Andrew C A1 - Hengstenberg, Christian A1 - Hicks, Andrew A A1 - Hinney, Anke A1 - Hofman, Albert A1 - Homuth, Georg A1 - Hui, Jennie A1 - Igl, Wilmar A1 - Iribarren, Carlos A1 - Isomaa, Bo A1 - Jacobs, Kevin B A1 - Jarick, Ivonne A1 - Jewell, Elizabeth A1 - John, Ulrich A1 - Jørgensen, Torben A1 - Jousilahti, Pekka A1 - Jula, Antti A1 - Kaakinen, Marika A1 - Kajantie, Eero A1 - Kaplan, Lee M A1 - Kathiresan, Sekar A1 - Kettunen, Johannes A1 - Kinnunen, Leena A1 - Knowles, Joshua W A1 - Kolcic, Ivana A1 - König, Inke R A1 - Koskinen, Seppo A1 - Kovacs, Peter A1 - Kuusisto, Johanna A1 - Kraft, Peter A1 - Kvaløy, Kirsti A1 - Laitinen, Jaana A1 - Lantieri, Olivier A1 - Lanzani, Chiara A1 - Launer, Lenore J A1 - Lecoeur, Cécile A1 - Lehtimäki, Terho A1 - Lettre, Guillaume A1 - Liu, Jianjun A1 - Lokki, Marja-Liisa A1 - Lorentzon, Mattias A1 - Luben, Robert N A1 - Ludwig, Barbara A1 - Manunta, Paolo A1 - Marek, Diana A1 - Marre, Michel A1 - Martin, Nicholas G A1 - McArdle, Wendy L A1 - McCarthy, Anne A1 - McKnight, Barbara A1 - Meitinger, Thomas A1 - Melander, Olle A1 - Meyre, David A1 - Midthjell, Kristian A1 - Montgomery, Grant W A1 - Morken, Mario A A1 - Morris, Andrew P A1 - Mulic, Rosanda A1 - Ngwa, Julius S A1 - Nelis, Mari A1 - Neville, Matt J A1 - Nyholt, Dale R A1 - O'Donnell, Christopher J A1 - O'Rahilly, Stephen A1 - Ong, Ken K A1 - Oostra, Ben A1 - Paré, Guillaume A1 - Parker, Alex N A1 - Perola, Markus A1 - Pichler, Irene A1 - Pietiläinen, Kirsi H A1 - Platou, Carl G P A1 - Polasek, Ozren A1 - Pouta, Anneli A1 - Rafelt, Suzanne A1 - Raitakari, Olli A1 - Rayner, Nigel W A1 - Ridderstråle, Martin A1 - Rief, Winfried A1 - Ruokonen, Aimo A1 - Robertson, Neil R A1 - Rzehak, Peter A1 - Salomaa, Veikko A1 - Sanders, Alan R A1 - Sandhu, Manjinder S A1 - Sanna, Serena A1 - Saramies, Jouko A1 - Savolainen, Markku J A1 - Scherag, Susann A1 - Schipf, Sabine A1 - Schreiber, Stefan A1 - Schunkert, Heribert A1 - Silander, Kaisa A1 - Sinisalo, Juha A1 - Siscovick, David S A1 - Smit, Jan H A1 - Soranzo, Nicole A1 - Sovio, Ulla A1 - Stephens, Jonathan A1 - Surakka, Ida A1 - Swift, Amy J A1 - Tammesoo, Mari-Liis A1 - Tardif, Jean-Claude A1 - Teder-Laving, Maris A1 - Teslovich, Tanya M A1 - Thompson, John R A1 - Thomson, Brian A1 - Tönjes, Anke A1 - Tuomi, Tiinamaija A1 - van Meurs, Joyce B J A1 - van Ommen, Gert-Jan A1 - Vatin, Vincent A1 - Viikari, Jorma A1 - Visvikis-Siest, Sophie A1 - Vitart, Veronique A1 - Vogel, Carla I G A1 - Voight, Benjamin F A1 - Waite, Lindsay L A1 - Wallaschofski, Henri A1 - Walters, G Bragi A1 - Widen, Elisabeth A1 - Wiegand, Susanna A1 - Wild, Sarah H A1 - Willemsen, Gonneke A1 - Witte, Daniel R A1 - Witteman, Jacqueline C A1 - Xu, Jianfeng A1 - Zhang, Qunyuan A1 - Zgaga, Lina A1 - Ziegler, Andreas A1 - Zitting, Paavo A1 - Beilby, John P A1 - Farooqi, I Sadaf A1 - Hebebrand, Johannes A1 - Huikuri, Heikki V A1 - James, Alan L A1 - Kähönen, Mika A1 - Levinson, Douglas F A1 - Macciardi, Fabio A1 - Nieminen, Markku S A1 - Ohlsson, Claes A1 - Palmer, Lyle J A1 - Ridker, Paul M A1 - Stumvoll, Michael A1 - Beckmann, Jacques S A1 - Boeing, Heiner A1 - Boerwinkle, Eric A1 - Boomsma, Dorret I A1 - Caulfield, Mark J A1 - Chanock, Stephen J A1 - Collins, Francis S A1 - Cupples, L Adrienne A1 - Smith, George Davey A1 - Erdmann, Jeanette A1 - Froguel, Philippe A1 - Grönberg, Henrik A1 - Gyllensten, Ulf A1 - Hall, Per A1 - Hansen, Torben A1 - Harris, Tamara B A1 - Hattersley, Andrew T A1 - Hayes, Richard B A1 - Heinrich, Joachim A1 - Hu, Frank B A1 - Hveem, Kristian A1 - Illig, Thomas A1 - Jarvelin, Marjo-Riitta A1 - Kaprio, Jaakko A1 - Karpe, Fredrik A1 - Khaw, Kay-Tee A1 - Kiemeney, Lambertus A A1 - Krude, Heiko A1 - Laakso, Markku A1 - Lawlor, Debbie A A1 - Metspalu, Andres A1 - Munroe, Patricia B A1 - Ouwehand, Willem H A1 - Pedersen, Oluf A1 - Penninx, Brenda W A1 - Peters, Annette A1 - Pramstaller, Peter P A1 - Quertermous, Thomas A1 - Reinehr, Thomas A1 - Rissanen, Aila A1 - Rudan, Igor A1 - Samani, Nilesh J A1 - Schwarz, Peter E H A1 - Shuldiner, Alan R A1 - Spector, Timothy D A1 - Tuomilehto, Jaakko A1 - Uda, Manuela A1 - Uitterlinden, Andre A1 - Valle, Timo T A1 - Wabitsch, Martin A1 - Waeber, Gérard A1 - Wareham, Nicholas J A1 - Watkins, Hugh A1 - Wilson, James F A1 - Wright, Alan F A1 - Zillikens, M Carola A1 - Chatterjee, Nilanjan A1 - McCarroll, Steven A A1 - Purcell, Shaun A1 - Schadt, Eric E A1 - Visscher, Peter M A1 - Assimes, Themistocles L A1 - Borecki, Ingrid B A1 - Deloukas, Panos A1 - Fox, Caroline S A1 - Groop, Leif C A1 - Haritunians, Talin A1 - Hunter, David J A1 - Kaplan, Robert C A1 - Mohlke, Karen L A1 - O'Connell, Jeffrey R A1 - Peltonen, Leena A1 - Schlessinger, David A1 - Strachan, David P A1 - van Duijn, Cornelia M A1 - Wichmann, H-Erich A1 - Frayling, Timothy M A1 - Thorsteinsdottir, Unnur A1 - Abecasis, Goncalo R A1 - Barroso, Inês A1 - Boehnke, Michael A1 - Stefansson, Kari A1 - North, Kari E A1 - McCarthy, Mark I A1 - Hirschhorn, Joel N A1 - Ingelsson, Erik A1 - Loos, Ruth J F KW - Body Height KW - Body Mass Index KW - Body Size KW - Body Weight KW - Chromosome Mapping KW - European Continental Ancestry Group KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Obesity KW - Polymorphism, Single Nucleotide AB -

Obesity is globally prevalent and highly heritable, but its underlying genetic factors remain largely elusive. To identify genetic loci for obesity susceptibility, we examined associations between body mass index and ∼ 2.8 million SNPs in up to 123,865 individuals with targeted follow up of 42 SNPs in up to 125,931 additional individuals. We confirmed 14 known obesity susceptibility loci and identified 18 new loci associated with body mass index (P < 5 × 10⁻⁸), one of which includes a copy number variant near GPRC5B. Some loci (at MC4R, POMC, SH2B1 and BDNF) map near key hypothalamic regulators of energy balance, and one of these loci is near GIPR, an incretin receptor. Furthermore, genes in other newly associated loci may provide new insights into human body weight regulation.

VL - 42 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20935630?dopt=Abstract ER - TY - JOUR T1 - Association of genome-wide variation with the risk of incident heart failure in adults of European and African ancestry: a prospective meta-analysis from the cohorts for heart and aging research in genomic epidemiology (CHARGE) consortium. JF - Circ Cardiovasc Genet Y1 - 2010 A1 - Smith, Nicholas L A1 - Felix, Janine F A1 - Morrison, Alanna C A1 - Demissie, Serkalem A1 - Glazer, Nicole L A1 - Loehr, Laura R A1 - Cupples, L Adrienne A1 - Dehghan, Abbas A1 - Lumley, Thomas A1 - Rosamond, Wayne D A1 - Lieb, Wolfgang A1 - Rivadeneira, Fernando A1 - Bis, Joshua C A1 - Folsom, Aaron R A1 - Benjamin, Emelia A1 - Aulchenko, Yurii S A1 - Haritunians, Talin A1 - Couper, David A1 - Murabito, Joanne A1 - Wang, Ying A A1 - Stricker, Bruno H A1 - Gottdiener, John S A1 - Chang, Patricia P A1 - Wang, Thomas J A1 - Rice, Kenneth M A1 - Hofman, Albert A1 - Heckbert, Susan R A1 - Fox, Ervin R A1 - O'Donnell, Christopher J A1 - Uitterlinden, André G A1 - Rotter, Jerome I A1 - Willerson, James T A1 - Levy, Daniel A1 - van Duijn, Cornelia M A1 - Psaty, Bruce M A1 - Witteman, Jacqueline C M A1 - Boerwinkle, Eric A1 - Vasan, Ramachandran S KW - African Americans KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Endopeptidases KW - European Continental Ancestry Group KW - Female KW - Genome-Wide Association Study KW - Heart Failure KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Risk KW - Ubiquitin-Specific Proteases AB -

BACKGROUND: Although genetic factors contribute to the onset of heart failure (HF), no large-scale genome-wide investigation of HF risk has been published to date. We have investigated the association of 2,478,304 single-nucleotide polymorphisms with incident HF by meta-analyzing data from 4 community-based prospective cohorts: the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, the Framingham Heart Study, and the Rotterdam Study.

METHODS AND RESULTS: Eligible participants for these analyses were of European or African ancestry and free of clinical HF at baseline. Each study independently conducted genome-wide scans and imputed data to the approximately 2.5 million single-nucleotide polymorphisms in HapMap. Within each study, Cox proportional hazards regression models provided age- and sex-adjusted estimates of the association between each variant and time to incident HF. Fixed-effect meta-analyses combined results for each single-nucleotide polymorphism from the 4 cohorts to produce an overall association estimate and P value. A genome-wide significance P value threshold was set a priori at 5.0x10(-7). During a mean follow-up of 11.5 years, 2526 incident HF events (12%) occurred in 20 926 European-ancestry participants. The meta-analysis identified a genome-wide significant locus at chromosomal position 15q22 (1.4x10(-8)), which was 58.8 kb from USP3. Among 2895 African-ancestry participants, 466 incident HF events (16%) occurred during a mean follow-up of 13.7 years. One genome-wide significant locus was identified at 12q14 (6.7x10(-8)), which was 6.3 kb from LRIG3.

CONCLUSIONS: We identified 2 loci that were associated with incident HF and exceeded genome-wide significance. The findings merit replication in other community-based settings of incident HF.

VL - 3 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20445134?dopt=Abstract ER - TY - JOUR T1 - Common variants in 22 loci are associated with QRS duration and cardiac ventricular conduction. JF - Nat Genet Y1 - 2010 A1 - Sotoodehnia, Nona A1 - Isaacs, Aaron A1 - de Bakker, Paul I W A1 - Dörr, Marcus A1 - Newton-Cheh, Christopher A1 - Nolte, Ilja M A1 - van der Harst, Pim A1 - Müller, Martina A1 - Eijgelsheim, Mark A1 - Alonso, Alvaro A1 - Hicks, Andrew A A1 - Padmanabhan, Sandosh A1 - Hayward, Caroline A1 - Smith, Albert Vernon A1 - Polasek, Ozren A1 - Giovannone, Steven A1 - Fu, Jingyuan A1 - Magnani, Jared W A1 - Marciante, Kristin D A1 - Pfeufer, Arne A1 - Gharib, Sina A A1 - Teumer, Alexander A1 - Li, Man A1 - Bis, Joshua C A1 - Rivadeneira, Fernando A1 - Aspelund, Thor A1 - Köttgen, Anna A1 - Johnson, Toby A1 - Rice, Kenneth A1 - Sie, Mark P S A1 - Wang, Ying A A1 - Klopp, Norman A1 - Fuchsberger, Christian A1 - Wild, Sarah H A1 - Mateo Leach, Irene A1 - Estrada, Karol A1 - Völker, Uwe A1 - Wright, Alan F A1 - Asselbergs, Folkert W A1 - Qu, Jiaxiang A1 - Chakravarti, Aravinda A1 - Sinner, Moritz F A1 - Kors, Jan A A1 - Petersmann, Astrid A1 - Harris, Tamara B A1 - Soliman, Elsayed Z A1 - Munroe, Patricia B A1 - Psaty, Bruce M A1 - Oostra, Ben A A1 - Cupples, L Adrienne A1 - Perz, Siegfried A1 - de Boer, Rudolf A A1 - Uitterlinden, André G A1 - Völzke, Henry A1 - Spector, Timothy D A1 - Liu, Fang-Yu A1 - Boerwinkle, Eric A1 - Dominiczak, Anna F A1 - Rotter, Jerome I A1 - van Herpen, Gé A1 - Levy, Daniel A1 - Wichmann, H-Erich A1 - van Gilst, Wiek H A1 - Witteman, Jacqueline C M A1 - Kroemer, Heyo K A1 - Kao, W H Linda A1 - Heckbert, Susan R A1 - Meitinger, Thomas A1 - Hofman, Albert A1 - Campbell, Harry A1 - Folsom, Aaron R A1 - van Veldhuisen, Dirk J A1 - Schwienbacher, Christine A1 - O'Donnell, Christopher J A1 - Volpato, Claudia Beu A1 - Caulfield, Mark J A1 - Connell, John M A1 - Launer, Lenore A1 - Lu, Xiaowen A1 - Franke, Lude A1 - Fehrmann, Rudolf S N A1 - te Meerman, Gerard A1 - Groen, Harry J M A1 - Weersma, Rinse K A1 - van den Berg, Leonard H A1 - Wijmenga, Cisca A1 - Ophoff, Roel A A1 - Navis, Gerjan A1 - Rudan, Igor A1 - Snieder, Harold A1 - Wilson, James F A1 - Pramstaller, Peter P A1 - Siscovick, David S A1 - Wang, Thomas J A1 - Gudnason, Vilmundur A1 - van Duijn, Cornelia M A1 - Felix, Stephan B A1 - Fishman, Glenn I A1 - Jamshidi, Yalda A1 - Stricker, Bruno H Ch A1 - Samani, Nilesh J A1 - Kääb, Stefan A1 - Arking, Dan E KW - Animals KW - Animals, Newborn KW - Chromosomes, Human KW - Computational Biology KW - Electrocardiography KW - Genetic Loci KW - Genome-Wide Association Study KW - Heart Conduction System KW - Humans KW - Mice KW - Mice, Transgenic KW - Models, Animal KW - Myocytes, Cardiac KW - NAV1.8 Voltage-Gated Sodium Channel KW - Polymorphism, Single Nucleotide KW - Sodium Channels AB -

The QRS interval, from the beginning of the Q wave to the end of the S wave on an electrocardiogram, reflects ventricular depolarization and conduction time and is a risk factor for mortality, sudden death and heart failure. We performed a genome-wide association meta-analysis in 40,407 individuals of European descent from 14 studies, with further genotyping in 7,170 additional Europeans, and we identified 22 loci associated with QRS duration (P < 5 × 10(-8)). These loci map in or near genes in pathways with established roles in ventricular conduction such as sodium channels, transcription factors and calcium-handling proteins, but also point to previously unidentified biologic processes, such as kinase inhibitors and genes related to tumorigenesis. We demonstrate that SCN10A, a candidate gene at the most significantly associated locus in this study, is expressed in the mouse ventricular conduction system, and treatment with a selective SCN10A blocker prolongs QRS duration. These findings extend our current knowledge of ventricular depolarization and conduction.

VL - 42 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21076409?dopt=Abstract ER - TY - JOUR T1 - Genome-wide association analysis identifies multiple loci related to resting heart rate. JF - Hum Mol Genet Y1 - 2010 A1 - Eijgelsheim, Mark A1 - Newton-Cheh, Christopher A1 - Sotoodehnia, Nona A1 - de Bakker, Paul I W A1 - Müller, Martina A1 - Morrison, Alanna C A1 - Smith, Albert V A1 - Isaacs, Aaron A1 - Sanna, Serena A1 - Dörr, Marcus A1 - Navarro, Pau A1 - Fuchsberger, Christian A1 - Nolte, Ilja M A1 - de Geus, Eco J C A1 - Estrada, Karol A1 - Hwang, Shih-Jen A1 - Bis, Joshua C A1 - Rückert, Ina-Maria A1 - Alonso, Alvaro A1 - Launer, Lenore J A1 - Hottenga, Jouke Jan A1 - Rivadeneira, Fernando A1 - Noseworthy, Peter A A1 - Rice, Kenneth M A1 - Perz, Siegfried A1 - Arking, Dan E A1 - Spector, Tim D A1 - Kors, Jan A A1 - Aulchenko, Yurii S A1 - Tarasov, Kirill V A1 - Homuth, Georg A1 - Wild, Sarah H A1 - Marroni, Fabio A1 - Gieger, Christian A1 - Licht, Carmilla M A1 - Prineas, Ronald J A1 - Hofman, Albert A1 - Rotter, Jerome I A1 - Hicks, Andrew A A1 - Ernst, Florian A1 - Najjar, Samer S A1 - Wright, Alan F A1 - Peters, Annette A1 - Fox, Ervin R A1 - Oostra, Ben A A1 - Kroemer, Heyo K A1 - Couper, David A1 - Völzke, Henry A1 - Campbell, Harry A1 - Meitinger, Thomas A1 - Uda, Manuela A1 - Witteman, Jacqueline C M A1 - Psaty, Bruce M A1 - Wichmann, H-Erich A1 - Harris, Tamara B A1 - Kääb, Stefan A1 - Siscovick, David S A1 - Jamshidi, Yalda A1 - Uitterlinden, André G A1 - Folsom, Aaron R A1 - Larson, Martin G A1 - Wilson, James F A1 - Penninx, Brenda W A1 - Snieder, Harold A1 - Pramstaller, Peter P A1 - van Duijn, Cornelia M A1 - Lakatta, Edward G A1 - Felix, Stephan B A1 - Gudnason, Vilmundur A1 - Pfeufer, Arne A1 - Heckbert, Susan R A1 - Stricker, Bruno H Ch A1 - Boerwinkle, Eric A1 - O'Donnell, Christopher J KW - Adult KW - Aged KW - Base Pairing KW - Cohort Studies KW - Female KW - Genetic Loci KW - Genome, Human KW - Genome-Wide Association Study KW - Heart Rate KW - Humans KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Rest AB -

Higher resting heart rate is associated with increased cardiovascular disease and mortality risk. Though heritable factors play a substantial role in population variation, little is known about specific genetic determinants. This knowledge can impact clinical care by identifying novel factors that influence pathologic heart rate states, modulate heart rate through cardiac structure and function or by improving our understanding of the physiology of heart rate regulation. To identify common genetic variants associated with heart rate, we performed a meta-analysis of 15 genome-wide association studies (GWAS), including 38,991 subjects of European ancestry, estimating the association between age-, sex- and body mass-adjusted RR interval (inverse heart rate) and approximately 2.5 million markers. Results with P < 5 × 10(-8) were considered genome-wide significant. We constructed regression models with multiple markers to assess whether results at less stringent thresholds were likely to be truly associated with RR interval. We identified six novel associations with resting heart rate at six loci: 6q22 near GJA1; 14q12 near MYH7; 12p12 near SOX5, c12orf67, BCAT1, LRMP and CASC1; 6q22 near SLC35F1, PLN and c6orf204; 7q22 near SLC12A9 and UfSp1; and 11q12 near FADS1. Associations at 6q22 400 kb away from GJA1, at 14q12 MYH6 and at 1q32 near CD34 identified in previously published GWAS were confirmed. In aggregate, these variants explain approximately 0.7% of RR interval variance. A multivariant regression model including 20 variants with P < 10(-5) increased the explained variance to 1.6%, suggesting that some loci falling short of genome-wide significance are likely truly associated. Future research is warranted to elucidate underlying mechanisms that may impact clinical care.

VL - 19 IS - 19 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20639392?dopt=Abstract ER - TY - JOUR T1 - Genomic variation associated with mortality among adults of European and African ancestry with heart failure: the cohorts for heart and aging research in genomic epidemiology consortium. JF - Circ Cardiovasc Genet Y1 - 2010 A1 - Morrison, Alanna C A1 - Felix, Janine F A1 - Cupples, L Adrienne A1 - Glazer, Nicole L A1 - Loehr, Laura R A1 - Dehghan, Abbas A1 - Demissie, Serkalem A1 - Bis, Joshua C A1 - Rosamond, Wayne D A1 - Aulchenko, Yurii S A1 - Wang, Ying A A1 - Haritunians, Talin A1 - Folsom, Aaron R A1 - Rivadeneira, Fernando A1 - Benjamin, Emelia J A1 - Lumley, Thomas A1 - Couper, David A1 - Stricker, Bruno H A1 - O'Donnell, Christopher J A1 - Rice, Kenneth M A1 - Chang, Patricia P A1 - Hofman, Albert A1 - Levy, Daniel A1 - Rotter, Jerome I A1 - Fox, Ervin R A1 - Uitterlinden, André G A1 - Wang, Thomas J A1 - Psaty, Bruce M A1 - Willerson, James T A1 - van Duijn, Cornelia M A1 - Boerwinkle, Eric A1 - Witteman, Jacqueline C M A1 - Vasan, Ramachandran S A1 - Smith, Nicholas L KW - African Americans KW - Aged KW - Aged, 80 and over KW - Chemokines KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Genome-Wide Association Study KW - Genotype KW - Heart Failure KW - Humans KW - Introns KW - Male KW - MARVEL Domain-Containing Proteins KW - Membrane Proteins KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Risk Factors AB -

BACKGROUND: Prognosis and survival are significant concerns for individuals with heart failure (HF). To better understand the pathophysiology of HF prognosis, the association between 2,366,858 single-nucleotide polymorphisms (SNPs) and all-cause mortality was evaluated among individuals with incident HF from 4 community-based prospective cohorts: the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, the Framingham Heart Study, and the Rotterdam Study.

METHODS AND RESULTS: Participants were 2526 individuals of European ancestry and 466 individuals of African ancestry who experienced an incident HF event during follow-up in the respective cohorts. Within each study, the association between genetic variants and time to mortality among individuals with HF was assessed by Cox proportional hazards models that included adjustment for sex and age at the time of the HF event. Prospective fixed-effect meta-analyses were conducted for the 4 study populations of European ancestry (N=1645 deaths) and for the 2 populations of African ancestry (N=281 deaths). Genome-wide significance was set at P=5.0x10(-7). Meta-analytic findings among individuals of European ancestry revealed 1 genome-wide significant locus on chromosome 3p22 in an intron of CKLF-like MARVEL transmembrane domain containing 7 (CMTM7, P=3.2x10(-7)). Eight additional loci in individuals of European ancestry and 4 loci in individuals of African ancestry were identified by high-signal SNPs (P<1.0x10(-5)) but did not meet genome-wide significance.

CONCLUSIONS: This study identified a novel locus associated with all-cause mortality among individuals of European ancestry with HF. This finding warrants additional investigation, including replication, in other studies of HF.

VL - 3 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20400778?dopt=Abstract ER - TY - JOUR T1 - Novel associations of multiple genetic loci with plasma levels of factor VII, factor VIII, and von Willebrand factor: The CHARGE (Cohorts for Heart and Aging Research in Genome Epidemiology) Consortium. JF - Circulation Y1 - 2010 A1 - Smith, Nicholas L A1 - Chen, Ming-Huei A1 - Dehghan, Abbas A1 - Strachan, David P A1 - Basu, Saonli A1 - Soranzo, Nicole A1 - Hayward, Caroline A1 - Rudan, Igor A1 - Sabater-Lleal, Maria A1 - Bis, Joshua C A1 - de Maat, Moniek P M A1 - Rumley, Ann A1 - Kong, Xiaoxiao A1 - Yang, Qiong A1 - Williams, Frances M K A1 - Vitart, Veronique A1 - Campbell, Harry A1 - Mälarstig, Anders A1 - Wiggins, Kerri L A1 - van Duijn, Cornelia M A1 - McArdle, Wendy L A1 - Pankow, James S A1 - Johnson, Andrew D A1 - Silveira, Angela A1 - McKnight, Barbara A1 - Uitterlinden, André G A1 - Aleksic, Nena A1 - Meigs, James B A1 - Peters, Annette A1 - Koenig, Wolfgang A1 - Cushman, Mary A1 - Kathiresan, Sekar A1 - Rotter, Jerome I A1 - Bovill, Edwin G A1 - Hofman, Albert A1 - Boerwinkle, Eric A1 - Tofler, Geoffrey H A1 - Peden, John F A1 - Psaty, Bruce M A1 - Leebeek, Frank A1 - Folsom, Aaron R A1 - Larson, Martin G A1 - Spector, Timothy D A1 - Wright, Alan F A1 - Wilson, James F A1 - Hamsten, Anders A1 - Lumley, Thomas A1 - Witteman, Jacqueline C M A1 - Tang, Weihong A1 - O'Donnell, Christopher J KW - Adult KW - Factor VII KW - Factor VIII KW - Female KW - Genome-Wide Association Study KW - Hemostasis KW - Humans KW - Male KW - Middle Aged KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Thrombosis KW - von Willebrand Factor AB -

BACKGROUND: Plasma levels of coagulation factors VII (FVII), VIII (FVIII), and von Willebrand factor (vWF) influence risk of hemorrhage and thrombosis. We conducted genome-wide association studies to identify new loci associated with plasma levels.

