Association of APOL1 With Heart Failure With Preserved Ejection Fraction in Postmenopausal African American Women.
Association of APOL1 With Heart Failure With Preserved Ejection Fraction in Postmenopausal African American Women.
- 2018
Conclusions and Relevance: Status as a carrier of a high-risk APOL1 genotype was associated with HFpEF hospitalization among postmenopausal women, which is partly accounted for by baseline kidney function. These findings do not support an association of high-risk APOL1 genotypes with coronary heart disease, stroke, or mortality in postmenopausal African American women. Design, Setting, and Participants: The Women's Health Initiative is a prospective cohort that enrolled 161838 postmenopausal women into clinical trials and an observational study between 1993 and 1998. This study includes 11137 African American women participants who had a clinical event from enrollment to June 2014. Data analyses were completed from January 2017 to August 2017. Exposures: The variants of APOL1 were genotyped or imputed from whole-exome sequencing. Importance: APOL1 genotypes are associated with kidney diseases in African American individuals and may influence cardiovascular disease and mortality risk, but findings have been inconsistent. Main Outcomes and Measures: Incident coronary heart disease, stroke and heart failure subtypes, and overall and cause-specific mortality were adjudicated from hospital records and death certificates. Estimated incidence rates were determined for each outcome and hazard ratios (HR) and 95% CIs for the associations of APOL1 groups with outcomes. Objective: To discern whether high-risk APOL1 genotypes are associated with cardiovascular disease and stroke in postmenopausal African American women, who are at high risk for these outcomes. Results: The mean (SD) age of participants was 61.7 (7.1) years. Carriers of high-risk APOL1 variants (n = 1370; 12.3%) had higher prevalence of hypertension, use of cholesterol-lowering medications, and reduced estimated glomerular filtration rate (eGFR). After a mean (SD) of 11.0 (3.6) years, carriers of high-risk APOL1 variants had a higher incidence rate of hospitalized heart failure with preserved ejection fraction (HFpEF) than low-risk carriers did but showed no differences for other outcomes. In adjusted models, there was a significant 58% increased hazard of hospitalized HFpEF (HR, 1.58 [95% CI, 1.03-2.41]) among carriers of high-risk APOL1 variants compared with carriers of low-risk APOL1 variants. The association with HFpEF was attenuated (HR = 1.50 [95% CI, 0.98-2.30]) and no longer significant when adjusting for baseline eGFR.
English
10.1001/jamacardio.2018.1827 [doi] 2686710 [pii] PMC6143074 [pmc]
*African Americans/ge [Genetics]
*Apolipoprotein L1/ge [Genetics]
*Heart Failure/ge [Genetics]
*Postmenopause
*Stroke Volume
Aged
Cardiovascular Diseases/mo [Mortality]
Cause of Death
Coronary Disease/ep [Epidemiology]
Coronary Disease/ge [Genetics]
Female
Genotype
Heart Failure/pp [Physiopathology]
Humans
Incidence
Middle Aged
Mortality
Renal Insufficiency, Chronic/ge [Genetics]
Stroke/ep [Epidemiology]
Stroke/ge [Genetics]
MedStar Heart & Vascular Institute
Journal Article
Conclusions and Relevance: Status as a carrier of a high-risk APOL1 genotype was associated with HFpEF hospitalization among postmenopausal women, which is partly accounted for by baseline kidney function. These findings do not support an association of high-risk APOL1 genotypes with coronary heart disease, stroke, or mortality in postmenopausal African American women. Design, Setting, and Participants: The Women's Health Initiative is a prospective cohort that enrolled 161838 postmenopausal women into clinical trials and an observational study between 1993 and 1998. This study includes 11137 African American women participants who had a clinical event from enrollment to June 2014. Data analyses were completed from January 2017 to August 2017. Exposures: The variants of APOL1 were genotyped or imputed from whole-exome sequencing. Importance: APOL1 genotypes are associated with kidney diseases in African American individuals and may influence cardiovascular disease and mortality risk, but findings have been inconsistent. Main Outcomes and Measures: Incident coronary heart disease, stroke and heart failure subtypes, and overall and cause-specific mortality were adjudicated from hospital records and death certificates. Estimated incidence rates were determined for each outcome and hazard ratios (HR) and 95% CIs for the associations of APOL1 groups with outcomes. Objective: To discern whether high-risk APOL1 genotypes are associated with cardiovascular disease and stroke in postmenopausal African American women, who are at high risk for these outcomes. Results: The mean (SD) age of participants was 61.7 (7.1) years. Carriers of high-risk APOL1 variants (n = 1370; 12.3%) had higher prevalence of hypertension, use of cholesterol-lowering medications, and reduced estimated glomerular filtration rate (eGFR). After a mean (SD) of 11.0 (3.6) years, carriers of high-risk APOL1 variants had a higher incidence rate of hospitalized heart failure with preserved ejection fraction (HFpEF) than low-risk carriers did but showed no differences for other outcomes. In adjusted models, there was a significant 58% increased hazard of hospitalized HFpEF (HR, 1.58 [95% CI, 1.03-2.41]) among carriers of high-risk APOL1 variants compared with carriers of low-risk APOL1 variants. The association with HFpEF was attenuated (HR = 1.50 [95% CI, 0.98-2.30]) and no longer significant when adjusting for baseline eGFR.
English
10.1001/jamacardio.2018.1827 [doi] 2686710 [pii] PMC6143074 [pmc]
*African Americans/ge [Genetics]
*Apolipoprotein L1/ge [Genetics]
*Heart Failure/ge [Genetics]
*Postmenopause
*Stroke Volume
Aged
Cardiovascular Diseases/mo [Mortality]
Cause of Death
Coronary Disease/ep [Epidemiology]
Coronary Disease/ge [Genetics]
Female
Genotype
Heart Failure/pp [Physiopathology]
Humans
Incidence
Middle Aged
Mortality
Renal Insufficiency, Chronic/ge [Genetics]
Stroke/ep [Epidemiology]
Stroke/ge [Genetics]
MedStar Heart & Vascular Institute
Journal Article