European journal of preventive cardiology最新文献

Aims: Interleukin-6 (IL-6) levels have been related to increased risk of chronic disease and mortality. Whether genetic IL-6 receptor (IL6R) blockade is associated with lower chronic disease risk or greater longevity is unknown.

Methods and results: The analytic cohort consisted of 38 807 Women's Health Initiative participants who had available genotyping information, of which 23 464 were eligible to survive to 90 years of age through February 192 023. Carrier status of the IL6R variant (rs8192284; p.Asp358Ala) was determined via genotyping. Chronic-disease outcome data were available through 19 February 2023 for coronary heart disease (CHD), heart failure (HF), stroke, and invasive cancer events. Prospective associations of IL6R carrier status with chronic-disease outcomes were assessed with the Cox proportional hazards models, and logistic regression was used to evaluate survival to 90 years of age during follow-up. During a median follow-up of 20 years, 12 181 of 23 464 women (52.0%) survived to age 90. No significant difference in the likelihood of surviving to age 90 was detected between women with 2 alleles of the IL6R gene variant compared to women without any allele (Odds Ratio, 1.00; 95% confidence interval, 0.91-1.09). The risks of CHD, HF, stroke, or cancer did not differ among IL6R variant carriers. High-sensitive C-reactive Protein (hsCRP) levels ≥2 mg/L compared to <2 mg/L were associated with a modest increase in all-cause mortality and CHD risk, independent of IL6R allele carrier status.

Conclusion: Genetic IL6R blockade was not associated with incident chronic-disease risk, including invasive cancer and longevity, in a large, ethnically diverse cohort of postmenopausal women. No significant interaction with hsCRP levels was observed. While pharmacological blockade of IL6R has become a major therapeutic strategy in the treatment of immune-mediated inflammatory disease, these long-term data on genetic IL6R blockade do not indicate an altered likelihood for survival to very old age.

Genetic factors can influence cardiovascular disease (CVD) risk through multiple behavioural and physiological mechanisms, including lipid metabolism, blood pressure regulation, and inflammatory responses. The present narrative review examines the impact of physical activity on the relationship between genetic susceptibility and CVD risk. Specifically, we synthesize evidence regarding gene-physical activity interplay and whether individuals with a genetic predisposition for CVD benefit more from physical activity than individuals with more health-favourable genotypes. Most single-gene studies on gene-physical activity interactions have shown that physical activity can significantly reduce CVD risk also in individuals with high genetic predisposition for CVD. Those with higher genetic risk may experience more substantial benefits from physical activity than those with lower genetic risk. Additionally, genetics may play a role in how people respond to exercise and why some people find it harder to adopt a healthy lifestyle. The evidence showed the central role of physical activity in reducing the CVD risk across different genetic profiles, highlighting the need for personalized preventive strategies to optimize cardiovascular health.

Aims: Most polygenic risk scores (PRSs) for coronary heart disease (CHD) are derived from European ancestry populations. This paper evaluates the performance of CHD PRSs in a Mexican population.

Methods and results: 133 207 participants aged 35-79 years from the Mexico City Prospective Study were included. Eight PRSs (comprising 44-6 472 620 polymorphisms) were selected for prediction of CHD (defined as self-reported prior heart attack or angina, or CHD death before age 80 years). Logistic regression was adjusted for age, sex, and the first seven genetic principal components, before and after adjustment for other cardiovascular risk factors. The area under the receiving operating characteristic curve ('C-statistic') was also estimated. Of the included participants, 67% were women, the mean (±SD) age was 51 ± 12 years, and Indigenous American ancestry averaged 67%. CHD was documented for 5163 participants (3.9%), including 1901 prevalent and 3479 fatal cases. All eight PRSs were positively and log-linearly associated with CHD, with odds ratios (ORs) per 1 SD PRS increase ranging from 1.05 (95% CI, 1.03-1.08) to 1.29 (95% CI, 1.25-1.33). Associations were consistent across strata of age and ancestry and were independent of other vascular risk factors. For six PRSs, however, associations were substantially stronger in men than women. Multi-ancestry PRSs outperformed Eurocentric-ancestry PRSs. Despite remaining predictive of risk independently of established non-genetic risk factors, inclusion of a PRS into a risk model did not increase the C-statistic noticeably.

Conclusion: In this Mexican population, existing PRSs predicted CHD independently of established vascular risk factors, particularly for men. PRSs better capturing genetic variation in Latin American people may further enhance risk prediction in such populations.

Aims: Iron levels imbalances are linked to cardiovascular outcomes. We aimed to assess the association between genetically predicted lifelong higher iron levels and cardiovascular outcomes, employing a two-sample Mendelian randomization (MR) approach to account for confounding biases.

Methods and results: We used a study involving 257 953 subjects across six cohort studies that identified genetic variants consistently associated with iron biomarkers, including ferritin, serum iron, total iron binding capacity (TIBC), and transferrin saturation (TSAT). The UK Biobank study was used to investigate the association between the same genetic variants and left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), left ventricular mass (LVM), and left ventricular mass-to-end-diastolic volume ratio (LVMVR). Two-sample MR approach was used in our main analysis. Heterogeneity, pleiotropy, bidirectional MR, MR-Egger, weighted median, and weighted mode were explored in the sensitivity analysis. One standard deviation (SD) increase in genetically predicted serum iron levels was associated with lower LVEDV (beta (95%CI): -0.11, (-0.19, -0.03), P-value = 0.006) and lower LVESV (-0.11 (-0.19, -0.03), P-value = 0.007). Moreover, one SD increase in genetically predicted TSAT was associated with higher LVMVR (0.09, (0.03, 0.15), P-value = 0.005). Heterogeneity, pleiotropy, and bidirectional effects were not observed. The identified associations were explained by HFE, TMPRSS6, TF, and TFR2 genes. No other associations were identified between iron biomarkers and cardiovascular outcomes.

Conclusion: Our study provides MR evidence that iron status may alter cardiovascular function and structure. HFE, TMPRSS6, TF and TFR2 genes play a crucial role in the identified associations.