METHODS AND RESULTS: The setting of the study included 5 community-based studies for discovery comprising 23 608 European-ancestry participants: Atherosclerosis Risk In Communities Study, Cardiovascular Health Study, British 1958 Birth Cohort, Framingham Heart Study, and Rotterdam Study. All subjects had genome-wide single-nucleotide polymorphism (SNP) scans and at least 1 phenotype measured: FVII activity/antigen, FVIII activity, and vWF antigen. Each study used its genotype data to impute to HapMap SNPs and independently conducted association analyses of hemostasis measures using an additive genetic model. Study findings were combined by meta-analysis. Replication was conducted in 7604 participants not in the discovery cohort. For FVII, 305 SNPs exceeded the genome-wide significance threshold of 5.0x10(-8) and comprised 5 loci on 5 chromosomes: 2p23 (smallest P value 6.2x10(-24)), 4q25 (3.6x10(-12)), 11q12 (2.0x10(-10)), 13q34 (9.0x10(-259)), and 20q11.2 (5.7x10(-37)). Loci were within or near genes, including 4 new candidate genes and F7 (13q34). For vWF, 400 SNPs exceeded the threshold and marked 8 loci on 6 chromosomes: 6q24 (1.2x10(-22)), 8p21 (1.3x10(-16)), 9q34 (<5.0x10(-324)), 12p13 (1.7x10(-32)), 12q23 (7.3x10(-10)), 12q24.3 (3.8x10(-11)), 14q32 (2.3x10(-10)), and 19p13.2 (1.3x10(-9)). All loci were within genes, including 6 new candidate genes, as well as ABO (9q34) and VWF (12p13). For FVIII, 5 loci were identified and overlapped vWF findings. Nine of the 10 new findings were replicated.

CONCLUSIONS: New genetic associations were discovered outside previously known biological pathways and may point to novel prevention and treatment targets of hemostasis disorders.

VL - 121 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20231535?dopt=Abstract ER - TY - JOUR T1 - Reproductive history, hormone replacement, and incidence of venous thromboembolism: the Longitudinal Investigation of Thromboembolism Etiology. JF - Br J Haematol Y1 - 2010 A1 - Ohira, Tetsuya A1 - Folsom, Aaron R A1 - Cushman, Mary A1 - White, Richard H A1 - Hannan, Peter J A1 - Rosamond, Wayne D A1 - Heckbert, Susan R KW - Age Factors KW - Aged KW - Epidemiologic Methods KW - Estrogen Replacement Therapy KW - Female KW - Humans KW - Male KW - Middle Aged KW - Parity KW - Pregnancy KW - Reproductive History KW - United States KW - Venous Thromboembolism AB -

Numerous studies have established that hormone replacement therapy increases the risk of venous thromboembolism (VTE), but an association of endogenous oestrogen exposure with the incidence of VTE is not fully established. Using a prospective design combining the Atherosclerosis Risk in Communities and the Cardiovascular Health Study cohort, we studied the 12-year risk of VTE in relation to hormone replacement therapy use, age at menopause, parity number, and type of menopause in 8236 post-menopausal women. There were no significant associations of age at menopause, parity number, or type of menopause with incidence of VTE. Women currently using hormone replacement had a 1.6-times higher multivariate-adjusted rate ratio (RR) of VTE compared with those without hormone use in the time-dependent model (RR=1.60, 95% confidence interval [CI], 1.06-2.36; Population attributable fraction=6.7%, 95%CI, 1.0-10.3). When we excluded women with 1-year or more duration of hormone therapy at baseline, the association was stronger (RR=2.02, 95%CI, 1.31-3.12). The multivariate-adjusted RRs of VTE for current users tended to be higher in those with idiopathic VTE (RR=2.40, 95%CI, 1.40-4.12) than those with secondary VTE (RR=1.08, 95%CI, 0.63-1.85). Hormone replacement therapy is associated with increased risk of VTE, but reproductive history markers of endogenous oestrogen exposure were not associated with VTE.

VL - 149 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20230397?dopt=Abstract ER - TY - JOUR T1 - Serum albumin and risk of venous thromboembolism. JF - Thromb Haemost Y1 - 2010 A1 - Folsom, Aaron R A1 - Lutsey, Pamela L A1 - Heckbert, Susan R A1 - Cushman, Mary KW - Aged KW - Biomarkers KW - Female KW - Follow-Up Studies KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Risk Factors KW - Serum Albumin KW - United States KW - Venous Thromboembolism AB -

The incidence of venous thromboembolism (VTE) is increased in patients with albuminuria. However, whether a low serum albumin concentration is associated with increased risk of VTE has been a matter of controversy. We determined the association of serum albumin with VTE incidence in two large, prospective, population-based cohorts: the Atherosclerosis Risk in Communities (ARIC) Study (n = 15,300) and the Cardiovascular Health Study (CHS) (n = 5,400). Validated VTE occurrence (n = 462 in ARIC and n = 174 in CHS) was ascertained during follow-up. In both studies, after adjustment for age, sex, race, use of hormone replacement therapy, estimated glomerular filtration rate, history of cancer, and diabetes, serum albumin tended to be associated inversely with VTE. The adjusted hazard ratio per standard deviation lower albumin was 1.18 (95% confidence interval [CI] = 1.08, 1.31) in ARIC and 1.10 (95% CI = 0.94, 1.29) in CHS. The hazard ratio for albumin below (vs. above) the fifth percentile was 1.28 (95% CI = 0.90, 1.84) in ARIC and 1.80 (95% CI = 1.11, 2.93) in CHS. In conclusion, low serum albumin was a modest marker of increased VTE risk. The observed association likely does not reflect cause and effect, but rather that low serum albumin reflects a hyperinflammatory or hypercoagulable state. Whether this association has clinical relevance warrants further study.

VL - 104 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20390234?dopt=Abstract ER - TY - JOUR T1 - Association of genomic loci from a cardiovascular gene SNP array with fibrinogen levels in European Americans and African-Americans from six cohort studies: the Candidate Gene Association Resource (CARe). JF - Blood Y1 - 2011 A1 - Wassel, Christina L A1 - Lange, Leslie A A1 - Keating, Brendan J A1 - Taylor, Kira C A1 - Johnson, Andrew D A1 - Palmer, Cameron A1 - Ho, Lindsey A A1 - Smith, Nicholas L A1 - Lange, Ethan M A1 - Li, Yun A1 - Yang, Qiong A1 - Delaney, Joseph A A1 - Tang, Weihong A1 - Tofler, Geoffrey A1 - Redline, Susan A1 - Taylor, Herman A A1 - Wilson, James G A1 - Tracy, Russell P A1 - Jacobs, David R A1 - Folsom, Aaron R A1 - Green, David A1 - O'Donnell, Christopher J A1 - Reiner, Alexander P KW - Adult KW - African Americans KW - Aged KW - Cardiovascular Diseases KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Fibrinogen KW - Genetic Predisposition to Disease KW - Haplotypes KW - Humans KW - Male KW - Middle Aged KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Risk Factors AB -

Several common genomic loci, involving various immunity- and metabolism-related genes, have been associated with plasma fibrinogen in European Americans (EAs). The genetic determinants of fibrinogen in African Americans (AAs) are poorly characterized. Using a vascular gene-centric array in 23,634 EA and 6657 AA participants from 6 studies comprising the Candidate Gene Association Resource project, we examined the association of 47,539 common and lower frequency variants with fibrinogen concentration. We identified a rare Pro265Leu variant in FGB (rs6054) associated with lower fibrinogen. Common fibrinogen gene single nucleotide polymorphisms (FGB rs1800787 and FGG rs2066861) significantly associated with fibrinogen in EAs were prevalent in AAs and showed consistent associations. Several fibrinogen locus single nucleotide polymorphism associated with lower fibrinogen were exclusive to AAs; these include a newly reported association with FGA rs10050257. For IL6R, IL1RN, and NLRP3 inflammatory gene loci, associations with fibrinogen were concordant between EAs and AAs, but not at other loci (CPS1, PCCB, and SCL22A5-IRF1). The association of FGG rs2066861 with fibrinogen differed according to assay type used to measure fibrinogen. Further characterization of common and lower-frequency genetic variants that contribute to interpopulation differences in fibrinogen phenotype may help refine our understanding of the contribution of hemostasis and inflammation to atherothrombotic risk.

VL - 117 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20978265?dopt=Abstract ER - TY - JOUR T1 - Carotid intima-media thickness, electrocardiographic left ventricular hypertrophy, and incidence of intracerebral hemorrhage. JF - Stroke Y1 - 2011 A1 - Folsom, Aaron R A1 - Yatsuya, Hiroshi A1 - Psaty, Bruce M A1 - Shahar, Eyal A1 - Longstreth, W T KW - Carotid Intima-Media Thickness KW - Cerebral Hemorrhage KW - Cohort Studies KW - Electrocardiography KW - Female KW - Follow-Up Studies KW - Humans KW - Hypertrophy, Left Ventricular KW - Incidence KW - Male KW - Middle Aged KW - Prospective Studies KW - Risk Factors AB -

BACKGROUND AND PURPOSE: Carotid intima-media thickness and electrocardiographic left ventricular hypertrophy are 2 subclinical cardiovascular disease measures associated with increased risk of total and ischemic strokes. Increased intima-media thickness and electrocardiographic left ventricular hypertrophy also may reflect end-organ hypertensive effects. Information is scant on the associations of these subclinical measures with intracerebral hemorrhage (ICH). We hypothesized that greater carotid intima-media thickness and the presence of electrocardiographic left ventricular hypertrophy would be independently associated with increased ICH incidence.

METHODS: Among 18,155 participants initially free of stroke in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS), we assessed carotid intima-media thickness, carotid plaque, and electrocardiographic left ventricular hypertrophy. Over a median of 18 years of follow-up, 162 incident ICH events occurred.

RESULTS: After adjustment for other ICH risk factors, carotid intima-media thickness was associated positively with incidence of ICH in both ARIC and CHS. The risk was lowest in study-specific Quartile 1, elevated 1.6- to 2.6-fold in Quartiles 2 to 3, and elevated 2.5 to 3.7-fold in Quartile 4 (P<0.05 for both studies). In CHS, having a carotid plaque was associated with a 2-fold (95% CI, 1.1-3.4) greater ICH risk than having no plaque, but only 1.2-fold (95% CI, 0.76-2.0) greater ICH risk in ARIC. Electrocardiographic left ventricular hypertrophy carried a hazard ratio of ICH of 1.7 (95% CI, 0.77-3.7) in CHS and 2.8 (95% CI, 1.2-6.4) in ARIC.

CONCLUSIONS: Our data suggest that people with carotid atherosclerosis and possibly left ventricular hypertrophy are at increased risk not only of ischemic stroke, but also of ICH.

VL - 42 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21940954?dopt=Abstract ER - TY - JOUR T1 - A gene-centric association scan for Coagulation Factor VII levels in European and African Americans: the Candidate Gene Association Resource (CARe) Consortium. JF - Hum Mol Genet Y1 - 2011 A1 - Taylor, Kira C A1 - Lange, Leslie A A1 - Zabaneh, Delilah A1 - Lange, Ethan A1 - Keating, Brendan J A1 - Tang, Weihong A1 - Smith, Nicholas L A1 - Delaney, Joseph A A1 - Kumari, Meena A1 - Hingorani, Aroon A1 - North, Kari E A1 - Kivimaki, Mika A1 - Tracy, Russell P A1 - O'Donnell, Christopher J A1 - Folsom, Aaron R A1 - Green, David A1 - Humphries, Steve E A1 - Reiner, Alexander P KW - Adult KW - African Americans KW - Aged KW - Cardiovascular Diseases KW - European Continental Ancestry Group KW - Factor VII KW - Female KW - Genetic Predisposition to Disease KW - Humans KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide AB -

Polymorphisms in several distinct genomic regions, including the F7 gene, were recently associated with factor VII (FVII) levels in European Americans (EAs). The genetic determinants of FVII in African Americans (AAs) are unknown. We used a 50,000 single nucleotide polymorphism (SNP) gene-centric array having dense coverage of over 2,000 candidate genes for cardiovascular disease (CVD) pathways in a community-based sample of 16,324 EA and 3898 AA participants from the Candidate Gene Association Resource (CARe) consortium. Our aim was the discovery of new genomic loci and more detailed characterization of existing loci associated with FVII levels. In EAs, we identified three new loci associated with FVII, of which APOA5 on chromosome 11q23 and HNF4A on chromosome 20q12-13 were replicated in a sample of 4289 participants from the Whitehall II study. We confirmed four previously reported FVII-associated loci (GCKR, MS4A6A, F7 and PROCR) in CARe EA samples. In AAs, the F7 and PROCR regions were significantly associated with FVII. Several of the FVII-associated regions are known to be associated with lipids and other cardiovascular-related traits. At the F7 locus, there was evidence of at least five independently associated SNPs in EAs and three independent signals in AAs. Though the variance in FVII explained by the existing loci is substantial (20% in EA and 10% in AA), larger sample sizes and investigation of lower frequency variants may be required to identify additional FVII-associated loci in EAs and AAs and further clarify the relationship between FVII and other CVD risk factors.

VL - 20 IS - 17 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21676895?dopt=Abstract ER - TY - JOUR T1 - Longer legs are associated with greater risk of incident venous thromboembolism independent of total body height. The Longitudinal Study of Thromboembolism Etiology (LITE). JF - Thromb Haemost Y1 - 2011 A1 - Lutsey, Pamela L A1 - Cushman, Mary A1 - Heckbert, Susan R A1 - Tang, Weihong A1 - Folsom, Aaron R KW - Adult KW - Aged KW - Anthropometry KW - Body Height KW - Female KW - Follow-Up Studies KW - Humans KW - Leg KW - Male KW - Middle Aged KW - Population Groups KW - Prospective Studies KW - Risk Factors KW - United States KW - Venous Thromboembolism AB -

Several studies have reported that taller individuals are at greater risk of venous thromboembolism (VTE). We hypothesised that longer leg length would be positively associated with incident VTE, and would explain the height association. LITE ascertained VTE in a prospective population-based sample of 21,860 individuals aged 45 and older. Leg length was measured as standing height minus torso length. Cox regression models were adjusted for age, race, sex, waist circumference, diabetes, and factor VIII. To evaluate whether leg length was associated with VTE risk independent of height, we standardised leg length and height per 1 standard deviation (SD), and then included them simultaneously in Cox regression models. A total of 641 incident VTE cases accrued over a median follow-up of 16 years. Participants in the highest quintile of leg length were at 59% (95% CI: 22%-108%) greater risk of VTE, relative to the lowest quintile. For height, risk was 45% (12%-88%) greater for those in the highest quintile, compared to the lowest. When leg length and height were modelled simultaneously leg length remained associated with VTE risk (HR per 1 SD: 1.21 (1.04-1.40) while height was unrelated (HR per 1 SD: 1.00 (0.86-1.16). To conclude, participants with longer legs were at greater risk of incident VTE, and leg length explained the relation of height to VTE. It remains to be established whether this finding is due to greater venous surface area, a larger number of venous valves, or greater hydrostatic pressure among individuals with longer legs.

VL - 106 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21655679?dopt=Abstract ER - TY - JOUR T1 - Meta-analysis of genome-wide association studies in >80 000 subjects identifies multiple loci for C-reactive protein levels. JF - Circulation Y1 - 2011 A1 - Dehghan, Abbas A1 - Dupuis, Josée A1 - Barbalic, Maja A1 - Bis, Joshua C A1 - Eiriksdottir, Gudny A1 - Lu, Chen A1 - Pellikka, Niina A1 - Wallaschofski, Henri A1 - Kettunen, Johannes A1 - Henneman, Peter A1 - Baumert, Jens A1 - Strachan, David P A1 - Fuchsberger, Christian A1 - Vitart, Veronique A1 - Wilson, James F A1 - Paré, Guillaume A1 - Naitza, Silvia A1 - Rudock, Megan E A1 - Surakka, Ida A1 - de Geus, Eco J C A1 - Alizadeh, Behrooz Z A1 - Guralnik, Jack A1 - Shuldiner, Alan A1 - Tanaka, Toshiko A1 - Zee, Robert Y L A1 - Schnabel, Renate B A1 - Nambi, Vijay A1 - Kavousi, Maryam A1 - Ripatti, Samuli A1 - Nauck, Matthias A1 - Smith, Nicholas L A1 - Smith, Albert V A1 - Sundvall, Jouko A1 - Scheet, Paul A1 - Liu, Yongmei A1 - Ruokonen, Aimo A1 - Rose, Lynda M A1 - Larson, Martin G A1 - Hoogeveen, Ron C A1 - Freimer, Nelson B A1 - Teumer, Alexander A1 - Tracy, Russell P A1 - Launer, Lenore J A1 - Buring, Julie E A1 - Yamamoto, Jennifer F A1 - Folsom, Aaron R A1 - Sijbrands, Eric J G A1 - Pankow, James A1 - Elliott, Paul A1 - Keaney, John F A1 - Sun, Wei A1 - Sarin, Antti-Pekka A1 - Fontes, João D A1 - Badola, Sunita A1 - Astor, Brad C A1 - Hofman, Albert A1 - Pouta, Anneli A1 - Werdan, Karl A1 - Greiser, Karin H A1 - Kuss, Oliver A1 - Meyer zu Schwabedissen, Henriette E A1 - Thiery, Joachim A1 - Jamshidi, Yalda A1 - Nolte, Ilja M A1 - Soranzo, Nicole A1 - Spector, Timothy D A1 - Völzke, Henry A1 - Parker, Alexander N A1 - Aspelund, Thor A1 - Bates, David A1 - Young, Lauren A1 - Tsui, Kim A1 - Siscovick, David S A1 - Guo, Xiuqing A1 - Rotter, Jerome I A1 - Uda, Manuela A1 - Schlessinger, David A1 - Rudan, Igor A1 - Hicks, Andrew A A1 - Penninx, Brenda W A1 - Thorand, Barbara A1 - Gieger, Christian A1 - Coresh, Joe A1 - Willemsen, Gonneke A1 - Harris, Tamara B A1 - Uitterlinden, André G A1 - Jarvelin, Marjo-Riitta A1 - Rice, Kenneth A1 - Radke, Dörte A1 - Salomaa, Veikko A1 - Willems van Dijk, Ko A1 - Boerwinkle, Eric A1 - Vasan, Ramachandran S A1 - Ferrucci, Luigi A1 - Gibson, Quince D A1 - Bandinelli, Stefania A1 - Snieder, Harold A1 - Boomsma, Dorret I A1 - Xiao, Xiangjun A1 - Campbell, Harry A1 - Hayward, Caroline A1 - Pramstaller, Peter P A1 - van Duijn, Cornelia M A1 - Peltonen, Leena A1 - Psaty, Bruce M A1 - Gudnason, Vilmundur A1 - Ridker, Paul M A1 - Homuth, Georg A1 - Koenig, Wolfgang A1 - Ballantyne, Christie M A1 - Witteman, Jacqueline C M A1 - Benjamin, Emelia J A1 - Perola, Markus A1 - Chasman, Daniel I KW - Biomarkers KW - C-Reactive Protein KW - Cardiovascular Diseases KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Risk Factors KW - Vasculitis AB -

BACKGROUND: C-reactive protein (CRP) is a heritable marker of chronic inflammation that is strongly associated with cardiovascular disease. We sought to identify genetic variants that are associated with CRP levels.

METHODS AND RESULTS: We performed a genome-wide association analysis of CRP in 66 185 participants from 15 population-based studies. We sought replication for the genome-wide significant and suggestive loci in a replication panel comprising 16 540 individuals from 10 independent studies. We found 18 genome-wide significant loci, and we provided evidence of replication for 8 of them. Our results confirm 7 previously known loci and introduce 11 novel loci that are implicated in pathways related to the metabolic syndrome (APOC1, HNF1A, LEPR, GCKR, HNF4A, and PTPN2) or the immune system (CRP, IL6R, NLRP3, IL1F10, and IRF1) or that reside in regions previously not known to play a role in chronic inflammation (PPP1R3B, SALL1, PABPC4, ASCL1, RORA, and BCL7B). We found a significant interaction of body mass index with LEPR (P<2.9×10(-6)). A weighted genetic risk score that was developed to summarize the effect of risk alleles was strongly associated with CRP levels and explained ≈5% of the trait variance; however, there was no evidence for these genetic variants explaining the association of CRP with coronary heart disease.

CONCLUSIONS: We identified 18 loci that were associated with CRP levels. Our study highlights immune response and metabolic regulatory pathways involved in the regulation of chronic inflammation.

VL - 123 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21300955?dopt=Abstract ER - TY - JOUR T1 - New gene functions in megakaryopoiesis and platelet formation. JF - Nature Y1 - 2011 A1 - Gieger, Christian A1 - Radhakrishnan, Aparna A1 - Cvejic, Ana A1 - Tang, Weihong A1 - Porcu, Eleonora A1 - Pistis, Giorgio A1 - Serbanovic-Canic, Jovana A1 - Elling, Ulrich A1 - Goodall, Alison H A1 - Labrune, Yann A1 - Lopez, Lorna M A1 - Mägi, Reedik A1 - Meacham, Stuart A1 - Okada, Yukinori A1 - Pirastu, Nicola A1 - Sorice, Rossella A1 - Teumer, Alexander A1 - Voss, Katrin A1 - Zhang, Weihua A1 - Ramirez-Solis, Ramiro A1 - Bis, Joshua C A1 - Ellinghaus, David A1 - Gögele, Martin A1 - Hottenga, Jouke-Jan A1 - Langenberg, Claudia A1 - Kovacs, Peter A1 - O'Reilly, Paul F A1 - Shin, So-Youn A1 - Esko, Tõnu A1 - Hartiala, Jaana A1 - Kanoni, Stavroula A1 - Murgia, Federico A1 - Parsa, Afshin A1 - Stephens, Jonathan A1 - van der Harst, Pim A1 - Ellen van der Schoot, C A1 - Allayee, Hooman A1 - Attwood, Antony A1 - Balkau, Beverley A1 - Bastardot, François A1 - Basu, Saonli A1 - Baumeister, Sebastian E A1 - Biino, Ginevra A1 - Bomba, Lorenzo A1 - Bonnefond, Amélie A1 - Cambien, Francois A1 - Chambers, John C A1 - Cucca, Francesco A1 - D'Adamo, Pio A1 - Davies, Gail A1 - de Boer, Rudolf A A1 - de Geus, Eco J C A1 - Döring, Angela A1 - Elliott, Paul A1 - Erdmann, Jeanette A1 - Evans, David M A1 - Falchi, Mario A1 - Feng, Wei A1 - Folsom, Aaron R A1 - Frazer, Ian H A1 - Gibson, Quince D A1 - Glazer, Nicole L A1 - Hammond, Chris A1 - Hartikainen, Anna-Liisa A1 - Heckbert, Susan R A1 - Hengstenberg, Christian A1 - Hersch, Micha A1 - Illig, Thomas A1 - Loos, Ruth J F A1 - Jolley, Jennifer A1 - Khaw, Kay Tee A1 - Kuhnel, Brigitte A1 - Kyrtsonis, Marie-Christine A1 - Lagou, Vasiliki A1 - Lloyd-Jones, Heather A1 - Lumley, Thomas A1 - Mangino, Massimo A1 - Maschio, Andrea A1 - Mateo Leach, Irene A1 - McKnight, Barbara A1 - Memari, Yasin A1 - Mitchell, Braxton D A1 - Montgomery, Grant W A1 - Nakamura, Yusuke A1 - Nauck, Matthias A1 - Navis, Gerjan A1 - Nöthlings, Ute A1 - Nolte, Ilja M A1 - Porteous, David J A1 - Pouta, Anneli A1 - Pramstaller, Peter P A1 - Pullat, Janne A1 - Ring, Susan M A1 - Rotter, Jerome I A1 - Ruggiero, Daniela A1 - Ruokonen, Aimo A1 - Sala, Cinzia A1 - Samani, Nilesh J A1 - Sambrook, Jennifer A1 - Schlessinger, David A1 - Schreiber, Stefan A1 - Schunkert, Heribert A1 - Scott, James A1 - Smith, Nicholas L A1 - Snieder, Harold A1 - Starr, John M A1 - Stumvoll, Michael A1 - Takahashi, Atsushi A1 - Tang, W H Wilson A1 - Taylor, Kent A1 - Tenesa, Albert A1 - Lay Thein, Swee A1 - Tönjes, Anke A1 - Uda, Manuela A1 - Ulivi, Sheila A1 - van Veldhuisen, Dirk J A1 - Visscher, Peter M A1 - Völker, Uwe A1 - Wichmann, H-Erich A1 - Wiggins, Kerri L A1 - Willemsen, Gonneke A1 - Yang, Tsun-Po A1 - Hua Zhao, Jing A1 - Zitting, Paavo A1 - Bradley, John R A1 - Dedoussis, George V A1 - Gasparini, Paolo A1 - Hazen, Stanley L A1 - Metspalu, Andres A1 - Pirastu, Mario A1 - Shuldiner, Alan R A1 - Joost van Pelt, L A1 - Zwaginga, Jaap-Jan A1 - Boomsma, Dorret I A1 - Deary, Ian J A1 - Franke, Andre A1 - Froguel, Philippe A1 - Ganesh, Santhi K A1 - Jarvelin, Marjo-Riitta A1 - Martin, Nicholas G A1 - Meisinger, Christa A1 - Psaty, Bruce M A1 - Spector, Timothy D A1 - Wareham, Nicholas J A1 - Akkerman, Jan-Willem N A1 - Ciullo, Marina A1 - Deloukas, Panos A1 - Greinacher, Andreas A1 - Jupe, Steve A1 - Kamatani, Naoyuki A1 - Khadake, Jyoti A1 - Kooner, Jaspal S A1 - Penninger, Josef A1 - Prokopenko, Inga A1 - Stemple, Derek A1 - Toniolo, Daniela A1 - Wernisch, Lorenz A1 - Sanna, Serena A1 - Hicks, Andrew A A1 - Rendon, Augusto A1 - Ferreira, Manuel A A1 - Ouwehand, Willem H A1 - Soranzo, Nicole KW - Animals KW - Blood Platelets KW - Cell Size KW - Drosophila melanogaster KW - Drosophila Proteins KW - Europe KW - Gene Expression Profiling KW - Gene Silencing KW - Genome, Human KW - Genome-Wide Association Study KW - Hematopoiesis KW - Humans KW - Megakaryocytes KW - Platelet Count KW - Protein Interaction Maps KW - Transcription, Genetic KW - Zebrafish KW - Zebrafish Proteins AB -

Platelets are the second most abundant cell type in blood and are essential for maintaining haemostasis. Their count and volume are tightly controlled within narrow physiological ranges, but there is only limited understanding of the molecular processes controlling both traits. Here we carried out a high-powered meta-analysis of genome-wide association studies (GWAS) in up to 66,867 individuals of European ancestry, followed by extensive biological and functional assessment. We identified 68 genomic loci reliably associated with platelet count and volume mapping to established and putative novel regulators of megakaryopoiesis and platelet formation. These genes show megakaryocyte-specific gene expression patterns and extensive network connectivity. Using gene silencing in Danio rerio and Drosophila melanogaster, we identified 11 of the genes as novel regulators of blood cell formation. Taken together, our findings advance understanding of novel gene functions controlling fate-determining events during megakaryopoiesis and platelet formation, providing a new example of successful translation of GWAS to function.

VL - 480 IS - 7376 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22139419?dopt=Abstract ER - TY - JOUR T1 - Association between chromosome 9p21 variants and the ankle-brachial index identified by a meta-analysis of 21 genome-wide association studies. JF - Circ Cardiovasc Genet Y1 - 2012 A1 - Murabito, Joanne M A1 - White, Charles C A1 - Kavousi, Maryam A1 - Sun, Yan V A1 - Feitosa, Mary F A1 - Nambi, Vijay A1 - Lamina, Claudia A1 - Schillert, Arne A1 - Coassin, Stefan A1 - Bis, Joshua C A1 - Broer, Linda A1 - Crawford, Dana C A1 - Franceschini, Nora A1 - Frikke-Schmidt, Ruth A1 - Haun, Margot A1 - Holewijn, Suzanne A1 - Huffman, Jennifer E A1 - Hwang, Shih-Jen A1 - Kiechl, Stefan A1 - Kollerits, Barbara A1 - Montasser, May E A1 - Nolte, Ilja M A1 - Rudock, Megan E A1 - Senft, Andrea A1 - Teumer, Alexander A1 - van der Harst, Pim A1 - Vitart, Veronique A1 - Waite, Lindsay L A1 - Wood, Andrew R A1 - Wassel, Christina L A1 - Absher, Devin M A1 - Allison, Matthew A A1 - Amin, Najaf A1 - Arnold, Alice A1 - Asselbergs, Folkert W A1 - Aulchenko, Yurii A1 - Bandinelli, Stefania A1 - Barbalic, Maja A1 - Boban, Mladen A1 - Brown-Gentry, Kristin A1 - Couper, David J A1 - Criqui, Michael H A1 - Dehghan, Abbas A1 - den Heijer, Martin A1 - Dieplinger, Benjamin A1 - Ding, Jingzhong A1 - Dörr, Marcus A1 - Espinola-Klein, Christine A1 - Felix, Stephan B A1 - Ferrucci, Luigi A1 - Folsom, Aaron R A1 - Fraedrich, Gustav A1 - Gibson, Quince A1 - Goodloe, Robert A1 - Gunjaca, Grgo A1 - Haltmayer, Meinhard A1 - Heiss, Gerardo A1 - Hofman, Albert A1 - Kieback, Arne A1 - Kiemeney, Lambertus A A1 - Kolcic, Ivana A1 - Kullo, Iftikhar J A1 - Kritchevsky, Stephen B A1 - Lackner, Karl J A1 - Li, Xiaohui A1 - Lieb, Wolfgang A1 - Lohman, Kurt A1 - Meisinger, Christa A1 - Melzer, David A1 - Mohler, Emile R A1 - Mudnic, Ivana A1 - Mueller, Thomas A1 - Navis, Gerjan A1 - Oberhollenzer, Friedrich A1 - Olin, Jeffrey W A1 - O'Connell, Jeff A1 - O'Donnell, Christopher J A1 - Palmas, Walter A1 - Penninx, Brenda W A1 - Petersmann, Astrid A1 - Polasek, Ozren A1 - Psaty, Bruce M A1 - Rantner, Barbara A1 - Rice, Ken A1 - Rivadeneira, Fernando A1 - Rotter, Jerome I A1 - Seldenrijk, Adrie A1 - Stadler, Marietta A1 - Summerer, Monika A1 - Tanaka, Toshiko A1 - Tybjaerg-Hansen, Anne A1 - Uitterlinden, André G A1 - van Gilst, Wiek H A1 - Vermeulen, Sita H A1 - Wild, Sarah H A1 - Wild, Philipp S A1 - Willeit, Johann A1 - Zeller, Tanja A1 - Zemunik, Tatijana A1 - Zgaga, Lina A1 - Assimes, Themistocles L A1 - Blankenberg, Stefan A1 - Boerwinkle, Eric A1 - Campbell, Harry A1 - Cooke, John P A1 - de Graaf, Jacqueline A1 - Herrington, David A1 - Kardia, Sharon L R A1 - Mitchell, Braxton D A1 - Murray, Anna A1 - Münzel, Thomas A1 - Newman, Anne B A1 - Oostra, Ben A A1 - Rudan, Igor A1 - Shuldiner, Alan R A1 - Snieder, Harold A1 - van Duijn, Cornelia M A1 - Völker, Uwe A1 - Wright, Alan F A1 - Wichmann, H-Erich A1 - Wilson, James F A1 - Witteman, Jacqueline C M A1 - Liu, Yongmei A1 - Hayward, Caroline A1 - Borecki, Ingrid B A1 - Ziegler, Andreas A1 - North, Kari E A1 - Cupples, L Adrienne A1 - Kronenberg, Florian KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alleles KW - Ankle Brachial Index KW - Chromosomes, Human, Pair 9 KW - Cohort Studies KW - Cyclin-Dependent Kinase Inhibitor p15 KW - Female KW - Genome-Wide Association Study KW - Genotype KW - HapMap Project KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Peripheral Vascular Diseases KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - Sex Factors AB -

BACKGROUND: Genetic determinants of peripheral arterial disease (PAD) remain largely unknown. To identify genetic variants associated with the ankle-brachial index (ABI), a noninvasive measure of PAD, we conducted a meta-analysis of genome-wide association study data from 21 population-based cohorts.

METHODS AND RESULTS: Continuous ABI and PAD (ABI ≤0.9) phenotypes adjusted for age and sex were examined. Each study conducted genotyping and imputed data to the ≈2.5 million single nucleotide polymorphisms (SNPs) in HapMap. Linear and logistic regression models were used to test each SNP for association with ABI and PAD using additive genetic models. Study-specific data were combined using fixed effects inverse variance weighted meta-analyses. There were a total of 41 692 participants of European ancestry (≈60% women, mean ABI 1.02 to 1.19), including 3409 participants with PAD and with genome-wide association study data available. In the discovery meta-analysis, rs10757269 on chromosome 9 near CDKN2B had the strongest association with ABI (β=-0.006, P=2.46×10(-8)). We sought replication of the 6 strongest SNP associations in 5 population-based studies and 3 clinical samples (n=16 717). The association for rs10757269 strengthened in the combined discovery and replication analysis (P=2.65×10(-9)). No other SNP associations for ABI or PAD achieved genome-wide significance. However, 2 previously reported candidate genes for PAD and 1 SNP associated with coronary artery disease were associated with ABI: DAB21P (rs13290547, P=3.6×10(-5)), CYBA (rs3794624, P=6.3×10(-5)), and rs1122608 (LDLR, P=0.0026).

CONCLUSIONS: Genome-wide association studies in more than 40 000 individuals identified 1 genome wide significant association on chromosome 9p21 with ABI. Two candidate genes for PAD and 1 SNP for coronary artery disease are associated with ABI.

VL - 5 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22199011?dopt=Abstract ER - TY - JOUR T1 - Association of mild to moderate chronic kidney disease with venous thromboembolism: pooled analysis of five prospective general population cohorts. JF - Circulation Y1 - 2012 A1 - Mahmoodi, Bakhtawar K A1 - Gansevoort, Ron T A1 - Næss, Inger Anne A1 - Lutsey, Pamela L A1 - Brækkan, Sigrid K A1 - Veeger, Nic J G M A1 - Brodin, Ellen E A1 - Meijer, Karina A1 - Sang, Yingying A1 - Matsushita, Kunihiro A1 - Hallan, Stein I A1 - Hammerstrøm, Jens A1 - Cannegieter, Suzanne C A1 - Astor, Brad C A1 - Coresh, Josef A1 - Folsom, Aaron R A1 - Hansen, John-Bjarne A1 - Cushman, Mary KW - Aged KW - Cohort Studies KW - Europe KW - Female KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Prevalence KW - Renal Insufficiency, Chronic KW - Risk Factors KW - Severity of Illness Index KW - Venous Thromboembolism AB -

BACKGROUND: Recent findings suggest that chronic kidney disease (CKD) may be associated with an increased risk of venous thromboembolism (VTE). Given the high prevalence of mild-to-moderate CKD in the general population, in depth analysis of this association is warranted.

METHODS AND RESULTS: We pooled individual participant data from 5 community-based cohorts from Europe (second Nord-Trøndelag Health Study [HUNT2], Prevention of Renal and Vascular End-stage Disease [PREVEND], and the Tromsø study) and the United States (Atherosclerosis Risks in Communities [ARIC] and Cardiovascular Health Study [CHS]) to assess the association of estimated glomerular filtration rate (eGFR), albuminuria, and CKD with objectively verified VTE. To estimate adjusted hazard ratios for VTE, categorical and continuous spline models were fit by using Cox regression with shared-frailty or random-effect meta-analysis. A total of 1178 VTE events occurred over 599 453 person-years follow-up. Relative to eGFR 100 mL/min per 1.73 m(2), hazard ratios for VTE were 1.29 (95% confidence interval, 1.04-1.59) for eGFR 75, 1.31 (1.00-1.71) for eGFR 60, 1.82 (1.27-2.60) for eGFR 45, and 1.95 (1.26-3.01) for eGFR 30 mL/min per 1.73 m(2). In comparison with an albumin-to-creatinine ratio (ACR) of 5.0 mg/g, the hazard ratios for VTE were 1.34 (1.04-1.72) for ACR 30 mg/g, 1.60 (1.08-2.36) for ACR 300 mg/g, and 1.92 (1.19-3.09) for ACR 1000 mg/g. There was no interaction between clinical categories of eGFR and ACR (P=0.20). The adjusted hazard ratio for CKD, defined as eGFR <60 mL/min per 1.73 m(2) or albuminuria ≥30 mg/g, (versus no CKD) was 1.54 (95% confidence interval, 1.15-2.06). Associations were consistent in subgroups according to age, sex, and comorbidities, and for unprovoked versus provoked VTE, as well.

CONCLUSIONS: Both eGFR and ACR are independently associated with increased risk of VTE in the general population, even across the normal eGFR and ACR ranges.

VL - 126 IS - 16 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22977129?dopt=Abstract ER - TY - JOUR T1 - Genome-wide association study for circulating levels of PAI-1 provides novel insights into its regulation. JF - Blood Y1 - 2012 A1 - Huang, Jie A1 - Sabater-Lleal, Maria A1 - Asselbergs, Folkert W A1 - Tregouet, David A1 - Shin, So-Youn A1 - Ding, Jingzhong A1 - Baumert, Jens A1 - Oudot-Mellakh, Tiphaine A1 - Folkersen, Lasse A1 - Johnson, Andrew D A1 - Smith, Nicholas L A1 - Williams, Scott M A1 - Ikram, Mohammad A A1 - Kleber, Marcus E A1 - Becker, Diane M A1 - Truong, Vinh A1 - Mychaleckyj, Josyf C A1 - Tang, Weihong A1 - Yang, Qiong A1 - Sennblad, Bengt A1 - Moore, Jason H A1 - Williams, Frances M K A1 - Dehghan, Abbas A1 - Silbernagel, Günther A1 - Schrijvers, Elisabeth M C A1 - Smith, Shelly A1 - Karakas, Mahir A1 - Tofler, Geoffrey H A1 - Silveira, Angela A1 - Navis, Gerjan J A1 - Lohman, Kurt A1 - Chen, Ming-Huei A1 - Peters, Annette A1 - Goel, Anuj A1 - Hopewell, Jemma C A1 - Chambers, John C A1 - Saleheen, Danish A1 - Lundmark, Per A1 - Psaty, Bruce M A1 - Strawbridge, Rona J A1 - Boehm, Bernhard O A1 - Carter, Angela M A1 - Meisinger, Christa A1 - Peden, John F A1 - Bis, Joshua C A1 - McKnight, Barbara A1 - Ohrvik, John A1 - Taylor, Kent A1 - Franzosi, Maria Grazia A1 - Seedorf, Udo A1 - Collins, Rory A1 - Franco-Cereceda, Anders A1 - Syvänen, Ann-Christine A1 - Goodall, Alison H A1 - Yanek, Lisa R A1 - Cushman, Mary A1 - Müller-Nurasyid, Martina A1 - Folsom, Aaron R A1 - Basu, Saonli A1 - Matijevic, Nena A1 - van Gilst, Wiek H A1 - Kooner, Jaspal S A1 - Hofman, Albert A1 - Danesh, John A1 - Clarke, Robert A1 - Meigs, James B A1 - Kathiresan, Sekar A1 - Reilly, Muredach P A1 - Klopp, Norman A1 - Harris, Tamara B A1 - Winkelmann, Bernhard R A1 - Grant, Peter J A1 - Hillege, Hans L A1 - Watkins, Hugh A1 - Spector, Timothy D A1 - Becker, Lewis C A1 - Tracy, Russell P A1 - März, Winfried A1 - Uitterlinden, André G A1 - Eriksson, Per A1 - Cambien, Francois A1 - Morange, Pierre-Emmanuel A1 - Koenig, Wolfgang A1 - Soranzo, Nicole A1 - van der Harst, Pim A1 - Liu, Yongmei A1 - O'Donnell, Christopher J A1 - Hamsten, Anders KW - Adaptor Proteins, Signal Transducing KW - ARNTL Transcription Factors KW - ATPases Associated with Diverse Cellular Activities KW - Cell Line KW - Cell Line, Tumor KW - Cohort Studies KW - Coronary Artery Disease KW - Diabetes Mellitus, Type 2 KW - Gene Expression Profiling KW - Gene Expression Regulation KW - Gene Frequency KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - LIM Domain Proteins KW - Meta-Analysis as Topic KW - Monocytes KW - Mucin-3 KW - Plasminogen Activator Inhibitor 1 KW - Polymorphism, Single Nucleotide KW - PPAR gamma KW - Proteasome Endopeptidase Complex KW - RNA Interference KW - Transcription Factors AB -

We conducted a genome-wide association study to identify novel associations between genetic variants and circulating plasminogen activator inhibitor-1 (PAI-1) concentration, and examined functional implications of variants and genes that were discovered. A discovery meta-analysis was performed in 19 599 subjects, followed by replication analysis of genome-wide significant (P < 5 × 10(-8)) single nucleotide polymorphisms (SNPs) in 10 796 independent samples. We further examined associations with type 2 diabetes and coronary artery disease, assessed the functional significance of the SNPs for gene expression in human tissues, and conducted RNA-silencing experiments for one novel association. We confirmed the association of the 4G/5G proxy SNP rs2227631 in the promoter region of SERPINE1 (7q22.1) and discovered genome-wide significant associations at 3 additional loci: chromosome 7q22.1 close to SERPINE1 (rs6976053, discovery P = 3.4 × 10(-10)); chromosome 11p15.2 within ARNTL (rs6486122, discovery P = 3.0 × 10(-8)); and chromosome 3p25.2 within PPARG (rs11128603, discovery P = 2.9 × 10(-8)). Replication was achieved for the 7q22.1 and 11p15.2 loci. There was nominal association with type 2 diabetes and coronary artery disease at ARNTL (P < .05). Functional studies identified MUC3 as a candidate gene for the second association signal on 7q22.1. In summary, SNPs in SERPINE1 and ARNTL and an SNP associated with the expression of MUC3 were robustly associated with circulating levels of PAI-1.

VL - 120 IS - 24 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22990020?dopt=Abstract ER - TY - JOUR T1 - Meta-analyses identify 13 loci associated with age at menopause and highlight DNA repair and immune pathways. JF - Nat Genet Y1 - 2012 A1 - Stolk, Lisette A1 - Perry, John R B A1 - Chasman, Daniel I A1 - He, Chunyan A1 - Mangino, Massimo A1 - Sulem, Patrick A1 - Barbalic, Maja A1 - Broer, Linda A1 - Byrne, Enda M A1 - Ernst, Florian A1 - Esko, Tõnu A1 - Franceschini, Nora A1 - Gudbjartsson, Daniel F A1 - Hottenga, Jouke-Jan A1 - Kraft, Peter A1 - McArdle, Patrick F A1 - Porcu, Eleonora A1 - Shin, So-Youn A1 - Smith, Albert V A1 - van Wingerden, Sophie A1 - Zhai, Guangju A1 - Zhuang, Wei V A1 - Albrecht, Eva A1 - Alizadeh, Behrooz Z A1 - Aspelund, Thor A1 - Bandinelli, Stefania A1 - Lauc, Lovorka Barac A1 - Beckmann, Jacques S A1 - Boban, Mladen A1 - Boerwinkle, Eric A1 - Broekmans, Frank J A1 - Burri, Andrea A1 - Campbell, Harry A1 - Chanock, Stephen J A1 - Chen, Constance A1 - Cornelis, Marilyn C A1 - Corre, Tanguy A1 - Coviello, Andrea D A1 - D'Adamo, Pio A1 - Davies, Gail A1 - de Faire, Ulf A1 - de Geus, Eco J C A1 - Deary, Ian J A1 - Dedoussis, George V Z A1 - Deloukas, Panagiotis A1 - Ebrahim, Shah A1 - Eiriksdottir, Gudny A1 - Emilsson, Valur A1 - Eriksson, Johan G A1 - Fauser, Bart C J M A1 - Ferreli, Liana A1 - Ferrucci, Luigi A1 - Fischer, Krista A1 - Folsom, Aaron R A1 - Garcia, Melissa E A1 - Gasparini, Paolo A1 - Gieger, Christian A1 - Glazer, Nicole A1 - Grobbee, Diederick E A1 - Hall, Per A1 - Haller, Toomas A1 - Hankinson, Susan E A1 - Hass, Merli A1 - Hayward, Caroline A1 - Heath, Andrew C A1 - Hofman, Albert A1 - Ingelsson, Erik A1 - Janssens, A Cecile J W A1 - Johnson, Andrew D A1 - Karasik, David A1 - Kardia, Sharon L R A1 - Keyzer, Jules A1 - Kiel, Douglas P A1 - Kolcic, Ivana A1 - Kutalik, Zoltán A1 - Lahti, Jari A1 - Lai, Sandra A1 - Laisk, Triin A1 - Laven, Joop S E A1 - Lawlor, Debbie A A1 - Liu, Jianjun A1 - Lopez, Lorna M A1 - Louwers, Yvonne V A1 - Magnusson, Patrik K E A1 - Marongiu, Mara A1 - Martin, Nicholas G A1 - Klaric, Irena Martinovic A1 - Masciullo, Corrado A1 - McKnight, Barbara A1 - Medland, Sarah E A1 - Melzer, David A1 - Mooser, Vincent A1 - Navarro, Pau A1 - Newman, Anne B A1 - Nyholt, Dale R A1 - Onland-Moret, N Charlotte A1 - Palotie, Aarno A1 - Paré, Guillaume A1 - Parker, Alex N A1 - Pedersen, Nancy L A1 - Peeters, Petra H M A1 - Pistis, Giorgio A1 - Plump, Andrew S A1 - Polasek, Ozren A1 - Pop, Victor J M A1 - Psaty, Bruce M A1 - Räikkönen, Katri A1 - Rehnberg, Emil A1 - Rotter, Jerome I A1 - Rudan, Igor A1 - Sala, Cinzia A1 - Salumets, Andres A1 - Scuteri, Angelo A1 - Singleton, Andrew A1 - Smith, Jennifer A A1 - Snieder, Harold A1 - Soranzo, Nicole A1 - Stacey, Simon N A1 - Starr, John M A1 - Stathopoulou, Maria G A1 - Stirrups, Kathleen A1 - Stolk, Ronald P A1 - Styrkarsdottir, Unnur A1 - Sun, Yan V A1 - Tenesa, Albert A1 - Thorand, Barbara A1 - Toniolo, Daniela A1 - Tryggvadottir, Laufey A1 - Tsui, Kim A1 - Ulivi, Sheila A1 - van Dam, Rob M A1 - van der Schouw, Yvonne T A1 - van Gils, Carla H A1 - van Nierop, Peter A1 - Vink, Jacqueline M A1 - Visscher, Peter M A1 - Voorhuis, Marlies A1 - Waeber, Gérard A1 - Wallaschofski, Henri A1 - Wichmann, H Erich A1 - Widen, Elisabeth A1 - Wijnands-van Gent, Colette J M A1 - Willemsen, Gonneke A1 - Wilson, James F A1 - Wolffenbuttel, Bruce H R A1 - Wright, Alan F A1 - Yerges-Armstrong, Laura M A1 - Zemunik, Tatijana A1 - Zgaga, Lina A1 - Zillikens, M Carola A1 - Zygmunt, Marek A1 - Arnold, Alice M A1 - Boomsma, Dorret I A1 - Buring, Julie E A1 - Crisponi, Laura A1 - Demerath, Ellen W A1 - Gudnason, Vilmundur A1 - Harris, Tamara B A1 - Hu, Frank B A1 - Hunter, David J A1 - Launer, Lenore J A1 - Metspalu, Andres A1 - Montgomery, Grant W A1 - Oostra, Ben A A1 - Ridker, Paul M A1 - Sanna, Serena A1 - Schlessinger, David A1 - Spector, Tim D A1 - Stefansson, Kari A1 - Streeten, Elizabeth A A1 - Thorsteinsdottir, Unnur A1 - Uda, Manuela A1 - Uitterlinden, André G A1 - van Duijn, Cornelia M A1 - Völzke, Henry A1 - Murray, Anna A1 - Murabito, Joanne M A1 - Visser, Jenny A A1 - Lunetta, Kathryn L KW - Age Factors KW - DNA Helicases KW - DNA Polymerase gamma KW - DNA Primase KW - DNA Repair KW - DNA Repair Enzymes KW - DNA-Directed DNA Polymerase KW - European Continental Ancestry Group KW - Exodeoxyribonucleases KW - Female KW - Genetic Loci KW - Genome-Wide Association Study KW - Humans KW - Immunity KW - Menopause KW - Polymorphism, Single Nucleotide KW - Proteins AB -

To newly identify loci for age at natural menopause, we carried out a meta-analysis of 22 genome-wide association studies (GWAS) in 38,968 women of European descent, with replication in up to 14,435 women. In addition to four known loci, we identified 13 loci newly associated with age at natural menopause (at P < 5 × 10(-8)). Candidate genes located at these newly associated loci include genes implicated in DNA repair (EXO1, HELQ, UIMC1, FAM175A, FANCI, TLK1, POLG and PRIM1) and immune function (IL11, NLRP11 and PRRC2A (also known as BAT2)). Gene-set enrichment pathway analyses using the full GWAS data set identified exoDNase, NF-κB signaling and mitochondrial dysfunction as biological processes related to timing of menopause.

VL - 44 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22267201?dopt=Abstract ER - TY - JOUR T1 - Risk of intraparenchymal hemorrhage with magnetic resonance imaging-defined leukoaraiosis and brain infarcts. JF - Ann Neurol Y1 - 2012 A1 - Folsom, Aaron R A1 - Yatsuya, Hiroshi A1 - Mosley, Thomas H A1 - Psaty, Bruce M A1 - Longstreth, W T KW - Cerebral Infarction KW - Cohort Studies KW - Female KW - Humans KW - Incidence KW - Intracranial Hemorrhages KW - Leukoaraiosis KW - Magnetic Resonance Imaging KW - Male KW - Middle Aged KW - Risk Factors AB -

OBJECTIVE: To determine whether the burden of leukoaraiosis and the number of brain infarcts, defined by magnetic resonance imaging (MRI), are prospectively and independently associated with intraparenchymal hemorrhage (IPH) incidence in a pooled population-based study.

METHODS: Among 4,872 participants initially free of clinical stroke in the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study, we assessed white matter grade (range, 0-9), reflecting increasing leukoaraiosis, and brain infarcts using MRI. Over a median of 13 years of follow-up, 71 incident, spontaneous IPH events occurred.

RESULTS: After adjustment for other IPH risk factors, the hazard ratios (95% confidence intervals) across white matter grades 0 to 1, 2, 3, and 4 to 9 were 1.00, 1.68 (0.86-3.30), 3.52 (1.80-6.89), and 3.96 (1.90-8.27), respectively (p for trend <0.0001). These hazard ratios were weakened only modestly (p for trend = 0.0003) with adjustment for MRI-defined brain infarcts. The IPH hazard ratios for 0, 1, 2, or ≥3 MRI-defined brain infarcts were 1.00, 1.97 (1.10-3.54), 2.00 (0.83-4.78), and 3.12 (1.31-7.43) (p for trend = 0.002), but these were substantially attenuated when adjusted for white matter grade (p for trend = 0.049).

INTERPRETATION: Greater MRI-defined burden of leukoaraiosis is a risk factor for spontaneous IPH. Spontaneous IPH should be added to the growing list of potential poor outcomes in people with leukoaraiosis.

VL - 71 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22522444?dopt=Abstract ER - TY - JOUR T1 - Atrial fibrillation and the risk of sudden cardiac death: the atherosclerosis risk in communities study and cardiovascular health study. JF - JAMA Intern Med Y1 - 2013 A1 - Chen, Lin Y A1 - Sotoodehnia, Nona A1 - Bůzková, Petra A1 - Lopez, Faye L A1 - Yee, Laura M A1 - Heckbert, Susan R A1 - Prineas, Ronald A1 - Soliman, Elsayed Z A1 - Adabag, Selcuk A1 - Konety, Suma A1 - Folsom, Aaron R A1 - Siscovick, David A1 - Alonso, Alvaro KW - Aged KW - Atrial Fibrillation KW - Cardiovascular Diseases KW - Death, Sudden, Cardiac KW - Demography KW - Ethnic Groups KW - Female KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - Risk Assessment KW - Risk Factors KW - Sex Factors KW - United States AB -

BACKGROUND: It is unknown whether atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death (SCD) in the general population. This association was examined in 2 population-based cohorts.

METHODS: In the Atherosclerosis Risk in Communities (ARIC) Study, we analyzed data from 15 439 participants (baseline age, 45-64 years; 55.2% women; and 26.6% black) from baseline (1987-1989) through December 31, 2001. In the Cardiovascular Health Study (CHS), we analyzed data from 5479 participants (baseline age, ≥65 years; 58.2% women; and 15.4% black) from baseline (first cohort, 1989-1990; second cohort, 1992-1993) through December 31, 2006. The main outcome was physician-adjudicated SCD, defined as death from a sudden, pulseless condition presumed to be due to a ventricular tachyarrhythmia. The secondary outcome was non-SCD (NSCD), defined as coronary heart disease death not meeting SCD criteria. We used Cox proportional hazards models to assess the association between AF and SCD/NSCD, adjusting for baseline demographic and cardiovascular risk factors.

RESULTS: In the ARIC Study, 894 AF, 269 SCD, and 233 NSCD events occurred during follow-up (median, 13.1 years). The crude incidence rates of SCD were 2.89 per 1000 person-years (with AF) and 1.30 per 1000 person-years (without AF). The multivariable hazard ratios (HRs) (95% CIs) of AF for SCD and NSCD were 3.26 (2.17-4.91) and 2.43 (1.60-3.71), respectively. In the CHS, 1458 AF, 292 SCD, and 581 NSCD events occurred during follow-up (median, 13.1 years). The crude incidence rates of SCD were 12.00 per 1000 person-years (with AF) and 3.82 per 1000 person-years (without AF). The multivariable HRs (95% CIs) of AF for SCD and NSCD were 2.14 (1.60-2.87) and 3.10 (2.58-3.72), respectively. The meta-analyzed HRs (95% CIs) of AF for SCD and NSCD were 2.47 (1.95-3.13) and 2.98 (2.52-3.53), respectively.

CONCLUSIONS: Incident AF is associated with an increased risk of SCD and NSCD in the general population. Additional research to identify predictors of SCD in patients with AF is warranted.

VL - 173 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23404043?dopt=Abstract ER - TY - JOUR T1 - Epidemiology and long-term clinical and biologic risk factors for pneumonia in community-dwelling older Americans: analysis of three cohorts. JF - Chest Y1 - 2013 A1 - Yende, Sachin A1 - Alvarez, Karina A1 - Loehr, Laura A1 - Folsom, Aaron R A1 - Newman, Anne B A1 - Weissfeld, Lisa A A1 - Wunderink, Richard G A1 - Kritchevsky, Stephen B A1 - Mukamal, Kenneth J A1 - London, Stephanie J A1 - Harris, Tamara B A1 - Bauer, Doug C A1 - Angus, Derek C KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Community-Acquired Infections KW - Comorbidity KW - Female KW - Follow-Up Studies KW - Hospitalization KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Pneumonia KW - Prognosis KW - Prospective Studies KW - Risk Assessment KW - Risk Factors KW - Survival Rate KW - Time Factors AB -

BACKGROUND: Preventing pneumonia requires better understanding of incidence, mortality, and long-term clinical and biologic risk factors, particularly in younger individuals.

METHODS: This was a cohort study in three population-based cohorts of community-dwelling individuals. A derivation cohort (n = 16,260) was used to determine incidence and survival and develop a risk prediction model. The prediction model was validated in two cohorts (n = 8,495). The primary outcome was 10-year risk of pneumonia hospitalization.

RESULTS: The crude and age-adjusted incidences of pneumonia were 6.71 and 9.43 cases/1,000 person-years (10-year risk was 6.15%). The 30-day and 1-year mortality were 16.5% and 31.5%. Although age was the most important risk factor (range of crude incidence rates, 1.69-39.13 cases/1,000 person-years for each 5-year increment from 45-85 years), 38% of pneumonia cases occurred in adults < 65 years of age. The 30-day and 1-year mortality were 12.5% and 25.7% in those < 65 years of age. Although most comorbidities were associated with higher risk of pneumonia, reduced lung function was the most important risk factor (relative risk = 6.61 for severe reduction based on FEV1 by spirometry). A clinical risk prediction model based on age, smoking, and lung function predicted 10-year risk (area under curve [AUC] = 0.77 and Hosmer-Lemeshow [HL] C statistic = 0.12). Model discrimination and calibration were similar in the internal validation cohort (AUC = 0.77; HL C statistic, 0.65) but lower in the external validation cohort (AUC = 0.62; HL C statistic, 0.45). The model also calibrated well in blacks and younger adults. C-reactive protein and IL-6 were associated with higher pneumonia risk but did not improve model performance.

CONCLUSIONS: Pneumonia hospitalization is common and associated with high mortality, even in younger healthy adults. Long-term risk of pneumonia can be predicted in community-dwelling adults with a simple clinical risk prediction model.

VL - 144 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23744106?dopt=Abstract ER - TY - JOUR T1 - A genome-wide association study for venous thromboembolism: the extended cohorts for heart and aging research in genomic epidemiology (CHARGE) consortium. JF - Genet Epidemiol Y1 - 2013 A1 - Tang, Weihong A1 - Teichert, Martina A1 - Chasman, Daniel I A1 - Heit, John A A1 - Morange, Pierre-Emmanuel A1 - Li, Guo A1 - Pankratz, Nathan A1 - Leebeek, Frank W A1 - Paré, Guillaume A1 - de Andrade, Mariza A1 - Tzourio, Christophe A1 - Psaty, Bruce M A1 - Basu, Saonli A1 - Ruiter, Rikje A1 - Rose, Lynda A1 - Armasu, Sebastian M A1 - Lumley, Thomas A1 - Heckbert, Susan R A1 - Uitterlinden, André G A1 - Lathrop, Mark A1 - Rice, Kenneth M A1 - Cushman, Mary A1 - Hofman, Albert A1 - Lambert, Jean-Charles A1 - Glazer, Nicole L A1 - Pankow, James S A1 - Witteman, Jacqueline C A1 - Amouyel, Philippe A1 - Bis, Joshua C A1 - Bovill, Edwin G A1 - Kong, Xiaoxiao A1 - Tracy, Russell P A1 - Boerwinkle, Eric A1 - Rotter, Jerome I A1 - Trégouët, David-Alexandre A1 - Loth, Daan W A1 - Stricker, Bruno H Ch A1 - Ridker, Paul M A1 - Folsom, Aaron R A1 - Smith, Nicholas L KW - Aged KW - Aging KW - Case-Control Studies KW - Cohort Studies KW - Female KW - Genome-Wide Association Study KW - Humans KW - Male KW - Meta-Analysis as Topic KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Regression Analysis KW - Risk Factors KW - Venous Thromboembolism AB -

Venous thromboembolism (VTE) is a common, heritable disease resulting in high rates of hospitalization and mortality. Yet few associations between VTE and genetic variants, all in the coagulation pathway, have been established. To identify additional genetic determinants of VTE, we conducted a two-stage genome-wide association study (GWAS) among individuals of European ancestry in the extended cohorts for heart and aging research in genomic epidemiology (CHARGE) VTE consortium. The discovery GWAS comprised 1,618 incident VTE cases out of 44,499 participants from six community-based studies. Genotypes for genome-wide single-nucleotide polymorphisms (SNPs) were imputed to approximately 2.5 million SNPs in HapMap and association with VTE assessed using study-design appropriate regression methods. Meta-analysis of these results identified two known loci, in F5 and ABO. Top 1,047 tag SNPs (P ≤ 0.0016) from the discovery GWAS were tested for association in an additional 3,231 cases and 3,536 controls from three case-control studies. In the combined data from these two stages, additional genome-wide significant associations were observed on 4q35 at F11 (top SNP rs4253399, intronic to F11) and on 4q28 at FGG (rs6536024, 9.7 kb from FGG; P < 5.0 × 10(-13) for both). The associations at the FGG locus were not completely explained by previously reported variants. Loci at or near SUSD1 and OTUD7A showed borderline yet novel associations (P < 5.0 × 10(-6) ) and constitute new candidate genes. In conclusion, this large GWAS replicated key genetic associations in F5 and ABO, and confirmed the importance of F11 and FGG loci for VTE. Future studies are warranted to better characterize the associations with F11 and FGG and to replicate the new candidate associations.

VL - 37 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23650146?dopt=Abstract ER - TY - JOUR T1 - Height and risk of incident intraparenchymal hemorrhage: Atherosclerosis Risk in Communities and Cardiovascular Health study cohorts. JF - J Stroke Cerebrovasc Dis Y1 - 2013 A1 - Smith, Lindsay G A1 - Yatsuya, Hiroshi A1 - Psaty, Bruce M A1 - Longstreth, W T A1 - Folsom, Aaron R KW - African Americans KW - Aged KW - Body Height KW - Cerebral Hemorrhage KW - European Continental Ancestry Group KW - Female KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Assessment KW - Risk Factors KW - Sex Factors KW - Time Factors KW - United States AB -

BACKGROUND: Height is inversely associated with incident coronary disease and total stroke, but few studies have examined the association between height and intraparenchymal hemorrhage (IPH). We hypothesized that height would be inversely associated with incident IPH in the combined cohorts of the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study.

METHODS: Data on Caucasian and African American participants were used to estimate the association of height at baseline with incident IPH verified by clinician review of medical records and imaging reports. Sex-specific Cox proportional hazards regression models were used to calculate hazard ratios.

RESULTS: A total of 20,983 participants initially free of stroke (11,788 women and 9195 men) were followed for an average of 15.9 years (standard deviation [SD] 5.1 years). Incident IPH occurred in 115 women and 73 men. Sex, but not age, race, study, or blood pressure, modified the association (P = .03). After adjustment for risk factors (age, systolic blood pressure, triglycerides, low-density lipoprotein cholesterol, fibrinogen, and race), among women, height was significantly inversely associated with incident IPH (hazard ratio [HR] per SD [6.3 cm] was 0.81; 95% confidence interval [CI] 0.66-0.99; P = .04). The HR for tertile 3 vs 1 in women was 0.63 (95% CI 0.37-1.08). Among men, height was not linearly associated with incident IPH (HR per SD [6.7 cm] was 1.09; 95% CI 0.84-1.40; P = .52).

CONCLUSIONS: This large prospective study provides evidence that shorter height may be a risk factor for incident IPH in women.

VL - 22 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22177930?dopt=Abstract ER - TY - JOUR T1 - Long-chain monounsaturated Fatty acids and incidence of congestive heart failure in 2 prospective cohorts. JF - Circulation Y1 - 2013 A1 - Imamura, Fumiaki A1 - Lemaitre, Rozenn N A1 - King, Irena B A1 - Song, Xiaoling A1 - Steffen, Lyn M A1 - Folsom, Aaron R A1 - Siscovick, David S A1 - Mozaffarian, Dariush KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Dietary Fats KW - Fatty Acids, Monounsaturated KW - Feeding Behavior KW - Female KW - Heart Failure KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Nutrition Surveys KW - Prospective Studies KW - Risk Factors KW - Stroke AB -

BACKGROUND: Decades-old animal experiments suggested that dietary long-chain monounsaturated fatty acids (LCMUFAs) caused cardiotoxicity, leading, for example, development of Canola oil (Canadian oil low in erucic acid) from rapeseed. However, potential cardiotoxicity in humans and contemporary dietary sources of LCMUFAs are unknown.

METHODS AND RESULTS: We prospectively investigated the associations of plasma phospholipid LCMUFAs (20:1, 22:1, and 24:1), assessed as objective biomarkers of exposure, with incidence congestive heart failure in 2 independent cohorts: 3694 older adults (mean age, 75.2±5.2 years) in the Cardiovascular Health Study (CHS; 1992-2006) and 3577 middle-aged adults (mean age, 54.1±5.8 years) in the Atherosclerosis Risk in Communities Study, Minnesota subcohort (ARIC; 1987-2008). We further examined dietary correlates of circulating LCMUFAs in CHS and ARIC and US dietary sources of LCMUFAs in the 2003-2010 National Health and Nutrition Examination Survey (NHANES). In CHS, 997 congestive heart failure events occurred during 39 238 person-years; in ARIC, 330 events congestive heart failure events occurred during 64 438 person-years. After multivariable adjustment, higher levels of 22:1 and 24:1 were positively associated with greater incident congestive heart failure in both CHS and ARIC; hazard ratios were 1.34 (95% confidence interval, 1.02-1.76) and 1.57 (95% confidence interval, 1.11-2.23) for highest versus lowest quintiles of 22:1, respectively, and 1.75 (95% confidence interval, 1.23-2.50) and 1.92 (95% confidence interval, 1.22-3.03) for 24:1, respectively (P for trend ≤0.03 each). A variety of foods were related to circulating LCMUFAs in CHS and ARIC, consistent with food sources of LCMUFAs in NHANES, including fish, poultry, meats, whole grains, and mustard.

CONCLUSIONS: Higher circulating levels of 22:1 and 24:1, with apparently diverse dietary sources, were associated with incident congestive heart failure in 2 independent cohorts, suggesting possible cardiotoxicity of LCMUFAs in humans.

VL - 127 IS - 14 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23487436?dopt=Abstract ER - TY - JOUR T1 - Multiethnic meta-analysis of genome-wide association studies in >100 000 subjects identifies 23 fibrinogen-associated Loci but no strong evidence of a causal association between circulating fibrinogen and cardiovascular disease. JF - Circulation Y1 - 2013 A1 - Sabater-Lleal, Maria A1 - Huang, Jie A1 - Chasman, Daniel A1 - Naitza, Silvia A1 - Dehghan, Abbas A1 - Johnson, Andrew D A1 - Teumer, Alexander A1 - Reiner, Alex P A1 - Folkersen, Lasse A1 - Basu, Saonli A1 - Rudnicka, Alicja R A1 - Trompet, Stella A1 - Mälarstig, Anders A1 - Baumert, Jens A1 - Bis, Joshua C A1 - Guo, Xiuqing A1 - Hottenga, Jouke J A1 - Shin, So-Youn A1 - Lopez, Lorna M A1 - Lahti, Jari A1 - Tanaka, Toshiko A1 - Yanek, Lisa R A1 - Oudot-Mellakh, Tiphaine A1 - Wilson, James F A1 - Navarro, Pau A1 - Huffman, Jennifer E A1 - Zemunik, Tatijana A1 - Redline, Susan A1 - Mehra, Reena A1 - Pulanic, Drazen A1 - Rudan, Igor A1 - Wright, Alan F A1 - Kolcic, Ivana A1 - Polasek, Ozren A1 - Wild, Sarah H A1 - Campbell, Harry A1 - Curb, J David A1 - Wallace, Robert A1 - Liu, Simin A1 - Eaton, Charles B A1 - Becker, Diane M A1 - Becker, Lewis C A1 - Bandinelli, Stefania A1 - Räikkönen, Katri A1 - Widen, Elisabeth A1 - Palotie, Aarno A1 - Fornage, Myriam A1 - Green, David A1 - Gross, Myron A1 - Davies, Gail A1 - Harris, Sarah E A1 - Liewald, David C A1 - Starr, John M A1 - Williams, Frances M K A1 - Grant, Peter J A1 - Spector, Timothy D A1 - Strawbridge, Rona J A1 - Silveira, Angela A1 - Sennblad, Bengt A1 - Rivadeneira, Fernando A1 - Uitterlinden, André G A1 - Franco, Oscar H A1 - Hofman, Albert A1 - van Dongen, Jenny A1 - Willemsen, Gonneke A1 - Boomsma, Dorret I A1 - Yao, Jie A1 - Swords Jenny, Nancy A1 - Haritunians, Talin A1 - McKnight, Barbara A1 - Lumley, Thomas A1 - Taylor, Kent D A1 - Rotter, Jerome I A1 - Psaty, Bruce M A1 - Peters, Annette A1 - Gieger, Christian A1 - Illig, Thomas A1 - Grotevendt, Anne A1 - Homuth, Georg A1 - Völzke, Henry A1 - Kocher, Thomas A1 - Goel, Anuj A1 - Franzosi, Maria Grazia A1 - Seedorf, Udo A1 - Clarke, Robert A1 - Steri, Maristella A1 - Tarasov, Kirill V A1 - Sanna, Serena A1 - Schlessinger, David A1 - Stott, David J A1 - Sattar, Naveed A1 - Buckley, Brendan M A1 - Rumley, Ann A1 - Lowe, Gordon D A1 - McArdle, Wendy L A1 - Chen, Ming-Huei A1 - Tofler, Geoffrey H A1 - Song, Jaejoon A1 - Boerwinkle, Eric A1 - Folsom, Aaron R A1 - Rose, Lynda M A1 - Franco-Cereceda, Anders A1 - Teichert, Martina A1 - Ikram, M Arfan A1 - Mosley, Thomas H A1 - Bevan, Steve A1 - Dichgans, Martin A1 - Rothwell, Peter M A1 - Sudlow, Cathie L M A1 - Hopewell, Jemma C A1 - Chambers, John C A1 - Saleheen, Danish A1 - Kooner, Jaspal S A1 - Danesh, John A1 - Nelson, Christopher P A1 - Erdmann, Jeanette A1 - Reilly, Muredach P A1 - Kathiresan, Sekar A1 - Schunkert, Heribert A1 - Morange, Pierre-Emmanuel A1 - Ferrucci, Luigi A1 - Eriksson, Johan G A1 - Jacobs, David A1 - Deary, Ian J A1 - Soranzo, Nicole A1 - Witteman, Jacqueline C M A1 - de Geus, Eco J C A1 - Tracy, Russell P A1 - Hayward, Caroline A1 - Koenig, Wolfgang A1 - Cucca, Francesco A1 - Jukema, J Wouter A1 - Eriksson, Per A1 - Seshadri, Sudha A1 - Markus, Hugh S A1 - Watkins, Hugh A1 - Samani, Nilesh J A1 - Wallaschofski, Henri A1 - Smith, Nicholas L A1 - Tregouet, David A1 - Ridker, Paul M A1 - Tang, Weihong A1 - Strachan, David P A1 - Hamsten, Anders A1 - O'Donnell, Christopher J KW - Adolescent KW - Adult KW - African Continental Ancestry Group KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Coronary Artery Disease KW - European Continental Ancestry Group KW - Female KW - Fibrinogen KW - Genetic Loci KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Hispanic Americans KW - Humans KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - Stroke KW - Venous Thromboembolism KW - Young Adult AB -

BACKGROUND: Estimates of the heritability of plasma fibrinogen concentration, an established predictor of cardiovascular disease, range from 34% to 50%. Genetic variants so far identified by genome-wide association studies explain only a small proportion (<2%) of its variation.

METHODS AND RESULTS: We conducted a meta-analysis of 28 genome-wide association studies including >90 000 subjects of European ancestry, the first genome-wide association meta-analysis of fibrinogen levels in 7 studies in blacks totaling 8289 samples, and a genome-wide association study in Hispanics totaling 1366 samples. Evaluation for association of single-nucleotide polymorphisms with clinical outcomes included a total of 40 695 cases and 85 582 controls for coronary artery disease, 4752 cases and 24 030 controls for stroke, and 3208 cases and 46 167 controls for venous thromboembolism. Overall, we identified 24 genome-wide significant (P<5×10(-8)) independent signals in 23 loci, including 15 novel associations, together accounting for 3.7% of plasma fibrinogen variation. Gene-set enrichment analysis highlighted key roles in fibrinogen regulation for the 3 structural fibrinogen genes and pathways related to inflammation, adipocytokines, and thyrotrophin-releasing hormone signaling. Whereas lead single-nucleotide polymorphisms in a few loci were significantly associated with coronary artery disease, the combined effect of all 24 fibrinogen-associated lead single-nucleotide polymorphisms was not significant for coronary artery disease, stroke, or venous thromboembolism.

CONCLUSIONS: We identify 23 robustly associated fibrinogen loci, 15 of which are new. Clinical outcome analysis of these loci does not support a causal relationship between circulating levels of fibrinogen and coronary artery disease, stroke, or venous thromboembolism.

VL - 128 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23969696?dopt=Abstract ER - TY - JOUR T1 - Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls. JF - Eur J Epidemiol Y1 - 2013 A1 - Simone, Benedetto A1 - De Stefano, Valerio A1 - Leoncini, Emanuele A1 - Zacho, Jeppe A1 - Martinelli, Ida A1 - Emmerich, Joseph A1 - Rossi, Elena A1 - Folsom, Aaron R A1 - Almawi, Wassim Y A1 - Scarabin, Pierre Y A1 - den Heijer, Martin A1 - Cushman, Mary A1 - Penco, Silvana A1 - Vaya, Amparo A1 - Angchaisuksiri, Pantep A1 - Okumus, Gulfer A1 - Gemmati, Donato A1 - Cima, Simona A1 - Akar, Nejat A1 - Oguzulgen, Kivilcim I A1 - Ducros, Véronique A1 - Lichy, Christoph A1 - Fernandez-Miranda, Consuelo A1 - Szczeklik, Andrzej A1 - Nieto, José A A1 - Torres, Jose Domingo A1 - Le Cam-Duchez, Véronique A1 - Ivanov, Petar A1 - Cantu-Brito, Carlos A1 - Shmeleva, Veronika M A1 - Stegnar, Mojka A1 - Ogunyemi, Dotun A1 - Eid, Suhair S A1 - Nicolotti, Nicola A1 - De Feo, Emma A1 - Ricciardi, Walter A1 - Boccia, Stefania KW - Case-Control Studies KW - Factor V KW - Genetic Predisposition to Disease KW - Humans KW - Methylenetetrahydrofolate Reductase (NADPH2) KW - Prothrombin KW - Risk Factors KW - Venous Thromboembolism AB -

Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95 % confidence intervals [CI]: 0.98-1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR = 4.22; 95 % CI: 3.35-5.32; and OR = 2.79;95 % CI: 2.25-3.46, respectively), in double heterozygotes (OR = 3.42; 95 %CI 1.64-7.13), and in homozygous FVL or PT20210A (OR = 11.45; 95 %CI: 6.79-19.29; and OR: 6.74 (CI 95 % 2.19-20.72), respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤ 45 years (p value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.

VL - 28 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23900608?dopt=Abstract ER - TY - JOUR T1 - Association of kidney disease measures with ischemic versus hemorrhagic strokes: pooled analyses of 4 prospective community-based cohorts. JF - Stroke Y1 - 2014 A1 - Mahmoodi, Bakhtawar K A1 - Yatsuya, Hiroshi A1 - Matsushita, Kunihiro A1 - Sang, Yinying A1 - Gottesman, Rebecca F A1 - Astor, Brad C A1 - Woodward, Mark A1 - Longstreth, W T A1 - Psaty, Bruce M A1 - Shlipak, Michael G A1 - Folsom, Aaron R A1 - Gansevoort, Ron T A1 - Coresh, Josef KW - Aged KW - Albuminuria KW - Brain Ischemia KW - Comorbidity KW - Female KW - Glomerular Filtration Rate KW - Humans KW - Intracranial Hemorrhages KW - Kidney Diseases KW - Male KW - Middle Aged KW - Netherlands KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - Stroke KW - United States AB -

BACKGROUND AND PURPOSE: Although low glomerular filtration rate (GFR) and albuminuria are associated with increased risk of stroke, few studies compared their contribution to risk of ischemic versus hemorrhagic stroke separately. We contrasted the association of these kidney measures with ischemic versus hemorrhagic stroke.

METHODS: We pooled individual participant data from 4 community-based cohorts: 3 from the United States and 1 from The Netherlands. GFR was estimated using both creatinine and cystatin C, and albuminuria was quantified by urinary albumin-to-creatinine ratio (ACR). Associations of estimated GFR and ACR were compared for each stroke type (ischemic versus intraparenchymal hemorrhagic) using study-stratified Cox regression.

RESULTS: Among 29,595 participants (mean age, 61 [SD 12.5] years; 46% men; 17% black), 1261 developed stroke (12% hemorrhagic) during 280,549 person-years. Low estimated GFR was significantly associated with increased risk of ischemic stroke, but not hemorrhagic stroke, whereas high ACR was associated with both stroke types. Adjusted hazard ratios for ischemic and hemorrhagic stroke at estimated GFR of 45 (versus 95) mL/min per 1.73 m2 were 1.30 (95% confidence interval, 1.01-1.68) and 0.92 (0.47-1.81), respectively. In contrast, the corresponding hazard ratios for ACR of 300 (versus 5) mg/g were 1.62 (1.27-2.07) for ischemic and 2.57 (1.37-4.83) for hemorrhagic stroke, with significantly stronger association with hemorrhagic stroke (P=0.04). For hemorrhagic stroke, the association of elevated ACR was of similar magnitude as that of elevated systolic blood pressure.

CONCLUSIONS: Whereas albuminuria showed significant association with both stroke types, the association of decreased estimated GFR was only significant for ischemic stroke. The strong association of albuminuria with both stroke types warrants clinical attention and further investigations.

VL - 45 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24876078?dopt=Abstract ER - TY - JOUR T1 - Association of sick sinus syndrome with incident cardiovascular disease and mortality: the Atherosclerosis Risk in Communities study and Cardiovascular Health Study. JF - PLoS One Y1 - 2014 A1 - Alonso, Alvaro A1 - Jensen, Paul N A1 - Lopez, Faye L A1 - Chen, Lin Y A1 - Psaty, Bruce M A1 - Folsom, Aaron R A1 - Heckbert, Susan R KW - Age Distribution KW - Atherosclerosis KW - Cohort Studies KW - Continental Population Groups KW - Female KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Residence Characteristics KW - Risk KW - Sex Distribution KW - Sick Sinus Syndrome AB -

BACKGROUND: Sick sinus syndrome (SSS) is a common indication for pacemaker implantation. Limited information exists on the association of sick sinus syndrome (SSS) with mortality and cardiovascular disease (CVD) in the general population.

METHODS: We studied 19,893 men and women age 45 and older in the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS), two community-based cohorts, who were without a pacemaker or atrial fibrillation (AF) at baseline. Incident SSS cases were validated by review of medical charts. Incident CVD and mortality were ascertained using standardized protocols. Multivariable Cox models were used to estimate the association of incident SSS with selected outcomes.

RESULTS: During a mean follow-up of 17 years, 213 incident SSS events were identified and validated (incidence, 0.6 events per 1,000 person-years). After adjustment for confounders, SSS incidence was associated with increased mortality (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.14-1.70), coronary heart disease (HR 1.72, 95%CI 1.11-2.66), heart failure (HR 2.87, 95%CI 2.17-3.80), stroke (HR 1.56, 95%CI 0.99-2.46), AF (HR 5.75, 95%CI 4.43-7.46), and pacemaker implantation (HR 53.7, 95%CI 42.9-67.2). After additional adjustment for other incident CVD during follow-up, SSS was no longer associated with increased mortality, coronary heart disease, or stroke, but remained associated with higher risk of heart failure (HR 2.00, 95%CI 1.51-2.66), AF (HR 4.25, 95%CI 3.28-5.51), and pacemaker implantation (HR 25.2, 95%CI 19.8-32.1).

CONCLUSION: Individuals who develop SSS are at increased risk of death and CVD. The mechanisms underlying these associations warrant further investigation.

VL - 9 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25285853?dopt=Abstract ER - TY - JOUR T1 - A genetic association study of D-dimer levels with 50K SNPs from a candidate gene chip in four ethnic groups. JF - Thromb Res Y1 - 2014 A1 - Weng, Lu-Chen A1 - Tang, Weihong A1 - Rich, Stephen S A1 - Smith, Nicholas L A1 - Redline, Susan A1 - O'Donnell, Christopher J A1 - Basu, Saonli A1 - Reiner, Alexander P A1 - Delaney, Joseph A A1 - Tracy, Russell P A1 - Palmer, Cameron D A1 - Young, Taylor A1 - Yang, Qiong A1 - Folsom, Aaron R A1 - Cushman, Mary KW - Adult KW - Aged KW - Cardiovascular Diseases KW - Ethnic Groups KW - Factor V KW - Female KW - Fibrin Fibrinogen Degradation Products KW - Fibrinogen KW - Genetic Association Studies KW - Genotype KW - Humans KW - Male KW - Middle Aged KW - Oligonucleotide Array Sequence Analysis KW - Polymorphism, Single Nucleotide KW - Young Adult AB -

INTRODUCTION: D-dimer, a fibrin degradation product, is related to risk of cardiovascular disease and venous thromboembolism. Genetic determinants of D-dimer are not well characterized; notably, few data have been reported for African American (AA), Asian, and Hispanic populations.

MATERIALS AND METHODS: We conducted a large-scale candidate gene association study to identify variants in genes associated with D-dimer levels in multi-ethnic populations. Four cohorts, comprising 6,848 European Americans (EAs), 2,192 AAs, 670 Asians, and 1,286 Hispanics in the National Heart, Lung, and Blood Institute Candidate Gene Association Resource consortium, were assembled. Approximately 50,000 genotyped single nucleotide polymorphisms (SNPs) in 2,000 cardiovascular disease gene loci were analyzed by linear regression, adjusting for age, sex, study site, and principal components in each cohort and ethnic group. Results across studies were combined within each ethnic group by meta-analysis.

RESULTS: Twelve SNPs in coagulation factor V (F5) and 3 SNPs in the fibrinogen alpha chain (FGA) were significantly associated with D-dimer level in EAs with p<2.0×10(-6). The signal for the most associated SNP in F5 (rs6025, factor V Leiden) was replicated in Hispanics (p=0.023), while that for the top functional SNP in FGA (rs6050) was replicated in AAs (p=0.006). No additional SNPs were significantly associated with D-dimer.

CONCLUSIONS: Our study replicated previously reported associations of D-dimer with SNPs in F5 and FGA in EAs; we demonstrated replication of the association of D-dimer with FGA rs6050 in AAs and the factor V Leiden variant in Hispanics.

VL - 134 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24908450?dopt=Abstract ER - TY - JOUR T1 - Genome-wide association study for circulating tissue plasminogen activator levels and functional follow-up implicates endothelial STXBP5 and STX2. JF - Arterioscler Thromb Vasc Biol Y1 - 2014 A1 - Huang, Jie A1 - Huffman, Jennifer E A1 - Yamakuchi, Munekazu A1 - Yamkauchi, Munekazu A1 - Trompet, Stella A1 - Asselbergs, Folkert W A1 - Sabater-Lleal, Maria A1 - Trégouët, David-Alexandre A1 - Chen, Wei-Min A1 - Smith, Nicholas L A1 - Kleber, Marcus E A1 - Shin, So-Youn A1 - Becker, Diane M A1 - Tang, Weihong A1 - Dehghan, Abbas A1 - Johnson, Andrew D A1 - Truong, Vinh A1 - Folkersen, Lasse A1 - Yang, Qiong A1 - Oudot-Mellkah, Tiphaine A1 - Buckley, Brendan M A1 - Moore, Jason H A1 - Williams, Frances M K A1 - Campbell, Harry A1 - Silbernagel, Günther A1 - Vitart, Veronique A1 - Rudan, Igor A1 - Tofler, Geoffrey H A1 - Navis, Gerjan J A1 - DeStefano, Anita A1 - Wright, Alan F A1 - Chen, Ming-Huei A1 - de Craen, Anton J M A1 - Worrall, Bradford B A1 - Rudnicka, Alicja R A1 - Rumley, Ann A1 - Bookman, Ebony B A1 - Psaty, Bruce M A1 - Chen, Fang A1 - Keene, Keith L A1 - Franco, Oscar H A1 - Böhm, Bernhard O A1 - Uitterlinden, André G A1 - Carter, Angela M A1 - Jukema, J Wouter A1 - Sattar, Naveed A1 - Bis, Joshua C A1 - Ikram, Mohammad A A1 - Sale, Michèle M A1 - McKnight, Barbara A1 - Fornage, Myriam A1 - Ford, Ian A1 - Taylor, Kent A1 - Slagboom, P Eline A1 - McArdle, Wendy L A1 - Hsu, Fang-Chi A1 - Franco-Cereceda, Anders A1 - Goodall, Alison H A1 - Yanek, Lisa R A1 - Furie, Karen L A1 - Cushman, Mary A1 - Hofman, Albert A1 - Witteman, Jacqueline C M A1 - Folsom, Aaron R A1 - Basu, Saonli A1 - Matijevic, Nena A1 - van Gilst, Wiek H A1 - Wilson, James F A1 - Westendorp, Rudi G J A1 - Kathiresan, Sekar A1 - Reilly, Muredach P A1 - Tracy, Russell P A1 - Polasek, Ozren A1 - Winkelmann, Bernhard R A1 - Grant, Peter J A1 - Hillege, Hans L A1 - Cambien, Francois A1 - Stott, David J A1 - Lowe, Gordon D A1 - Spector, Timothy D A1 - Meigs, James B A1 - März, Winfried A1 - Eriksson, Per A1 - Becker, Lewis C A1 - Morange, Pierre-Emmanuel A1 - Soranzo, Nicole A1 - Williams, Scott M A1 - Hayward, Caroline A1 - van der Harst, Pim A1 - Hamsten, Anders A1 - Lowenstein, Charles J A1 - Strachan, David P A1 - O'Donnell, Christopher J KW - Aged KW - Cells, Cultured KW - Coronary Artery Disease KW - Endothelial Cells KW - Europe KW - Female KW - Gene Expression Regulation KW - Gene Silencing KW - Genetic Loci KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Nerve Tissue Proteins KW - Phenotype KW - Polymorphism, Single Nucleotide KW - R-SNARE Proteins KW - Risk Factors KW - Stroke KW - Syntaxin 1 KW - Tissue Plasminogen Activator KW - Transfection KW - United States KW - Up-Regulation AB -

OBJECTIVE: Tissue plasminogen activator (tPA), a serine protease, catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for endogenous fibrinolysis. In some populations, elevated plasma levels of tPA have been associated with myocardial infarction and other cardiovascular diseases. We conducted a meta-analysis of genome-wide association studies to identify novel correlates of circulating levels of tPA.

APPROACH AND RESULTS: Fourteen cohort studies with tPA measures (N=26 929) contributed to the meta-analysis. Three loci were significantly associated with circulating tPA levels (P<5.0×10(-8)). The first locus is on 6q24.3, with the lead single nucleotide polymorphism (SNP; rs9399599; P=2.9×10(-14)) within STXBP5. The second locus is on 8p11.21. The lead SNP (rs3136739; P=1.3×10(-9)) is intronic to POLB and <200 kb away from the tPA encoding the gene PLAT. We identified a nonsynonymous SNP (rs2020921) in modest linkage disequilibrium with rs3136739 (r(2)=0.50) within exon 5 of PLAT (P=2.0×10(-8)). The third locus is on 12q24.33, with the lead SNP (rs7301826; P=1.0×10(-9)) within intron 7 of STX2. We further found evidence for the association of lead SNPs in STXBP5 and STX2 with expression levels of the respective transcripts. In in vitro cell studies, silencing STXBP5 decreased the release of tPA from vascular endothelial cells, whereas silencing STX2 increased the tPA release. Through an in silico lookup, we found no associations of the 3 lead SNPs with coronary artery disease or stroke.

CONCLUSIONS: We identified 3 loci associated with circulating tPA levels, the PLAT region, STXBP5, and STX2. Our functional studies implicate a novel role for STXBP5 and STX2 in regulating tPA release.

VL - 34 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24578379?dopt=Abstract ER - TY - JOUR T1 - Glycated hemoglobin measurement and prediction of cardiovascular disease. JF - JAMA Y1 - 2014 A1 - Di Angelantonio, Emanuele A1 - Gao, Pei A1 - Khan, Hassan A1 - Butterworth, Adam S A1 - Wormser, David A1 - Kaptoge, Stephen A1 - Kondapally Seshasai, Sreenivasa Rao A1 - Thompson, Alex A1 - Sarwar, Nadeem A1 - Willeit, Peter A1 - Ridker, Paul M A1 - Barr, Elizabeth L M A1 - Khaw, Kay-Tee A1 - Psaty, Bruce M A1 - Brenner, Hermann A1 - Balkau, Beverley A1 - Dekker, Jacqueline M A1 - Lawlor, Debbie A A1 - Daimon, Makoto A1 - Willeit, Johann A1 - Njølstad, Inger A1 - Nissinen, Aulikki A1 - Brunner, Eric J A1 - Kuller, Lewis H A1 - Price, Jackie F A1 - Sundström, Johan A1 - Knuiman, Matthew W A1 - Feskens, Edith J M A1 - Verschuren, W M M A1 - Wald, Nicholas A1 - Bakker, Stephan J L A1 - Whincup, Peter H A1 - Ford, Ian A1 - Goldbourt, Uri A1 - Gómez-de-la-Cámara, Agustín A1 - Gallacher, John A1 - Simons, Leon A A1 - Rosengren, Annika A1 - Sutherland, Susan E A1 - Björkelund, Cecilia A1 - Blazer, Dan G A1 - Wassertheil-Smoller, Sylvia A1 - Onat, Altan A1 - Marín Ibañez, Alejandro A1 - Casiglia, Edoardo A1 - Jukema, J Wouter A1 - Simpson, Lara M A1 - Giampaoli, Simona A1 - Nordestgaard, Børge G A1 - Selmer, Randi A1 - Wennberg, Patrik A1 - Kauhanen, Jussi A1 - Salonen, Jukka T A1 - Dankner, Rachel A1 - Barrett-Connor, Elizabeth A1 - Kavousi, Maryam A1 - Gudnason, Vilmundur A1 - Evans, Denis A1 - Wallace, Robert B A1 - Cushman, Mary A1 - D'Agostino, Ralph B A1 - Umans, Jason G A1 - Kiyohara, Yutaka A1 - Nakagawa, Hidaeki A1 - Sato, Shinichi A1 - Gillum, Richard F A1 - Folsom, Aaron R A1 - van der Schouw, Yvonne T A1 - Moons, Karel G A1 - Griffin, Simon J A1 - Sattar, Naveed A1 - Wareham, Nicholas J A1 - Selvin, Elizabeth A1 - Thompson, Simon G A1 - Danesh, John KW - Aged KW - C-Reactive Protein KW - Cholesterol, HDL KW - Coronary Disease KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin A KW - Humans KW - Male KW - Middle Aged KW - Predictive Value of Tests KW - Prospective Studies KW - Risk Assessment KW - Stroke AB -

IMPORTANCE: The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain.

OBJECTIVE: To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk.

DESIGN, SETTING, AND PARTICIPANTS: Analysis of individual-participant data available from 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline assessment.

MAIN OUTCOMES AND MEASURES: Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (<5%), intermediate (5% to <7.5%), and high (≥ 7.5%) risk.

RESULTS: During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20,840 incident fatal and nonfatal CVD outcomes (13,237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (-0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels.

CONCLUSIONS AND RELEVANCE: In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk.

VL - 311 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24668104?dopt=Abstract ER - TY - JOUR T1 - Height and risk of sudden cardiac death: the Atherosclerosis Risk in Communities and Cardiovascular Health studies. JF - Ann Epidemiol Y1 - 2014 A1 - Rosenberg, Michael A A1 - Lopez, Faye L A1 - Bůzková, Petra A1 - Adabag, Selcuk A1 - Chen, Lin Y A1 - Sotoodehnia, Nona A1 - Kronmal, Richard A A1 - Siscovick, David S A1 - Alonso, Alvaro A1 - Buxton, Alfred A1 - Folsom, Aaron R A1 - Mukamal, Kenneth J KW - Adult KW - Aged KW - Atherosclerosis KW - Body Height KW - Coronary Disease KW - Death, Sudden, Cardiac KW - Female KW - Humans KW - Hypertension KW - Incidence KW - Male KW - Middle Aged KW - Population Surveillance KW - Prospective Studies KW - Risk Factors AB -

PURPOSE: Sudden cardiac death (SCD) is an important cause of mortality in the adult population. Height has been associated with cardiac hypertrophy and an increased risk of arrhythmias but also with decreased risk of coronary heart disease, suggesting a complex association with SCD.

METHODS: We examined the association of adult height with the risk of physician-adjudicated SCD in two large population-based cohorts: the Cardiovascular Health Study and the Atherosclerosis Risk in Communities study.

RESULTS: Over an average follow-up time of 11.7 years in Cardiovascular Health Study, there were 199 (3.6%) cases of SCD among 5556 participants. In Atherosclerosis Risk in Communities study, over 12.6 years, there were 227 (1.5%) cases of SCD among 15,633 participants. In both cohorts, there was a trend toward decreased SCD with taller height. In fixed effects meta-analysis, the pooled hazard ratio per 10 cm of height was 0.84; 95% confidence interval, 0.73-0.98; P = .03. The association of increased height with lower risk of SCD was slightly attenuated after inclusion of risk factors associated with height, such as hypertension and left ventricular hypertrophy. The association appeared stronger among men than women in both cohorts.

CONCLUSIONS: In two population-based prospective cohorts of different ages, greater height was associated with lower risk of SCD.

VL - 24 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24360853?dopt=Abstract ER - TY - JOUR T1 - Incidence of and risk factors for sick sinus syndrome in the general population. JF - J Am Coll Cardiol Y1 - 2014 A1 - Jensen, Paul N A1 - Gronroos, Noelle N A1 - Chen, Lin Y A1 - Folsom, Aaron R A1 - deFilippi, Chris A1 - Heckbert, Susan R A1 - Alonso, Alvaro KW - African Continental Ancestry Group KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Follow-Up Studies KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Population Surveillance KW - Prospective Studies KW - Risk Factors KW - Sick Sinus Syndrome AB -

BACKGROUND: Little is known about the incidence of and risk factors for sick sinus syndrome (SSS), a common indication for pacemaker implantation.

OBJECTIVES: This study sought to describe the epidemiology of SSS.

METHODS: This analysis included 20,572 participants (mean baseline age 59 years, 43% male) in the ARIC (Atherosclerosis Risk In Communities) study and the CHS (Cardiovascular Health Study), who at baseline were free of prevalent atrial fibrillation and pacemaker therapy, had a heart rate of ≥ 50 beats/min unless using beta blockers, and were identified as of white or black race. Incident SSS cases were identified by hospital discharge International Classification of Disease-revision 9-Clinical Modification code 427.81 and validated by medical record review.

RESULTS: During an average 17 years of follow-up, 291 incident SSS cases were identified (unadjusted rate 0.8 per 1,000 person-years). Incidence increased with age (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.47 to 2.05 per 5-year increment), and blacks had a 41% lower risk of SSS than whites (HR: 0.59; 95% CI: 0.37 to 0.98). Incident SSS was associated with greater baseline body mass index, height, N-terminal pro-B-type natriuretic peptide, and cystatin C, with longer QRS interval, with lower heart rate, and with prevalent hypertension, right bundle branch block, and cardiovascular disease. We project that the annual number of new SSS cases in the United States will increase from 78,000 in 2012 to 172,000 in 2060.

CONCLUSIONS: Blacks have a lower risk of SSS than whites, and several cardiovascular risk factors were associated with incident SSS. With the aging of the population, the number of Americans with SSS will increase dramatically over the next 50 years.

VL - 64 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25104519?dopt=Abstract ER - TY - JOUR T1 - No evidence for genome-wide interactions on plasma fibrinogen by smoking, alcohol consumption and body mass index: results from meta-analyses of 80,607 subjects. JF - PLoS One Y1 - 2014 A1 - Baumert, Jens A1 - Huang, Jie A1 - McKnight, Barbara A1 - Sabater-Lleal, Maria A1 - Steri, Maristella A1 - Chu, Audrey Y A1 - Trompet, Stella A1 - Lopez, Lorna M A1 - Fornage, Myriam A1 - Teumer, Alexander A1 - Tang, Weihong A1 - Rudnicka, Alicja R A1 - Mälarstig, Anders A1 - Hottenga, Jouke-Jan A1 - Kavousi, Maryam A1 - Lahti, Jari A1 - Tanaka, Toshiko A1 - Hayward, Caroline A1 - Huffman, Jennifer E A1 - Morange, Pierre-Emmanuel A1 - Rose, Lynda M A1 - Basu, Saonli A1 - Rumley, Ann A1 - Stott, David J A1 - Buckley, Brendan M A1 - de Craen, Anton J M A1 - Sanna, Serena A1 - Masala, Marco A1 - Biffar, Reiner A1 - Homuth, Georg A1 - Silveira, Angela A1 - Sennblad, Bengt A1 - Goel, Anuj A1 - Watkins, Hugh A1 - Müller-Nurasyid, Martina A1 - Rückerl, Regina A1 - Taylor, Kent A1 - Chen, Ming-Huei A1 - de Geus, Eco J C A1 - Hofman, Albert A1 - Witteman, Jacqueline C M A1 - de Maat, Moniek P M A1 - Palotie, Aarno A1 - Davies, Gail A1 - Siscovick, David S A1 - Kolcic, Ivana A1 - Wild, Sarah H A1 - Song, Jaejoon A1 - McArdle, Wendy L A1 - Ford, Ian A1 - Sattar, Naveed A1 - Schlessinger, David A1 - Grotevendt, Anne A1 - Franzosi, Maria Grazia A1 - Illig, Thomas A1 - Waldenberger, Melanie A1 - Lumley, Thomas A1 - Tofler, Geoffrey H A1 - Willemsen, Gonneke A1 - Uitterlinden, André G A1 - Rivadeneira, Fernando A1 - Räikkönen, Katri A1 - Chasman, Daniel I A1 - Folsom, Aaron R A1 - Lowe, Gordon D A1 - Westendorp, Rudi G J A1 - Slagboom, P Eline A1 - Cucca, Francesco A1 - Wallaschofski, Henri A1 - Strawbridge, Rona J A1 - Seedorf, Udo A1 - Koenig, Wolfgang A1 - Bis, Joshua C A1 - Mukamal, Kenneth J A1 - van Dongen, Jenny A1 - Widen, Elisabeth A1 - Franco, Oscar H A1 - Starr, John M A1 - Liu, Kiang A1 - Ferrucci, Luigi A1 - Polasek, Ozren A1 - Wilson, James F A1 - Oudot-Mellakh, Tiphaine A1 - Campbell, Harry A1 - Navarro, Pau A1 - Bandinelli, Stefania A1 - Eriksson, Johan A1 - Boomsma, Dorret I A1 - Dehghan, Abbas A1 - Clarke, Robert A1 - Hamsten, Anders A1 - Boerwinkle, Eric A1 - Jukema, J Wouter A1 - Naitza, Silvia A1 - Ridker, Paul M A1 - Völzke, Henry A1 - Deary, Ian J A1 - Reiner, Alexander P A1 - Trégouët, David-Alexandre A1 - O'Donnell, Christopher J A1 - Strachan, David P A1 - Peters, Annette A1 - Smith, Nicholas L KW - Alcohol Drinking KW - Body Mass Index KW - Fibrinogen KW - Gene-Environment Interaction KW - Genomics KW - Humans KW - Smoking AB -

Plasma fibrinogen is an acute phase protein playing an important role in the blood coagulation cascade having strong associations with smoking, alcohol consumption and body mass index (BMI). Genome-wide association studies (GWAS) have identified a variety of gene regions associated with elevated plasma fibrinogen concentrations. However, little is yet known about how associations between environmental factors and fibrinogen might be modified by genetic variation. Therefore, we conducted large-scale meta-analyses of genome-wide interaction studies to identify possible interactions of genetic variants and smoking status, alcohol consumption or BMI on fibrinogen concentration. The present study included 80,607 subjects of European ancestry from 22 studies. Genome-wide interaction analyses were performed separately in each study for about 2.6 million single nucleotide polymorphisms (SNPs) across the 22 autosomal chromosomes. For each SNP and risk factor, we performed a linear regression under an additive genetic model including an interaction term between SNP and risk factor. Interaction estimates were meta-analysed using a fixed-effects model. No genome-wide significant interaction with smoking status, alcohol consumption or BMI was observed in the meta-analyses. The most suggestive interaction was found for smoking and rs10519203, located in the LOC123688 region on chromosome 15, with a p value of 6.2 × 10(-8). This large genome-wide interaction study including 80,607 participants found no strong evidence of interaction between genetic variants and smoking status, alcohol consumption or BMI on fibrinogen concentrations. Further studies are needed to yield deeper insight in the interplay between environmental factors and gene variants on the regulation of fibrinogen concentrations.

VL - 9 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25551457?dopt=Abstract ER - TY - JOUR T1 - Predicting stroke through genetic risk functions: the CHARGE Risk Score Project. JF - Stroke Y1 - 2014 A1 - Ibrahim-Verbaas, Carla A A1 - Fornage, Myriam A1 - Bis, Joshua C A1 - Choi, Seung Hoan A1 - Psaty, Bruce M A1 - Meigs, James B A1 - Rao, Madhu A1 - Nalls, Mike A1 - Fontes, João D A1 - O'Donnell, Christopher J A1 - Kathiresan, Sekar A1 - Ehret, Georg B A1 - Fox, Caroline S A1 - Malik, Rainer A1 - Dichgans, Martin A1 - Schmidt, Helena A1 - Lahti, Jari A1 - Heckbert, Susan R A1 - Lumley, Thomas A1 - Rice, Kenneth A1 - Rotter, Jerome I A1 - Taylor, Kent D A1 - Folsom, Aaron R A1 - Boerwinkle, Eric A1 - Rosamond, Wayne D A1 - Shahar, Eyal A1 - Gottesman, Rebecca F A1 - Koudstaal, Peter J A1 - Amin, Najaf A1 - Wieberdink, Renske G A1 - Dehghan, Abbas A1 - Hofman, Albert A1 - Uitterlinden, André G A1 - DeStefano, Anita L A1 - Debette, Stephanie A1 - Xue, Luting A1 - Beiser, Alexa A1 - Wolf, Philip A A1 - DeCarli, Charles A1 - Ikram, M Arfan A1 - Seshadri, Sudha A1 - Mosley, Thomas H A1 - Longstreth, W T A1 - van Duijn, Cornelia M A1 - Launer, Lenore J KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Area Under Curve KW - Case-Control Studies KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Regression Analysis KW - Risk Factors KW - ROC Curve KW - Sex Factors KW - Stroke AB -

BACKGROUND AND PURPOSE: Beyond the Framingham Stroke Risk Score, prediction of future stroke may improve with a genetic risk score (GRS) based on single-nucleotide polymorphisms associated with stroke and its risk factors.

METHODS: The study includes 4 population-based cohorts with 2047 first incident strokes from 22,720 initially stroke-free European origin participants aged ≥55 years, who were followed for up to 20 years. GRSs were constructed with 324 single-nucleotide polymorphisms implicated in stroke and 9 risk factors. The association of the GRS to first incident stroke was tested using Cox regression; the GRS predictive properties were assessed with area under the curve statistics comparing the GRS with age and sex, Framingham Stroke Risk Score models, and reclassification statistics. These analyses were performed per cohort and in a meta-analysis of pooled data. Replication was sought in a case-control study of ischemic stroke.

RESULTS: In the meta-analysis, adding the GRS to the Framingham Stroke Risk Score, age and sex model resulted in a significant improvement in discrimination (all stroke: Δjoint area under the curve=0.016, P=2.3×10(-6); ischemic stroke: Δjoint area under the curve=0.021, P=3.7×10(-7)), although the overall area under the curve remained low. In all the studies, there was a highly significantly improved net reclassification index (P<10(-4)).

CONCLUSIONS: The single-nucleotide polymorphisms associated with stroke and its risk factors result only in a small improvement in prediction of future stroke compared with the classical epidemiological risk factors for stroke.

VL - 45 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24436238?dopt=Abstract ER - TY - JOUR T1 - Racial and regional differences in venous thromboembolism in the United States in 3 cohorts. JF - Circulation Y1 - 2014 A1 - Zakai, Neil A A1 - McClure, Leslie A A1 - Judd, Suzanne E A1 - Safford, Monika M A1 - Folsom, Aaron R A1 - Lutsey, Pamela L A1 - Cushman, Mary KW - African Continental Ancestry Group KW - Aged KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Prevalence KW - Proportional Hazards Models KW - Prospective Studies KW - Residence Characteristics KW - Risk Factors KW - United States KW - Venous Thromboembolism AB -

BACKGROUND: Blacks are thought to have a higher risk of venous thromboembolism (VTE) than whites. However, prior studies are limited to administrative databases that lack specific information on VTE risk factors or have limited geographic scope.

METHODS AND RESULTS: We ascertained VTE from 3 prospective studies: the Atherosclerosis Risk in Communities Study (ARIC), the Cardiovascular Health Study (CHS), and the Reasons for Geographic and Racial Differences in Stroke study (REGARDS). We tested the association of race with VTE using Cox proportional hazard models adjusted for VTE risk factors. Over 438 090 person-years, 916 incident VTE events (302 in blacks) occurred in 51 149 individuals (17 318 blacks) who were followed up. In risk factor-adjusted models, blacks had a higher rate of VTE than whites in the CHS (hazard ratio, 1.81; 95% confidence interval, 1.20-2.73) but not ARIC (hazard ratio, 1.21; 95% confidence interval, 0.96-1.54). In REGARDS, there was a significant region-by-race interaction (P=0.01): Blacks in the Southeast had a significantly higher rate of VTE than blacks in the rest of the United States (hazard ratio, 1.63; 95% confidence interval, 1.08-2.48) that was not seen in whites (hazard ratio, 0.83; 95% confidence interval, 0.61-1.14).

CONCLUSIONS: The association of race with VTE differed in each cohort, which may reflect the different time periods of the studies or different regional rates of VTE. Further studies of environmental and genetic risk factors for VTE are needed to determine which underlie racial and perhaps regional differences in VTE.

VL - 129 IS - 14 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24508826?dopt=Abstract ER - TY - JOUR T1 - Separate prediction of intracerebral hemorrhage and ischemic stroke. JF - Neurology Y1 - 2014 A1 - Ferket, Bart S A1 - van Kempen, Bob J H A1 - Wieberdink, Renske G A1 - Steyerberg, Ewout W A1 - Koudstaal, Peter J A1 - Hofman, Albert A1 - Shahar, Eyal A1 - Gottesman, Rebecca F A1 - Rosamond, Wayne A1 - Kizer, Jorge R A1 - Kronmal, Richard A A1 - Psaty, Bruce M A1 - Longstreth, W T A1 - Mosley, Thomas A1 - Folsom, Aaron R A1 - Hunink, M G Myriam A1 - Ikram, M Arfan KW - Aged KW - Aged, 80 and over KW - Atherosclerosis KW - Body Mass Index KW - Brain Ischemia KW - Cholesterol KW - Female KW - Humans KW - Incidence KW - Intracranial Hemorrhages KW - Male KW - Middle Aged KW - Models, Statistical KW - Predictive Value of Tests KW - Risk Assessment KW - Risk Factors KW - Stroke AB -

OBJECTIVES: To develop and validate 10-year cumulative incidence functions of intracerebral hemorrhage (ICH) and ischemic stroke (IS).

METHODS: We used data on 27,493 participants from 3 population-based cohort studies: the Atherosclerosis Risk in Communities Study, median age 54 years, 45% male, median follow-up 20.7 years; the Rotterdam Study, median age 68 years, 38% male, median follow-up 14.3 years; and the Cardiovascular Health Study, median age 71 years, 41% male, median follow-up 12.8 years. Among these participants, 325 ICH events, 2,559 IS events, and 9,909 nonstroke deaths occurred. We developed 10-year cumulative incidence functions for ICH and IS using stratified Cox regression and competing risks analysis. Basic models including only established nonlaboratory risk factors were extended with diastolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, body mass index, waist-to-hip ratio, and glomerular filtration rate. The cumulative incidence functions' performances were cross-validated in each cohort separately by Harrell C-statistic and calibration plots.

RESULTS: High total cholesterol/high-density lipoprotein cholesterol ratio decreased the ICH rates but increased IS rates (p for difference across stroke types <0.001). For both the ICH and IS models, C statistics increased more by model extension in the Atherosclerosis Risk in Communities and Cardiovascular Health Study cohorts. Improvements in C statistics were reproduced by cross-validation. Models were well calibrated in all cohorts. Correlations between 10-year ICH and IS risks were moderate in each cohort.

CONCLUSIONS: We developed and cross-validated cumulative incidence functions for separate prediction of 10-year ICH and IS risk. These functions can be useful to further specify an individual's stroke risk.

VL - 82 IS - 20 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24759844?dopt=Abstract ER - TY - JOUR T1 - Targeted sequencing in candidate genes for atrial fibrillation: the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Targeted Sequencing Study. JF - Heart Rhythm Y1 - 2014 A1 - Lin, Honghuang A1 - Sinner, Moritz F A1 - Brody, Jennifer A A1 - Arking, Dan E A1 - Lunetta, Kathryn L A1 - Rienstra, Michiel A1 - Lubitz, Steven A A1 - Magnani, Jared W A1 - Sotoodehnia, Nona A1 - McKnight, Barbara A1 - McManus, David D A1 - Boerwinkle, Eric A1 - Psaty, Bruce M A1 - Rotter, Jerome I A1 - Bis, Joshua C A1 - Gibbs, Richard A A1 - Muzny, Donna A1 - Kovar, Christie L A1 - Morrison, Alanna C A1 - Gupta, Mayetri A1 - Folsom, Aaron R A1 - Kääb, Stefan A1 - Heckbert, Susan R A1 - Alonso, Alvaro A1 - Ellinor, Patrick T A1 - Benjamin, Emelia J KW - Aged KW - Atrial Fibrillation KW - Female KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genome-Wide Association Study KW - Homeodomain Proteins KW - Humans KW - Linkage Disequilibrium KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Receptors, Interleukin-6 AB -

BACKGROUND: Genome-wide association studies (GWAS) have identified common genetic variants that predispose to atrial fibrillation (AF). It is unclear whether rare and low-frequency variants in genes implicated by such GWAS confer additional risk of AF.

OBJECTIVE: To study the association of genetic variants with AF at GWAS top loci.

METHODS: In the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Targeted Sequencing Study, we selected and sequenced 77 target gene regions from GWAS loci of complex diseases or traits, including 4 genes hypothesized to be related to AF (PRRX1, CAV1, CAV2, and ZFHX3). Sequencing was performed in participants with (n = 948) and without (n = 3330) AF from the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, the Framingham Heart Study, and the Massachusetts General Hospital.

RESULTS: One common variant (rs11265611; P = 1.70 × 10(-6)) intronic to IL6R (interleukin-6 receptor gene) was significantly associated with AF after Bonferroni correction (odds ratio 0.70; 95% confidence interval 0.58-0.85). The variant was not genotyped or imputed by prior GWAS, but it is in linkage disequilibrium (r(2) = .69) with the single-nucleotide polymorphism, with the strongest association with AF so far at this locus (rs4845625). In the rare variant joint analysis, damaging variants within the PRRX1 region showed significant association with AF after Bonferroni correction (P = .01).

CONCLUSIONS: We identified 1 common single-nucleotide polymorphism and 1 gene region that were significantly associated with AF. Future sequencing efforts with larger sample sizes and more comprehensive genome coverage are anticipated to identify additional AF-related variants.

VL - 11 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24239840?dopt=Abstract ER - TY - JOUR T1 - Troponin T, NT-proBNP, and venous thromboembolism: the Longitudinal Investigation of Thromboembolism Etiology (LITE). JF - Vasc Med Y1 - 2014 A1 - Folsom, Aaron R A1 - Lutsey, Pamela L A1 - Nambi, Vijay A1 - deFilippi, Christopher R A1 - Heckbert, Susan R A1 - Cushman, Mary A1 - Ballantyne, Christie M KW - Aged KW - Aged, 80 and over KW - Atherosclerosis KW - Biomarkers KW - Female KW - Heart Failure KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Natriuretic Peptide, Brain KW - Peptide Fragments KW - Prospective Studies KW - Risk Factors KW - Troponin T KW - Venous Thromboembolism AB -

Increased levels of plasma troponins and natriuretic peptides are markers of cardiac dysfunction associated with increased risk of cardiovascular disease. Little information exists on cardiac dysfunction and occurrence of venous thromboembolism (VTE). In two prospective epidemiological cohorts, we tested the hypothesis that high-sensitivity troponin T (TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) are associated positively with VTE occurrence. The Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS) measured plasma TnT and NT-proBNP in 13,719 men or women with no history of venous thrombosis, coronary heart disease, or heart failure and followed them for approximately 10 years for VTE occurrence (n = 348 VTEs). In both ARIC and CHS, TnT was associated positively with incidence of total VTE and provoked VTE, but not with unprovoked VTE: age, race, and sex-adjusted hazard ratios for total VTE in the pooled analysis were 1.00, 0.85, 1.36, 1.51, and 1.98 (p-trend <0.0001) across five categories of TnT. In contrast, the association of NT-proBNP with VTE was positive in ARIC (hazard ratios approximately 2.5-fold for the highest versus lowest NT-proBNP quintiles), but non-existent in CHS.

VL - 19 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24558027?dopt=Abstract ER - TY - JOUR T1 - Whole-exome sequencing identifies rare and low-frequency coding variants associated with LDL cholesterol. JF - Am J Hum Genet Y1 - 2014 A1 - Lange, Leslie A A1 - Hu, Youna A1 - Zhang, He A1 - Xue, Chenyi A1 - Schmidt, Ellen M A1 - Tang, Zheng-Zheng A1 - Bizon, Chris A1 - Lange, Ethan M A1 - Smith, Joshua D A1 - Turner, Emily H A1 - Jun, Goo A1 - Kang, Hyun Min A1 - Peloso, Gina A1 - Auer, Paul A1 - Li, Kuo-Ping A1 - Flannick, Jason A1 - Zhang, Ji A1 - Fuchsberger, Christian A1 - Gaulton, Kyle A1 - Lindgren, Cecilia A1 - Locke, Adam A1 - Manning, Alisa A1 - Sim, Xueling A1 - Rivas, Manuel A A1 - Holmen, Oddgeir L A1 - Gottesman, Omri A1 - Lu, Yingchang A1 - Ruderfer, Douglas A1 - Stahl, Eli A A1 - Duan, Qing A1 - Li, Yun A1 - Durda, Peter A1 - Jiao, Shuo A1 - Isaacs, Aaron A1 - Hofman, Albert A1 - Bis, Joshua C A1 - Correa, Adolfo A1 - Griswold, Michael E A1 - Jakobsdottir, Johanna A1 - Smith, Albert V A1 - Schreiner, Pamela J A1 - Feitosa, Mary F A1 - Zhang, Qunyuan A1 - Huffman, Jennifer E A1 - Crosby, Jacy A1 - Wassel, Christina L A1 - Do, Ron A1 - Franceschini, Nora A1 - Martin, Lisa W A1 - Robinson, Jennifer G A1 - Assimes, Themistocles L A1 - Crosslin, David R A1 - Rosenthal, Elisabeth A A1 - Tsai, Michael A1 - Rieder, Mark J A1 - Farlow, Deborah N A1 - Folsom, Aaron R A1 - Lumley, Thomas A1 - Fox, Ervin R A1 - Carlson, Christopher S A1 - Peters, Ulrike A1 - Jackson, Rebecca D A1 - van Duijn, Cornelia M A1 - Uitterlinden, André G A1 - Levy, Daniel A1 - Rotter, Jerome I A1 - Taylor, Herman A A1 - Gudnason, Vilmundur A1 - Siscovick, David S A1 - Fornage, Myriam A1 - Borecki, Ingrid B A1 - Hayward, Caroline A1 - Rudan, Igor A1 - Chen, Y Eugene A1 - Bottinger, Erwin P A1 - Loos, Ruth J F A1 - Sætrom, Pål A1 - Hveem, Kristian A1 - Boehnke, Michael A1 - Groop, Leif A1 - McCarthy, Mark A1 - Meitinger, Thomas A1 - Ballantyne, Christie M A1 - Gabriel, Stacey B A1 - O'Donnell, Christopher J A1 - Post, Wendy S A1 - North, Kari E A1 - Reiner, Alexander P A1 - Boerwinkle, Eric A1 - Psaty, Bruce M A1 - Altshuler, David A1 - Kathiresan, Sekar A1 - Lin, Dan-Yu A1 - Jarvik, Gail P A1 - Cupples, L Adrienne A1 - Kooperberg, Charles A1 - Wilson, James G A1 - Nickerson, Deborah A A1 - Abecasis, Goncalo R A1 - Rich, Stephen S A1 - Tracy, Russell P A1 - Willer, Cristen J KW - Adult KW - Aged KW - Apolipoproteins E KW - Cholesterol, LDL KW - Cohort Studies KW - Dyslipidemias KW - Exome KW - Female KW - Follow-Up Studies KW - Gene Frequency KW - Genetic Code KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Lipase KW - Male KW - Middle Aged KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Proprotein Convertase 9 KW - Proprotein Convertases KW - Receptors, LDL KW - Sequence Analysis, DNA KW - Serine Endopeptidases AB -

Elevated low-density lipoprotein cholesterol (LDL-C) is a treatable, heritable risk factor for cardiovascular disease. Genome-wide association studies (GWASs) have identified 157 variants associated with lipid levels but are not well suited to assess the impact of rare and low-frequency variants. To determine whether rare or low-frequency coding variants are associated with LDL-C, we exome sequenced 2,005 individuals, including 554 individuals selected for extreme LDL-C (>98(th) or <2(nd) percentile). Follow-up analyses included sequencing of 1,302 additional individuals and genotype-based analysis of 52,221 individuals. We observed significant evidence of association between LDL-C and the burden of rare or low-frequency variants in PNPLA5, encoding a phospholipase-domain-containing protein, and both known and previously unidentified variants in PCSK9, LDLR and APOB, three known lipid-related genes. The effect sizes for the burden of rare variants for each associated gene were substantially higher than those observed for individual SNPs identified from GWASs. We replicated the PNPLA5 signal in an independent large-scale sequencing study of 2,084 individuals. In conclusion, this large whole-exome-sequencing study for LDL-C identified a gene not known to be implicated in LDL-C and provides unique insight into the design and analysis of similar experiments.

VL - 94 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24507775?dopt=Abstract ER - TY - JOUR T1 - Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JF - JAMA Y1 - 2015 A1 - Corrales-Medina, Vicente F A1 - Alvarez, Karina N A1 - Weissfeld, Lisa A A1 - Angus, Derek C A1 - Chirinos, Julio A A1 - Chang, Chung-Chou H A1 - Newman, Anne A1 - Loehr, Laura A1 - Folsom, Aaron R A1 - Elkind, Mitchell S A1 - Lyles, Mary F A1 - Kronmal, Richard A A1 - Yende, Sachin KW - Aged KW - Atherosclerosis KW - Cardiovascular Diseases KW - Cohort Studies KW - Comorbidity KW - Female KW - Hospitalization KW - Humans KW - Male KW - Middle Aged KW - Pneumonia KW - Risk Factors AB -

IMPORTANCE: The risk of cardiovascular disease (CVD) after infection is poorly understood.

OBJECTIVE: To determine whether hospitalization for pneumonia is associated with an increased short-term and long-term risk of CVD.

DESIGN, SETTINGS, AND PARTICIPANTS: We examined 2 community-based cohorts: the Cardiovascular Health Study (CHS, n = 5888; enrollment age, ≥65 years; enrollment period, 1989-1994) and the Atherosclerosis Risk in Communities study (ARIC, n = 15,792; enrollment age, 45-64 years; enrollment period, 1987-1989). Participants were followed up through December 31, 2010. We matched each participant hospitalized with pneumonia to 2 controls. Pneumonia cases and controls were followed for occurrence of CVD over 10 years after matching. We estimated hazard ratios (HRs) for CVD at different time intervals, adjusting for demographics, CVD risk factors, subclinical CVD, comorbidities, and functional status.

EXPOSURES: Hospitalization for pneumonia.

MAIN OUTCOMES AND MEASURES: Incident CVD (myocardial infarction, stroke, and fatal coronary heart disease).

RESULTS: Of 591 pneumonia cases in CHS, 206 had CVD events over 10 years after pneumonia hospitalization. CVD risk after pneumonia was highest in the first year. CVD occurred in 54 cases and 6 controls in the first 30 days (HR, 4.07; 95% CI, 2.86-5.27); 11 cases and 9 controls between 31 and 90 days (HR, 2.94; 95% CI, 2.18-3.70); and 22 cases and 55 controls between 91 days and 1 year (HR, 2.10; 95% CI, 1.59-2.60). Additional CVD risk remained elevated into the tenth year, when 4 cases and 12 controls developed CVD (HR, 1.86; 95% CI, 1.18-2.55). In ARIC, of 680 pneumonia cases, 112 had CVD over 10 years after hospitalization. CVD occurred in 4 cases and 3 controls in the first 30 days (HR, 2.38; 95% CI, 1.12-3.63); 4 cases and 0 controls between 31 and 90 days (HR, 2.40; 95% CI, 1.23-3.47); 11 cases and 8 controls between 91 days and 1 year (HR, 2.19; 95% CI, 1.20-3.19); and 8 cases and 7 controls during the second year (HR, 1.88; 95% CI, 1.10-2.66). After the second year, the HRs were no longer statistically significant.

CONCLUSIONS AND RELEVANCE: Hospitalization for pneumonia was associated with increased short-term and long-term risk of CVD, suggesting that pneumonia may be a risk factor for CVD.

VL - 313 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25602997?dopt=Abstract ER - TY - JOUR T1 - Exome sequencing identifies rare LDLR and APOA5 alleles conferring risk for myocardial infarction. JF - Nature Y1 - 2015 A1 - Do, Ron A1 - Stitziel, Nathan O A1 - Won, Hong-Hee A1 - Jørgensen, Anders Berg A1 - Duga, Stefano A1 - Angelica Merlini, Pier A1 - Kiezun, Adam A1 - Farrall, Martin A1 - Goel, Anuj A1 - Zuk, Or A1 - Guella, Illaria A1 - Asselta, Rosanna A1 - Lange, Leslie A A1 - Peloso, Gina M A1 - Auer, Paul L A1 - Girelli, Domenico A1 - Martinelli, Nicola A1 - Farlow, Deborah N A1 - DePristo, Mark A A1 - Roberts, Robert A1 - Stewart, Alexander F R A1 - Saleheen, Danish A1 - Danesh, John A1 - Epstein, Stephen E A1 - Sivapalaratnam, Suthesh A1 - Hovingh, G Kees A1 - Kastelein, John J A1 - Samani, Nilesh J A1 - Schunkert, Heribert A1 - Erdmann, Jeanette A1 - Shah, Svati H A1 - Kraus, William E A1 - Davies, Robert A1 - Nikpay, Majid A1 - Johansen, Christopher T A1 - Wang, Jian A1 - Hegele, Robert A A1 - Hechter, Eliana A1 - März, Winfried A1 - Kleber, Marcus E A1 - Huang, Jie A1 - Johnson, Andrew D A1 - Li, Mingyao A1 - Burke, Greg L A1 - Gross, Myron A1 - Liu, Yongmei A1 - Assimes, Themistocles L A1 - Heiss, Gerardo A1 - Lange, Ethan M A1 - Folsom, Aaron R A1 - Taylor, Herman A A1 - Olivieri, Oliviero A1 - Hamsten, Anders A1 - Clarke, Robert A1 - Reilly, Dermot F A1 - Yin, Wu A1 - Rivas, Manuel A A1 - Donnelly, Peter A1 - Rossouw, Jacques E A1 - Psaty, Bruce M A1 - Herrington, David M A1 - Wilson, James G A1 - Rich, Stephen S A1 - Bamshad, Michael J A1 - Tracy, Russell P A1 - Cupples, L Adrienne A1 - Rader, Daniel J A1 - Reilly, Muredach P A1 - Spertus, John A A1 - Cresci, Sharon A1 - Hartiala, Jaana A1 - Tang, W H Wilson A1 - Hazen, Stanley L A1 - Allayee, Hooman A1 - Reiner, Alex P A1 - Carlson, Christopher S A1 - Kooperberg, Charles A1 - Jackson, Rebecca D A1 - Boerwinkle, Eric A1 - Lander, Eric S A1 - Schwartz, Stephen M A1 - Siscovick, David S A1 - McPherson, Ruth A1 - Tybjaerg-Hansen, Anne A1 - Abecasis, Goncalo R A1 - Watkins, Hugh A1 - Nickerson, Deborah A A1 - Ardissino, Diego A1 - Sunyaev, Shamil R A1 - O'Donnell, Christopher J A1 - Altshuler, David A1 - Gabriel, Stacey A1 - Kathiresan, Sekar KW - Age Factors KW - Age of Onset KW - Alleles KW - Apolipoproteins A KW - Case-Control Studies KW - Cholesterol, LDL KW - Coronary Artery Disease KW - Exome KW - Female KW - Genetic Predisposition to Disease KW - Genetics, Population KW - Heterozygote KW - Humans KW - Male KW - Middle Aged KW - Mutation KW - Myocardial Infarction KW - National Heart, Lung, and Blood Institute (U.S.) KW - Receptors, LDL KW - Triglycerides KW - United States AB -

Myocardial infarction (MI), a leading cause of death around the world, displays a complex pattern of inheritance. When MI occurs early in life, genetic inheritance is a major component to risk. Previously, rare mutations in low-density lipoprotein (LDL) genes have been shown to contribute to MI risk in individual families, whereas common variants at more than 45 loci have been associated with MI risk in the population. Here we evaluate how rare mutations contribute to early-onset MI risk in the population. We sequenced the protein-coding regions of 9,793 genomes from patients with MI at an early age (≤50 years in males and ≤60 years in females) along with MI-free controls. We identified two genes in which rare coding-sequence mutations were more frequent in MI cases versus controls at exome-wide significance. At low-density lipoprotein receptor (LDLR), carriers of rare non-synonymous mutations were at 4.2-fold increased risk for MI; carriers of null alleles at LDLR were at even higher risk (13-fold difference). Approximately 2% of early MI cases harbour a rare, damaging mutation in LDLR; this estimate is similar to one made more than 40 years ago using an analysis of total cholesterol. Among controls, about 1 in 217 carried an LDLR coding-sequence mutation and had plasma LDL cholesterol > 190 mg dl(-1). At apolipoprotein A-V (APOA5), carriers of rare non-synonymous mutations were at 2.2-fold increased risk for MI. When compared with non-carriers, LDLR mutation carriers had higher plasma LDL cholesterol, whereas APOA5 mutation carriers had higher plasma triglycerides. Recent evidence has connected MI risk with coding-sequence mutations at two genes functionally related to APOA5, namely lipoprotein lipase and apolipoprotein C-III (refs 18, 19). Combined, these observations suggest that, as well as LDL cholesterol, disordered metabolism of triglyceride-rich lipoproteins contributes to MI risk.

VL - 518 IS - 7537 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25487149?dopt=Abstract ER - TY - JOUR T1 - Gene-centric approach identifies new and known loci for FVIII activity and VWF antigen levels in European Americans and African Americans. JF - Am J Hematol Y1 - 2015 A1 - Tang, Weihong A1 - Cushman, Mary A1 - Green, David A1 - Rich, Stephen S A1 - Lange, Leslie A A1 - Yang, Qiong A1 - Tracy, Russell P A1 - Tofler, Geoffrey H A1 - Basu, Saonli A1 - Wilson, James G A1 - Keating, Brendan J A1 - Weng, Lu-Chen A1 - Taylor, Herman A A1 - Jacobs, David R A1 - Delaney, Joseph A A1 - Palmer, Cameron D A1 - Young, Taylor A1 - Pankow, James S A1 - O'Donnell, Christopher J A1 - Smith, Nicholas L A1 - Reiner, Alexander P A1 - Folsom, Aaron R KW - Adult KW - African Americans KW - Aged KW - European Continental Ancestry Group KW - Factor VIII KW - Female KW - Genetic Loci KW - Genome-Wide Association Study KW - Humans KW - Male KW - Methionine Adenosyltransferase KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Venous Thromboembolism KW - von Willebrand Factor AB -

Coagulation factor VIII and von Willebrand factor (VWF) are key proteins in procoagulant activation. Higher FVIII coagulant activity (FVIII :C) and VWF antigen (VWF :Ag) are risk factors for cardiovascular disease and venous thromboembolism. Beyond associations with ABO blood group, genetic determinants of FVIII and VWF are not well understood, especially in non European-American populations. We performed a genetic association study of FVIII :C and VWF:Ag that assessed 50,000 gene-centric single nucleotide polymorphisms (SNPs) in 18,556 European Americans (EAs) and 5,047 African Americans (AAs) from five population-based cohorts. Previously unreported associations for FVIII :C were identified in both AAs and EAs with KNG1 (most significantly associated SNP rs710446, Ile581Thr, Ile581Thr, P = 5.10 × 10(-7) in EAs and P = 3.88 × 10(-3) in AAs) and VWF rs7962217 (Gly2705Arg,P = 6.30 × 10(-9) in EAs and P = 2.98 × 10(-2) in AAs. Significant associations for FVIII :C were also observed with F8/TMLHE region SNP rs12557310 in EAs (P = 8.02 × 10(-10) ), with VWF rs1800380 in AAs (P = 5.62 × 10(-11) ), and with MAT1A rs2236568 in AAs (P51.69 × 10(-6) ). We replicated previously reported associations of FVIII :C and VWF :Ag with the ABO blood group, VWF rs1063856(Thr789Ala), rs216321 (Ala852Gln), and VWF rs2229446 (Arg2185Gln). Findings from this study expand our understanding of genetic influences for FVIII :C and VWF :Ag in both EAs and AAs.

VL - 90 IS - 6 ER - TY - JOUR T1 - Meta-analysis of 65,734 individuals identifies TSPAN15 and SLC44A2 as two susceptibility loci for venous thromboembolism. JF - Am J Hum Genet Y1 - 2015 A1 - Germain, Marine A1 - Chasman, Daniel I A1 - de Haan, Hugoline A1 - Tang, Weihong A1 - Lindström, Sara A1 - Weng, Lu-Chen A1 - de Andrade, Mariza A1 - de Visser, Marieke C H A1 - Wiggins, Kerri L A1 - Suchon, Pierre A1 - Saut, Noémie A1 - Smadja, David M A1 - Le Gal, Grégoire A1 - van Hylckama Vlieg, Astrid A1 - Di Narzo, Antonio A1 - Hao, Ke A1 - Nelson, Christopher P A1 - Rocanin-Arjo, Ares A1 - Folkersen, Lasse A1 - Monajemi, Ramin A1 - Rose, Lynda M A1 - Brody, Jennifer A A1 - Slagboom, Eline A1 - Aïssi, Dylan A1 - Gagnon, France A1 - Deleuze, Jean-Francois A1 - Deloukas, Panos A1 - Tzourio, Christophe A1 - Dartigues, Jean-François A1 - Berr, Claudine A1 - Taylor, Kent D A1 - Civelek, Mete A1 - Eriksson, Per A1 - Psaty, Bruce M A1 - Houwing-Duitermaat, Jeanine A1 - Goodall, Alison H A1 - Cambien, Francois A1 - Kraft, Peter A1 - Amouyel, Philippe A1 - Samani, Nilesh J A1 - Basu, Saonli A1 - Ridker, Paul M A1 - Rosendaal, Frits R A1 - Kabrhel, Christopher A1 - Folsom, Aaron R A1 - Heit, John A1 - Reitsma, Pieter H A1 - Trégouët, David-Alexandre A1 - Smith, Nicholas L A1 - Morange, Pierre-Emmanuel KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Membrane Glycoproteins KW - Membrane Transport Proteins KW - Odds Ratio KW - Tetraspanins KW - Venous Thromboembolism AB -

Venous thromboembolism (VTE), the third leading cause of cardiovascular mortality, is a complex thrombotic disorder with environmental and genetic determinants. Although several genetic variants have been found associated with VTE, they explain a minor proportion of VTE risk in cases. We undertook a meta-analysis of genome-wide association studies (GWASs) to identify additional VTE susceptibility genes. Twelve GWASs totaling 7,507 VTE case subjects and 52,632 control subjects formed our discovery stage where 6,751,884 SNPs were tested for association with VTE. Nine loci reached the genome-wide significance level of 5 × 10(-8) including six already known to associate with VTE (ABO, F2, F5, F11, FGG, and PROCR) and three unsuspected loci. SNPs mapping to these latter were selected for replication in three independent case-control studies totaling 3,009 VTE-affected individuals and 2,586 control subjects. This strategy led to the identification and replication of two VTE-associated loci, TSPAN15 and SLC44A2, with lead risk alleles associated with odds ratio for disease of 1.31 (p = 1.67 × 10(-16)) and 1.21 (p = 2.75 × 10(-15)), respectively. The lead SNP at the TSPAN15 locus is the intronic rs78707713 and the lead SLC44A2 SNP is the non-synonymous rs2288904 previously shown to associate with transfusion-related acute lung injury. We further showed that these two variants did not associate with known hemostatic plasma markers. TSPAN15 and SLC44A2 do not belong to conventional pathways for thrombosis and have not been associated to other cardiovascular diseases nor related quantitative biomarkers. Our findings uncovered unexpected actors of VTE etiology and pave the way for novel mechanistic concepts of VTE pathophysiology.

VL - 96 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25772935?dopt=Abstract ER - TY - JOUR T1 - Prospective study of circulating factor XI and incident venous thromboembolism: The Longitudinal Investigation of Thromboembolism Etiology (LITE). JF - Am J Hematol Y1 - 2015 A1 - Folsom, Aaron R A1 - Tang, Weihong A1 - Roetker, Nicholas S A1 - Heckbert, Susan R A1 - Cushman, Mary A1 - Pankow, James S KW - African Americans KW - Aged KW - Alleles KW - European Continental Ancestry Group KW - Factor XI KW - Female KW - Gene Expression KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors KW - United States KW - Venous Thromboembolism AB -

Elevated plasma concentrations of coagulation factor XI may increase risk of venous thromboembolism (VTE), but prospective data are limited. We studied prospectively the associations of plasma factor XI and a key F11 genetic variant with incident VTE in whites and African-Americans. We measured factor XI in 16,299 participants, initially free of VTE, in two prospective population cohorts. We also measured the F11 single nucleotide polymorphism rs4241824, which a genome-wide association study had linked to factor XI concentration. During follow-up, we identified 606 VTEs. The age, race, sex, and study-adjusted hazard ratio of VTE increased across factor XI quintiles (P < 0.001 for trend), and the hazard ratio was 1.51 (95% CI 1.16, 1.97) for the highest versus lowest quintile overall, and was 1.42 (95% CI 1.03, 1.95) in whites and 1.72 (95% CI 1.08, 2.73) in African-Americans. In whites, the F11 variant was associated with both factor XI concentration and VTE incidence (1.15-fold greater incidence of VTE per risk allele). In African-Americans, these associations were absent. In conclusion, this cohort study documented that an elevated plasma factor XI concentration is a risk factor for VTE over extended follow-up, not only in whites but also in African-Americans. In whites, the association of the F11 genetic variant with VTE suggests a causal relation, but we did not observe this genetic relation in African-Americans.

VL - 90 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26260105?dopt=Abstract ER - TY - JOUR T1 - Rare and low-frequency variants and their association with plasma levels of fibrinogen, FVII, FVIII, and vWF. JF - Blood Y1 - 2015 A1 - Huffman, Jennifer E A1 - de Vries, Paul S A1 - Morrison, Alanna C A1 - Sabater-Lleal, Maria A1 - Kacprowski, Tim A1 - Auer, Paul L A1 - Brody, Jennifer A A1 - Chasman, Daniel I A1 - Chen, Ming-Huei A1 - Guo, Xiuqing A1 - Lin, Li-An A1 - Marioni, Riccardo E A1 - Müller-Nurasyid, Martina A1 - Yanek, Lisa R A1 - Pankratz, Nathan A1 - Grove, Megan L A1 - de Maat, Moniek P M A1 - Cushman, Mary A1 - Wiggins, Kerri L A1 - Qi, Lihong A1 - Sennblad, Bengt A1 - Harris, Sarah E A1 - Polasek, Ozren A1 - Riess, Helene A1 - Rivadeneira, Fernando A1 - Rose, Lynda M A1 - Goel, Anuj A1 - Taylor, Kent D A1 - Teumer, Alexander A1 - Uitterlinden, André G A1 - Vaidya, Dhananjay A1 - Yao, Jie A1 - Tang, Weihong A1 - Levy, Daniel A1 - Waldenberger, Melanie A1 - Becker, Diane M A1 - Folsom, Aaron R A1 - Giulianini, Franco A1 - Greinacher, Andreas A1 - Hofman, Albert A1 - Huang, Chiang-Ching A1 - Kooperberg, Charles A1 - Silveira, Angela A1 - Starr, John M A1 - Strauch, Konstantin A1 - Strawbridge, Rona J A1 - Wright, Alan F A1 - McKnight, Barbara A1 - Franco, Oscar H A1 - Zakai, Neil A1 - Mathias, Rasika A A1 - Psaty, Bruce M A1 - Ridker, Paul M A1 - Tofler, Geoffrey H A1 - Völker, Uwe A1 - Watkins, Hugh A1 - Fornage, Myriam A1 - Hamsten, Anders A1 - Deary, Ian J A1 - Boerwinkle, Eric A1 - Koenig, Wolfgang A1 - Rotter, Jerome I A1 - Hayward, Caroline A1 - Dehghan, Abbas A1 - Reiner, Alex P A1 - O'Donnell, Christopher J A1 - Smith, Nicholas L KW - Cohort Studies KW - Factor VII KW - Factor VIII KW - Fibrinogen KW - Gene Frequency KW - Genetic Association Studies KW - Genetic Variation KW - Humans KW - Nerve Tissue Proteins KW - Polymorphism, Single Nucleotide KW - Potassium Channels KW - von Willebrand Factor AB -

Fibrinogen, coagulation factor VII (FVII), and factor VIII (FVIII) and its carrier von Willebrand factor (vWF) play key roles in hemostasis. Previously identified common variants explain only a small fraction of the trait heritabilities, and additional variations may be explained by associations with rarer variants with larger effects. The aim of this study was to identify low-frequency (minor allele frequency [MAF] ≥0.01 and <0.05) and rare (MAF <0.01) variants that influence plasma concentrations of these 4 hemostatic factors by meta-analyzing exome chip data from up to 76,000 participants of 4 ancestries. We identified 12 novel associations of low-frequency (n = 2) and rare (n = 10) variants across the fibrinogen, FVII, FVIII, and vWF traits that were independent of previously identified associations. Novel loci were found within previously reported genes and had effect sizes much larger than and independent of previously identified common variants. In addition, associations at KCNT1, HID1, and KATNB1 identified new candidate genes related to hemostasis for follow-up replication and functional genomic analysis. Newly identified low-frequency and rare-variant associations accounted for modest amounts of trait variance and therefore are unlikely to increase predicted trait heritability but provide new information for understanding individual variation in hemostasis pathways.

VL - 126 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26105150?dopt=Abstract ER - TY - JOUR T1 - Body size measures, hemostatic and inflammatory markers and risk of venous thrombosis: The Longitudinal Investigation of Thromboembolism Etiology. JF - Thromb Res Y1 - 2016 A1 - Cushman, Mary A1 - O'Meara, Ellen S A1 - Heckbert, Susan R A1 - Zakai, Neil A A1 - Rosamond, Wayne A1 - Folsom, Aaron R AB -

OBJECTIVE: Obesity is an important venous thrombosis (VT) risk factor but the reasons for this are unclear.

MATERIALS AND METHODS: In a cohort of 20,914 individuals aged 45 and older without prior VT, we calculated the relative risk (RR) of VT over 12.6years follow-up according to baseline body size measures, and studied whether associations were mediated by biomarkers of hemostasis and inflammation that are related to adiposity.

RESULTS: Greater levels of all body size measures (weight, height, waist, hip circumference, calf circumference, body-mass index, waist-hip ratio, fat mass and fat-free mass) were associated with increased risk of VT, with 4th versus 1st quartile RRs of 1.5-3.0. There were no multiplicative interactions of biomarkers with obesity status. Adjustment for biomarkers associated with VT risk and body size (factors VII and VIII, von Willebrand factor, partial thromboplastin time, D-dimer, C-reactive protein and factor XI) only marginally lowered, or did not impact, the RRs associated with body size measures.

CONCLUSIONS: Greater body size, by multiple measures, is a risk factor for VT. Associations were not mediated by circulating levels of studied biomarkers suggesting that body size relates to VT because of physical factors associated with blood flow, not the hypercoagulability or inflammation associated with adiposity.

VL - 144 ER - TY - JOUR T1 - Development and Validation of a Sudden Cardiac Death Prediction Model for the General Population. JF - Circulation Y1 - 2016 A1 - Deo, Rajat A1 - Norby, Faye L A1 - Katz, Ronit A1 - Sotoodehnia, Nona A1 - Adabag, Selcuk A1 - deFilippi, Christopher R A1 - Kestenbaum, Bryan A1 - Chen, Lin Y A1 - Heckbert, Susan R A1 - Folsom, Aaron R A1 - Kronmal, Richard A A1 - Konety, Suma A1 - Patton, Kristen K A1 - Siscovick, David A1 - Shlipak, Michael G A1 - Alonso, Alvaro AB -

BACKGROUND: Most sudden cardiac death (SCD) events occur in the general population among persons who do not have any prior history of clinical heart disease. We sought to develop a predictive model of SCD among US adults.

METHODS: We evaluated a series of demographic, clinical, laboratory, electrocardiographic, and echocardiographic measures in participants in the ARIC study (Atherosclerosis Risk in Communities) (n=13 677) and the CHS (Cardiovascular Health Study) (n=4207) who were free of baseline cardiovascular disease. Our initial objective was to derive a SCD prediction model using the ARIC cohort and validate it in CHS. Independent risk factors for SCD were first identified in the ARIC cohort to derive a 10-year risk model of SCD. We compared the prediction of SCD with non-SCD and all-cause mortality in both the derivation and validation cohorts. Furthermore, we evaluated whether the SCD prediction equation was better at predicting SCD than the 2013 American College of Cardiology/American Heart Association Cardiovascular Disease Pooled Cohort risk equation.

RESULTS: There were a total of 345 adjudicated SCD events in our analyses, and the 12 independent risk factors in the ARIC study included age, male sex, black race, current smoking, systolic blood pressure, use of antihypertensive medication, diabetes mellitus, serum potassium, serum albumin, high-density lipoprotein, estimated glomerular filtration rate, and QTc interval. During a 10-year follow-up period, a model combining these risk factors showed good to excellent discrimination for SCD risk (c-statistic 0.820 in ARIC and 0.745 in CHS). The SCD prediction model was slightly better in predicting SCD than the 2013 American College of Cardiology/American Heart Association Pooled Cohort risk equations (c-statistic 0.808 in ARIC and 0.743 in CHS). Only the SCD prediction model, however, demonstrated similar and accurate prediction for SCD using both the original, uncalibrated score and the recalibrated equation. Finally, in the echocardiographic subcohort, a left ventricular ejection fraction <50% was present in only 1.1% of participants and did not enhance SCD prediction.

CONCLUSIONS: Our study is the first to derive and validate a generalizable risk score that provides well-calibrated, absolute risk estimates across different risk strata in an adult population of white and black participants without a clinical diagnosis of cardiovascular disease.

VL - 134 IS - 11 ER - TY - JOUR T1 - Diabetes mellitus and venous thromboembolism: A systematic review and meta-analysis. JF - Diabetes Res Clin Pract Y1 - 2016 A1 - Bell, Elizabeth J A1 - Folsom, Aaron R A1 - Lutsey, Pamela L A1 - Selvin, Elizabeth A1 - Zakai, Neil A A1 - Cushman, Mary A1 - Alonso, Alvaro AB -

UNLABELLED: Diabetes mellitus (DM) may be a risk factor for venous thromboembolism (VTE) but results are inconsistent.

AIM: We conducted a systematic review and meta-analysis of epidemiologic studies to quantify the association between DM and VTE.

METHODS AND RESULTS: We included studies identified in PubMed, Web of Science, and CINAHL through 07/31/2014. We identified 19 studies that met our selection criteria. We pooled RRs using a random-effects model: the pooled RR for the association of DM with VTE was 1.10 (95% CI: 0.94-1.29). Between-study heterogeneity was explored with a forest plot, funnel plot, meta-regression, and a stratified analysis. Between-study heterogeneity was observed and not explained by study design, method of DM assessment, or degree of adjustment for confounding. Sensitivity analyses omitted one study at a time to assess the influence of any single study on the pooled estimate. These analyses indicated that one large study was highly influential; when this study was excluded, the pooled estimate increased and just reached statistical significance: 1.16 (95% CI: 1.01-1.34).

CONCLUSIONS: This meta-analysis suggests either no association or a modest positive one between DM and VTE in the general population. DM is unlikely to play a major role in VTE development.

VL - 111 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26612139?dopt=Abstract ER - TY - JOUR T1 - Echocardiographic Predictors of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study. JF - Circ Cardiovasc Imaging Y1 - 2016 A1 - Konety, Suma H A1 - Koene, Ryan J A1 - Norby, Faye L A1 - Wilsdon, Tony A1 - Alonso, Alvaro A1 - Siscovick, David A1 - Sotoodehnia, Nona A1 - Gottdiener, John A1 - Fox, Ervin R A1 - Chen, Lin Y A1 - Adabag, Selcuk A1 - Folsom, Aaron R AB -

BACKGROUND: This study assessed the echocardiographic predictors of sudden cardiac death (SCD) within 2 population-based cohorts.

METHODS AND RESULTS: Echocardiograms were obtained on 2383 participants (1993-1995) from the ARIC study (Atherosclerosis Risk in Communities; 100% black) and 5366 participants (1987-1989 and 1994-1995) from the CHS (Cardiovascular Health Study). The main outcome was physician-adjudicated SCD. We used Cox proportional-hazards models with incident coronary heart disease and heart failure as time-dependent covariates to assess the association between echocardiographic variables and SCD, adjusting for Framingham risk score variables, coronary heart disease, and renal function. Cohort-specific results were meta-analyzed. During a median follow-up of 7.3 and 13.1 years, 44 ARIC study participants and 275 CHS participants had SCD, respectively. In the meta-analyzed results, the adjusted hazard ratios (95% confidence intervals) for predictors of SCD were 3.07 (2.29-4.11) for reduced left ventricular ejection fraction; 1.85 (1.36-2.52) for mitral annular calcification; 1.64 (1.07-2.51) for mitral E/A >1.5, and 1.52 (1.14-2.02) for mitral E/A <0.7 (versus mitral E/A 0.7-1.5); 1.30 (1.15-1.48) per 1 SD increase in left ventricular mass; and 1.15 (1.02-1.30) per 1 SD increase in left atrial diameter. A receiver-operating characteristic model for prediction of SCD using Framingham risk score variables had a C statistic of 0.61 for ARIC study and 0.67 for CHS; the full multivariable model including all echocardiographic variables had a C statistic of 0.76 for ARIC study and 0.74 for CHS.

CONCLUSIONS: In addition to reduced left ventricular ejection fraction, we identified other echocardiographic-derived variables predictive for SCD that provided incremental value compared with clinical risk factors.

VL - 9 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27496550?dopt=Abstract ER - TY - JOUR T1 - Genome-Wide Association Study for Incident Myocardial Infarction and Coronary Heart Disease in Prospective Cohort Studies: The CHARGE Consortium. JF - PLoS One Y1 - 2016 A1 - Dehghan, Abbas A1 - Bis, Joshua C A1 - White, Charles C A1 - Smith, Albert Vernon A1 - Morrison, Alanna C A1 - Cupples, L Adrienne A1 - Trompet, Stella A1 - Chasman, Daniel I A1 - Lumley, Thomas A1 - Völker, Uwe A1 - Buckley, Brendan M A1 - Ding, Jingzhong A1 - Jensen, Majken K A1 - Folsom, Aaron R A1 - Kritchevsky, Stephen B A1 - Girman, Cynthia J A1 - Ford, Ian A1 - Dörr, Marcus A1 - Salomaa, Veikko A1 - Uitterlinden, André G A1 - Eiriksdottir, Gudny A1 - Vasan, Ramachandran S A1 - Franceschini, Nora A1 - Carty, Cara L A1 - Virtamo, Jarmo A1 - Demissie, Serkalem A1 - Amouyel, Philippe A1 - Arveiler, Dominique A1 - Heckbert, Susan R A1 - Ferrieres, Jean A1 - Ducimetiere, Pierre A1 - Smith, Nicholas L A1 - Wang, Ying A A1 - Siscovick, David S A1 - Rice, Kenneth M A1 - Wiklund, Per-Gunnar A1 - Taylor, Kent D A1 - Evans, Alun A1 - Kee, Frank A1 - Rotter, Jerome I A1 - Karvanen, Juha A1 - Kuulasmaa, Kari A1 - Heiss, Gerardo A1 - Kraft, Peter A1 - Launer, Lenore J A1 - Hofman, Albert A1 - Markus, Marcello R P A1 - Rose, Lynda M A1 - Silander, Kaisa A1 - Wagner, Peter A1 - Benjamin, Emelia J A1 - Lohman, Kurt A1 - Stott, David J A1 - Rivadeneira, Fernando A1 - Harris, Tamara B A1 - Levy, Daniel A1 - Liu, Yongmei A1 - Rimm, Eric B A1 - Jukema, J Wouter A1 - Völzke, Henry A1 - Ridker, Paul M A1 - Blankenberg, Stefan A1 - Franco, Oscar H A1 - Gudnason, Vilmundur A1 - Psaty, Bruce M A1 - Boerwinkle, Eric A1 - O'Donnell, Christopher J KW - Aged KW - Cohort Studies KW - Cooperative Behavior KW - Coronary Artery Disease KW - Female KW - Genetic Predisposition to Disease KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Polymorphism, Single Nucleotide KW - Prospective Studies AB -

BACKGROUND: Data are limited on genome-wide association studies (GWAS) for incident coronary heart disease (CHD). Moreover, it is not known whether genetic variants identified to date also associate with risk of CHD in a prospective setting.

METHODS: We performed a two-stage GWAS analysis of incident myocardial infarction (MI) and CHD in a total of 64,297 individuals (including 3898 MI cases, 5465 CHD cases). SNPs that passed an arbitrary threshold of 5×10-6 in Stage I were taken to Stage II for further discovery. Furthermore, in an analysis of prognosis, we studied whether known SNPs from former GWAS were associated with total mortality in individuals who experienced MI during follow-up.

RESULTS: In Stage I 15 loci passed the threshold of 5×10-6; 8 loci for MI and 8 loci for CHD, for which one locus overlapped and none were reported in previous GWAS meta-analyses. We took 60 SNPs representing these 15 loci to Stage II of discovery. Four SNPs near QKI showed nominally significant association with MI (p-value<8.8×10-3) and three exceeded the genome-wide significance threshold when Stage I and Stage II results were combined (top SNP rs6941513: p = 6.2×10-9). Despite excellent power, the 9p21 locus SNP (rs1333049) was only modestly associated with MI (HR = 1.09, p-value = 0.02) and marginally with CHD (HR = 1.06, p-value = 0.08). Among an inception cohort of those who experienced MI during follow-up, the risk allele of rs1333049 was associated with a decreased risk of subsequent mortality (HR = 0.90, p-value = 3.2×10-3).

CONCLUSIONS: QKI represents a novel locus that may serve as a predictor of incident CHD in prospective studies. The association of the 9p21 locus both with increased risk of first myocardial infarction and longer survival after MI highlights the importance of study design in investigating genetic determinants of complex disorders.

VL - 11 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26950853?dopt=Abstract ER - TY - JOUR T1 - Lack of association of plasma gamma prime (γ') fibrinogen with incident cardiovascular disease. JF - Thromb Res Y1 - 2016 A1 - Appiah, Duke A1 - Heckbert, Susan R A1 - Cushman, Mary A1 - Psaty, Bruce M A1 - Folsom, Aaron R AB -

INTRODUCTION: The association of gamma prime (γ') fibrinogen; a fibrinogen γ chain variant generated via alternative mRNA processing, with cardiovascular disease (CVD) remains equivocal. We prospectively examine the association of plasma γ' fibrinogen with the incidence of multiple cardiovascular disease (CVD) endpoints, independent of established CVD risk factors and total fibrinogen.

MATERIALS AND METHODS: We measured plasma γ' fibrinogen on plasma samples collected in 1992-1993 from adults ≥65years (n=3219) enrolled in the Cardiovascular Health Study, who were followed through 2013 for incident CVD events.

RESULTS AND CONCLUSIONS: In multivariable Cox models adjusted for traditional CVD risk factors and total fibrinogen, the hazard ratio per 1 standard deviation (10.7mg/dl) increment of γ' fibrinogen was 1.02 (95%CI: 0.95-1.10) for coronary heart disease; 0.88 (0.77-1.00) for ischemic stroke; 1.07 (0.87-1.32) for peripheral artery disease; 1.00 (0.92-1.08) for heart failure and 1.01 (0.92-1.10) for CVD mortality. Likewise, we failed to show a statistically significant association of γ'/total fibrinogen ratio with any CVD endpoint. These results suggest that among the elderly, γ' fibrinogen does not add much to CVD prediction beyond traditional risk factors and total fibrinogen level.

VL - 143 ER - TY - JOUR T1 - Lifetime Risk of Venous Thromboembolism in Two Cohort Studies. JF - Am J Med Y1 - 2016 A1 - Bell, Elizabeth J A1 - Lutsey, Pamela L A1 - Basu, Saonli A1 - Cushman, Mary A1 - Heckbert, Susan R A1 - Lloyd-Jones, Donald M A1 - Folsom, Aaron R KW - African Continental Ancestry Group KW - Aged KW - Anemia, Sickle Cell KW - Cohort Studies KW - Factor V KW - Follow-Up Studies KW - Heterozygote KW - Humans KW - Kaplan-Meier Estimate KW - Middle Aged KW - Obesity KW - Risk KW - Sickle Cell Trait KW - United States KW - Venous Thromboembolism AB -

BACKGROUND: Greater public awareness of venous thromboembolism may be an important next step for optimizing venous thromboembolism prevention and treatment. "Lifetime risk" is an easily interpretable way of presenting risk information. Therefore, we sought to calculate the lifetime risk of venous thromboembolism (deep vein thrombosis or pulmonary embolism) using data from 2 large, prospective cohort studies: the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) study.

METHODS: We followed participants aged 45-64 years in ARIC (n = 14,185) and ≥65 in CHS (n = 5414) at baseline visits (1987-1989 in ARIC, 1989-1990 and 1992-1993 in CHS) for incident venous thromboembolism (n = 728 in ARIC through 2011 and n = 172 in CHS through 2001). We estimated lifetime risks and 95% confidence intervals of incident venous thromboembolism using a modified Kaplan-Meier method, accounting for the competing risk of death from other causes.

RESULTS: At age 45 years, the remaining lifetime risk of venous thromboembolism in ARIC was 8.1% (95% confidence interval, 7.1-8.7). High-risk groups were African Americans (11.5% lifetime risk), those with obesity (10.9%), heterozygous for the factor V Leiden (17.1%), or with sickle cell trait or disease (18.2%). Lifetime risk estimates differed by cohort; these differences were explained by differences in time period of venous thromboembolism ascertainment.

CONCLUSIONS: At least 1 in 12 middle-aged adults will develop venous thromboembolism in their remaining lifetime. This estimate of lifetime risk may be useful to promote awareness of venous thromboembolism and guide decisions at both clinical and policy levels.

VL - 129 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26597668?dopt=Abstract ER - TY - JOUR T1 - A meta-analysis of 120 246 individuals identifies 18 new loci for fibrinogen concentration. JF - Hum Mol Genet Y1 - 2016 A1 - de Vries, Paul S A1 - Chasman, Daniel I A1 - Sabater-Lleal, Maria A1 - Chen, Ming-Huei A1 - Huffman, Jennifer E A1 - Steri, Maristella A1 - Tang, Weihong A1 - Teumer, Alexander A1 - Marioni, Riccardo E A1 - Grossmann, Vera A1 - Hottenga, Jouke J A1 - Trompet, Stella A1 - Müller-Nurasyid, Martina A1 - Zhao, Jing Hua A1 - Brody, Jennifer A A1 - Kleber, Marcus E A1 - Guo, Xiuqing A1 - Wang, Jie Jin A1 - Auer, Paul L A1 - Attia, John R A1 - Yanek, Lisa R A1 - Ahluwalia, Tarunveer S A1 - Lahti, Jari A1 - Venturini, Cristina A1 - Tanaka, Toshiko A1 - Bielak, Lawrence F A1 - Joshi, Peter K A1 - Rocanin-Arjo, Ares A1 - Kolcic, Ivana A1 - Navarro, Pau A1 - Rose, Lynda M A1 - Oldmeadow, Christopher A1 - Riess, Helene A1 - Mazur, Johanna A1 - Basu, Saonli A1 - Goel, Anuj A1 - Yang, Qiong A1 - Ghanbari, Mohsen A1 - Willemsen, Gonneke A1 - Rumley, Ann A1 - Fiorillo, Edoardo A1 - de Craen, Anton J M A1 - Grotevendt, Anne A1 - Scott, Robert A1 - Taylor, Kent D A1 - Delgado, Graciela E A1 - Yao, Jie A1 - Kifley, Annette A1 - Kooperberg, Charles A1 - Qayyum, Rehan A1 - Lopez, Lorna M A1 - Berentzen, Tina L A1 - Räikkönen, Katri A1 - Mangino, Massimo A1 - Bandinelli, Stefania A1 - Peyser, Patricia A A1 - Wild, Sarah A1 - Trégouët, David-Alexandre A1 - Wright, Alan F A1 - Marten, Jonathan A1 - Zemunik, Tatijana A1 - Morrison, Alanna C A1 - Sennblad, Bengt A1 - Tofler, Geoffrey A1 - de Maat, Moniek P M A1 - de Geus, Eco J C A1 - Lowe, Gordon D A1 - Zoledziewska, Magdalena A1 - Sattar, Naveed A1 - Binder, Harald A1 - Völker, Uwe A1 - Waldenberger, Melanie A1 - Khaw, Kay-Tee A1 - McKnight, Barbara A1 - Huang, Jie A1 - Jenny, Nancy S A1 - Holliday, Elizabeth G A1 - Qi, Lihong A1 - Mcevoy, Mark G A1 - Becker, Diane M A1 - Starr, John M A1 - Sarin, Antti-Pekka A1 - Hysi, Pirro G A1 - Hernandez, Dena G A1 - Jhun, Min A A1 - Campbell, Harry A1 - Hamsten, Anders A1 - Rivadeneira, Fernando A1 - McArdle, Wendy L A1 - Slagboom, P Eline A1 - Zeller, Tanja A1 - Koenig, Wolfgang A1 - Psaty, Bruce M A1 - Haritunians, Talin A1 - Liu, Jingmin A1 - Palotie, Aarno A1 - Uitterlinden, André G A1 - Stott, David J A1 - Hofman, Albert A1 - Franco, Oscar H A1 - Polasek, Ozren A1 - Rudan, Igor A1 - Morange, Pierre-Emmanuel A1 - Wilson, James F A1 - Kardia, Sharon L R A1 - Ferrucci, Luigi A1 - Spector, Tim D A1 - Eriksson, Johan G A1 - Hansen, Torben A1 - Deary, Ian J A1 - Becker, Lewis C A1 - Scott, Rodney J A1 - Mitchell, Paul A1 - März, Winfried A1 - Wareham, Nick J A1 - Peters, Annette A1 - Greinacher, Andreas A1 - Wild, Philipp S A1 - Jukema, J Wouter A1 - Boomsma, Dorret I A1 - Hayward, Caroline A1 - Cucca, Francesco A1 - Tracy, Russell A1 - Watkins, Hugh A1 - Reiner, Alex P A1 - Folsom, Aaron R A1 - Ridker, Paul M A1 - O'Donnell, Christopher J A1 - Smith, Nicholas L A1 - Strachan, David P A1 - Dehghan, Abbas AB -

Genome-wide association studies have previously identified 23 genetic loci associated with circulating fibrinogen concentration. These studies used HapMap imputation and did not examine the X-chromosome. 1000 Genomes imputation provides better coverage of uncommon variants, and includes indels. We conducted a genome-wide association analysis of 34 studies imputed to the 1000 Genomes Project reference panel and including ∼120 000 participants of European ancestry (95 806 participants with data on the X-chromosome). Approximately 10.7 million single-nucleotide polymorphisms and 1.2 million indels were examined. We identified 41 genome-wide significant fibrinogen loci; of which, 18 were newly identified. There were no genome-wide significant signals on the X-chromosome. The lead variants of five significant loci were indels. We further identified six additional independent signals, including three rare variants, at two previously characterized loci: FGB and IRF1. Together the 41 loci explain 3% of the variance in plasma fibrinogen concentration.

VL - 25 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26561523?dopt=Abstract ER - TY - JOUR T1 - Orthostatic Hypotension and Risk of Venous Thromboembolism in 2 Cohort Studies. JF - Am J Hypertens Y1 - 2016 A1 - Bell, Elizabeth J A1 - Agarwal, Sunil K A1 - Cushman, Mary A1 - Heckbert, Susan R A1 - Lutsey, Pamela L A1 - Folsom, Aaron R AB -

BACKGROUND: Although venous stasis is a risk factor for venous thromboembolism (VTE) and orthostatic hypotension (OH) can cause venous stasis, to our knowledge no study has examined the relationship between OH and VTE risk. We sought to quantify the association between OH and VTE (deep vein thrombosis or pulmonary embolism) using data from 2 large, prospective cohort studies: the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) Study. We hypothesized that OH was positively associated with incident VTE.

METHODS: We measured OH-defined as a drop in systolic blood pressure (SBP) of at least 20 mm Hg or diastolic blood pressure (DBP) of at least 10 mm Hg within 3 minutes of standing-in participants aged 45-64 years in ARIC (n = 12,480) and ≥65 years in CHS (n = 5,027) at baseline visits (1987-1989 in ARIC; 1989-1990 and 1992-1993 in CHS), and followed participants for incident VTE (n = 568 in ARIC through 2011 and n = 148 in CHS through 2001). We calculated adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) for incident VTE in relation to OH status.

RESULTS: In CHS, there was a positive association between OH status and incident VTE (HR for VTE = 1.74 (95% CI: 1.20-2.51)). In contrast, there was no association between OH and VTE in the ARIC study (HR for VTE = 0.97 (95% CI: 0.70-1.33)).

CONCLUSIONS: Community-dwelling older adults with OH had a moderately increased risk of VTE. These results were not seen in a population-based middle-aged cohort.

VL - 29 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26306405?dopt=Abstract ER - TY - JOUR T1 - Prospective study of γ' fibrinogen and incident venous thromboembolism: The Longitudinal Investigation of Thromboembolism Etiology (LITE). JF - Thromb Res Y1 - 2016 A1 - Folsom, Aaron R A1 - Tang, Weihong A1 - George, Kristen M A1 - Heckbert, Susan R A1 - MacLehose, Richard F A1 - Cushman, Mary A1 - Pankow, James S AB -

INTRODUCTION: Epidemiological studies generally have not found plasma total fibrinogen to be a risk factor for venous thromboembolism (VTE), but several have reported associations between variants in the fibrinogen gamma gene (FGG) and VTE. A case-control study in whites suggested plasma γ' fibrinogen concentration may be associated inversely with VTE, but this was not replicated in African Americans.

OBJECTIVE: To examine the prospective association between γ' fibrinogen concentrations and occurrence of VTE.

METHODS: We used the Longitudinal Investigation of Thromboembolism Etiology (LITE), involving two pooled population-based cohorts in the United States including 16,234 participants. The cohorts comprised white and African American men and women, aged 50years and older at study onset in the early 1990s. We identified VTEs during follow-up and documented they met standardized diagnostic criteria.

RESULTS: During two decades of follow-up, neither γ' fibrinogen nor total fibrinogen nor their ratio was associated with VTE overall (n=521 VTEs), in subgroups defined by race, or in other subgroups. In both race groups, the minor allele of FGG rs2066865 was associated with lower γ' fibrinogen concentrations, but this allele was not associated with VTE.

CONCLUSIONS: A lower plasma concentration of γ' fibrinogen in healthy adults does not appear to increase VTE risk.

VL - 139 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26916295?dopt=Abstract ER - TY - JOUR T1 - Relation of coagulation factor XI with incident coronary heart disease and stroke: the Cardiovascular Health Study. JF - Blood Coagul Fibrinolysis Y1 - 2016 A1 - Appiah, Duke A1 - Fashanu, Oluwaseun E A1 - Heckbert, Susa R A1 - Cushman, Mary A1 - Psaty, Bruce M A1 - Folsom, Aaron R AB -

The role of coagulation factor XI (FXI) in the cause of arterial thrombotic events remains uncertain. We examined the association of FXI with incident coronary heart disease (CHD), ischemic stroke, and hemorrhagic stroke. Data were from 3394 adults (mean age: 74.5 years) enrolled in the Cardiovascular Health Study who had FXI antigen from plasma samples drawn in 1992-1993 and were followed for cardiovascular events until 30 June 2013. Approximately 63% of participants were women and 17% were black. FXI levels were higher in blacks and women, showed positive associations with high-density lipoprotein and total cholesterol, BMI and diabetes, and negative associations with age and alcohol intake. During median follow-up of 13 years, we identified 1232 incident CHD, 473 ischemic stroke, and 84 hemorrhagic stroke events. In multivariable Cox models adjusted for traditional cardiovascular disease risk factors, the hazard ratio per one SD (32.2 mg/dl) increment of FXI was 1.02 (95% confidence interval: 0.96-1.08) for CHD; 0.94 (0.85-1.04) for ischemic stroke, and 0.85 (0.65-1.10) for hemorrhagic stroke. In this prospective cohort of elderly adults, there was no statistically significant association of higher FXI levels with incident CHD and stroke.

ER - TY - JOUR T1 - Galectin-3 and Venous Thromboembolism Incidence: the Atherosclerosis Risk in Communities (ARIC) Study. JF - Res Pract Thromb Haemost Y1 - 2017 A1 - Fashanu, Oluwaseun E A1 - Heckbert, Susan R A1 - Aguilar, David A1 - Jensen, Paul N A1 - Ballantyne, Christie M A1 - Basu, Saonli A1 - Hoogeveen, Ron C A1 - DeFilippi, Christopher A1 - Cushman, Mary A1 - Folsom, Aaron R AB -

Background: The inflammatory biomarker galectin-3 contributes to pathologic conditions such as heart failure and stimulates murine thrombogenesis. Its association with venous thromboembolism (VTE) has been sparsely studied.

Objectives: To assess the prospective association of plasma galectin-3 and the LGALS3 rs4644 SNP with VTE incidence.

Methods: We measured plasma galectin-3 in 9,916 participants in the Atherosclerosis Risk in Communities (ARIC) study cohort in 1996 - 1998 and identified VTEs through 2013. Using Cox regression, we estimated the hazard ratio associating galectin-3 with incident VTE over a median of 13.9 years. Replication was sought in the Cardiovascular Health Study (CHS).

Results: ARIC included 21.8% blacks and 56.2% females with mean baseline age of 62.7 years. The incidence rate of VTE (n=389 events) increased across quintiles of galectin-3, with hazard ratios (95% CI) of 1 (reference), 1.13 (0.80 - 1.61), 1.00 (0.70 - 1.43), 1.36 (0.96 - 1.91), and 1.55 (1.09 - 2.19) (p-trend = 0.005), adjusted for age, sex, race, body mass index, diabetes status, and renal function. Results did not replicate in the CHS (124 VTE), but meta-analysis of both studies yielded a pooled hazard ratio (95% CI) for 1 SD increment in log galectin-3 of 1.10 (1.00 - 1.22). In ARIC, the C allele of rs4644 in the LGALS3 gene was associated with higher galectin-3 level, and in whites, with an increased rate of VTE.

Conclusion: Galectin-3 levels were associated positively with VTE incidence.

VL - 1 IS - 2 ER - TY - JOUR T1 - Harmonization of Respiratory Data From 9 US Population-Based Cohorts: The NHLBI Pooled Cohorts Study. JF - Am J Epidemiol Y1 - 2018 A1 - Oelsner, Elizabeth C A1 - Balte, Pallavi P A1 - Cassano, Patricia A A1 - Couper, David A1 - Enright, Paul L A1 - Folsom, Aaron R A1 - Hankinson, John A1 - Jacobs, David R A1 - Kalhan, Ravi A1 - Kaplan, Robert A1 - Kronmal, Richard A1 - Lange, Leslie A1 - Loehr, Laura R A1 - London, Stephanie J A1 - Navas Acien, Ana A1 - Newman, Anne B A1 - O'Connor, George T A1 - Schwartz, Joseph E A1 - Smith, Lewis J A1 - Yeh, Fawn A1 - Zhang, Yiyi A1 - Moran, Andrew E A1 - Mwasongwe, Stanford A1 - White, Wendy B A1 - Yende, Sachin A1 - Barr, R Graham AB -

Chronic lower respiratory diseases (CLRDs) are the fourth leading cause of death in the United States. To support investigations into CLRD risk determinants and new approaches to primary prevention, we aimed to harmonize and pool respiratory data from US general population-based cohorts. Data were obtained from prospective cohorts that performed prebronchodilator spirometry and were harmonized following 2005 ATS/ERS standards. In cohorts conducting follow-up for noncardiovascular events, CLRD events were defined as hospitalizations/deaths adjudicated as CLRD-related or assigned relevant administrative codes. Coding and variable names were applied uniformly. The pooled sample included 65,251 adults in 9 cohorts followed-up for CLRD-related mortality over 653,380 person-years during 1983-2016. Average baseline age was 52 years; 56% were female; 49% were never-smokers; and racial/ethnic composition was 44% white, 22% black, 28% Hispanic/Latino, and 5% American Indian. Over 96% had complete data on smoking, clinical CLRD diagnoses, and dyspnea. After excluding invalid spirometry examinations (13%), there were 105,696 valid examinations (median, 2 per participant). Of 29,351 participants followed for CLRD hospitalizations, median follow-up was 14 years; only 5% were lost to follow-up at 10 years. The NHLBI Pooled Cohorts Study provides a harmonization standard applied to a large, US population-based sample that may be used to advance epidemiologic research on CLRD.

VL - 187 IS - 11 ER - TY - JOUR T1 - Burden of rare exome sequence variants in PROC gene is associated with venous thromboembolism: a population-based study. JF - J Thromb Haemost Y1 - 2020 A1 - Tang, Weihong A1 - Stimson, Mary Rachel A1 - Basu, Saonli A1 - Heckbert, Susan R A1 - Cushman, Mary A1 - Pankow, James S A1 - Folsom, Aaron R A1 - Pankratz, Nathan AB -

BACKGROUND: Rare coding mutations underlying deficiencies of antithrombin and proteins C and S contribute to familial venous thromboembolism (VTE). It is uncertain whether rare variants play a role in the etiology of VTE in the general population.

OBJECTIVES: We conducted a deep whole-exome sequencing (WES) study to investigate the associations between rare coding variants and the risk of VTE in two population-based prospective cohorts.

PATIENTS/METHODS: Whole-exome sequencing was performed in the Longitudinal Investigation of Thromboembolism Etiology (LITE), which combines the Atherosclerosis Risk in Communities (ARIC) study (316 incident VTE events among 3159 African Americans [AAs] and 458 incident VTEs among 7772 European Americans [EAs]) and the Cardiovascular Healthy Study (CHS; 60 incident VTEs among 1751 EAs). We performed gene-based tests of rare variants (allele frequency < 1%, exome-wide significance P < 1.47 × 10 ) separately in each study and ancestry group, and meta-analyzed the results for the EAs in ARIC and CHS.

RESULTS: In the meta-analysis of EAs, we identified one gene, PROC, in which the burden of rare, coding variants was significantly associated with increased risk of VTE (HR = 5.42 [3.11, 9.42] for carriers versus non-carriers, P = 2.27 × 10 ). In ARIC EAs, carriers of the PROC rare variants had on average 0.75 standard deviation (SD) lower concentrations of plasma protein C and 0.28 SD higher D-dimer (P < .05) than non-carriers. Adjustment for low protein C status did not eliminate the association of PROC burden with VTE. In AAs, rare coding PROC variants were not associated with VTE.

CONCLUSIONS: Rare coding variants in PROC contribute to increased VTE risk in EAs in this general population sample.

VL - 18 IS - 2 ER - TY - JOUR T1 - Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study. JF - Lancet Respir Med Y1 - 2020 A1 - Oelsner, Elizabeth C A1 - Balte, Pallavi P A1 - Bhatt, Surya P A1 - Cassano, Patricia A A1 - Couper, David A1 - Folsom, Aaron R A1 - Freedman, Neal D A1 - Jacobs, David R A1 - Kalhan, Ravi A1 - Mathew, Amanda R A1 - Kronmal, Richard A A1 - Loehr, Laura R A1 - London, Stephanie J A1 - Newman, Anne B A1 - O'Connor, George T A1 - Schwartz, Joseph E A1 - Smith, Lewis J A1 - White, Wendy B A1 - Yende, Sachin KW - Adult KW - Aged KW - Case-Control Studies KW - Ex-Smokers KW - Female KW - Follow-Up Studies KW - Humans KW - Lung KW - Male KW - Middle Aged KW - National Heart, Lung, and Blood Institute (U.S.) KW - Non-Smokers KW - Respiratory Physiological Phenomena KW - Smokers KW - Smoking KW - Spirometry KW - United States KW - Young Adult AB -

BACKGROUND: Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease.

METHODS: We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption.

FINDINGS: 25 352 participants (ages 17-93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3-20), FEV decline at the median age (57 years) was 31·01 mL per year (95% CI 30·66-31·37) in sustained never-smokers, 34·97 mL per year (34·36-35·57) in former smokers, and 39·92 mL per year (38·92-40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV decline of 1·82 mL per year (95% CI 1·24-2·40) compared to never-smokers, which was approximately 20% of the effect estimate for current smokers (9·21 mL per year; 95% CI 8·35-10·08). Compared to never-smokers, accelerated FEV decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption (<10 pack-years). With respect to current cigarette consumption, the effect estimate for FEV decline in current smokers consuming less than five cigarettes per day (7·65 mL per year; 95% CI 6·21-9·09) was 68% of that in current smokers consuming 30 or more cigarettes per day (11·24 mL per year; 9·86-12·62), and around five times greater than in former smokers (1·57 mL per year; 1·00-2·14). Among participants without prevalent lung disease, associations were attenuated but were consistent with the main results.

INTERPRETATION: Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage.

FUNDING: National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.

VL - 8 IS - 1 ER - TY - JOUR T1 - FGL1 as a modulator of plasma D-dimer levels: Exome-wide marker analysis of plasma tPA, PAI-1, and D-dimer. JF - J Thromb Haemost Y1 - 2021 A1 - Thibord, Florian A1 - Song, Ci A1 - Pattee, Jack A1 - Rodriguez, Benjamin A T A1 - Chen, Ming-Huei A1 - O'Donnell, Christopher J A1 - Kleber, Marcus E A1 - Delgado, Graciela E A1 - Guo, Xiuqing A1 - Yao, Jie A1 - Taylor, Kent D A1 - Ozel, Ayse Bilge A1 - Brody, Jennifer A A1 - McKnight, Barbara A1 - Gyorgy, Beata A1 - Simonsick, Eleanor A1 - Leonard, Hampton L A1 - Carrasquilla, Germán D A1 - Guindo-Martinez, Marta A1 - Silveira, Angela A1 - Temprano-Sagrera, Gerard A1 - Yanek, Lisa R A1 - Becker, Diane M A1 - Mathias, Rasika A A1 - Becker, Lewis C A1 - Raffield, Laura M A1 - Kilpeläinen, Tuomas O A1 - Grarup, Niels A1 - Pedersen, Oluf A1 - Hansen, Torben A1 - Linneberg, Allan A1 - Hamsten, Anders A1 - Watkins, Hugh A1 - Sabater-Lleal, Maria A1 - Nalls, Mike A A1 - Trégouët, David-Alexandre A1 - Morange, Pierre-Emmanuel A1 - Psaty, Bruce M A1 - Tracy, Russel P A1 - Smith, Nicholas L A1 - Desch, Karl C A1 - Cushman, Mary A1 - Rotter, Jerome I A1 - de Vries, Paul S A1 - Pankratz, Nathan D A1 - Folsom, Aaron R A1 - Morrison, Alanna C A1 - März, Winfried A1 - Tang, Weihong A1 - Johnson, Andrew D AB -

BACKGROUND: Use of targeted exome-arrays with common, rare variants and functionally enriched variation has led to discovery of new genes contributing to population variation in risk factors. Plasminogen activator-inhibitor 1 (PAI-1), tissue plasminogen activator (tPA), and the plasma product D-dimer are important components of the fibrinolytic system. There have been few large-scale genome-wide or exome-wide studies of PAI-1, tPA, and D-dimer.

OBJECTIVES: We sought to discover new genetic loci contributing to variation in these traits using an exome-array approach.

METHODS: Cohort-level analyses and fixed effects meta-analyses of PAI-1 (n = 15 603), tPA (n = 6876,) and D-dimer (n = 19 306) from 12 cohorts of European ancestry with diverse study design were conducted, including single-variant analyses and gene-based burden testing.

RESULTS: Five variants located in NME7, FGL1, and the fibrinogen locus, all associated with D-dimer levels, achieved genome-wide significance (P < 5 × 10 ). Replication was sought for these 5 variants, as well as 45 well-imputed variants with P < 1 × 10 in the discovery using an independent cohort. Replication was observed for three out of the five significant associations, including a novel and uncommon (0.013 allele frequency) coding variant p.Trp256Leu in FGL1 (fibrinogen-like-1) with increased plasma D-dimer levels. Additionally, a candidate-gene approach revealed a suggestive association for a coding variant (rs143202684-C) in SERPINB2, and suggestive associations with consistent effect in the replication analysis include an intronic variant (rs11057830-A) in SCARB1 associated with increased D-dimer levels.

CONCLUSION: This work provides new evidence for a role of FGL1 in hemostasis.

ER - TY - JOUR T1 - Whole exome sequencing of 14 389 individuals from the ESP and CHARGE consortia identifies novel rare variation associated with hemostatic factors. JF - Hum Mol Genet Y1 - 2022 A1 - Pankratz, Nathan A1 - Wei, Peng A1 - Brody, Jennifer A A1 - Chen, Ming-Huei A1 - Vries, Paul S A1 - Huffman, Jennifer E A1 - Stimson, Mary Rachel A1 - Auer, Paul L A1 - Boerwinkle, Eric A1 - Cushman, Mary A1 - Maat, Moniek P M A1 - Folsom, Aaron R A1 - Franco, Oscar H A1 - Gibbs, Richard A A1 - Haagenson, Kelly K A1 - Hofman, Albert A1 - Johnsen, Jill M A1 - Kovar, Christie L A1 - Kraaij, Robert A1 - McKnight, Barbara A1 - Metcalf, Ginger A A1 - Muzny, Donna A1 - Psaty, Bruce M A1 - Tang, Weihong A1 - Uitterlinden, André G A1 - Rooij, Jeroen G J A1 - Dehghan, Abbas A1 - O'Donnell, Christopher J A1 - Reiner, Alex P A1 - Morrison, Alanna C A1 - Smith, Nicholas L AB -

Plasma levels of fibrinogen, coagulation factors VII and VIII, and von Willebrand factor (vWF) are four intermediate phenotypes that are heritable and have been associated with the risk of clinical thrombotic events. To identify rare and low-frequency variants associated with these hemostatic factors, we conducted whole exome sequencing in 10 860 individuals of European ancestry (EA) and 3529 African Americans (AAs) from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium and the National Heart, Lung, and Blood Institute's Exome Sequencing Project (ESP). Gene-based tests demonstrated significant associations with rare variation (minor allele frequency < 5%) in FGG (with fibrinogen, p = 9.1x10-13), F7 (with factor VII, p = 1.3x10-72; seven novel variants), and VWF (with factor VIII and vWF; p = 3.2x10-14; one novel variant). These eight novel rare variant associations were independent of the known common variants at these loci and tended to have much larger effect sizes. In addition, one of the rare novel variants in F7 was significantly associated with an increased risk of venous thromboembolism in AAs (Ile200Ser; rs141219108; p = 4.2x10-5). After restricting gene-based analyses to only loss-of-function variants, a novel significant association was detected and replicated between factor VIII levels and a stop-gain mutation exclusive to African Americans (rs3211938) in CD36. This variant has previously been linked to dyslipidemia but not with levels of a hemostatic factor. These efforts represent the largest integration of whole exome sequence data from two national projects to identify genetic variation associated with plasma hemostatic factors.

ER -