👤 C M Schooling

Trials of incretins are making it increasingly clear that body mass index (BMI) is linked to several diseases throughout life, but trials cannot easily provide a comprehensive assessment of the role of BMI in health-related attributes for men and women. To systematically investigate the role of BMI, we conducted a sex-specific Mendelian randomization-phenome-wide association study. We comprehensively examined the associations of genetically predicted BMI in women ( BMI impacted 232 of 776 traits considered in women and 203 of 680 traits in men, after adjusting for false discovery; differences by sex were found for 105 traits, and 46 traits remained after adjusting for false discovery. BMI was more strongly positively associated with myocardial infarction, major coronary heart disease events, ischemic heart disease, and heart attack in men than women. BMI was more strongly positively associated with apolipoprotein B (ApoB) and diastolic blood pressure in women than men. Our study revealed that BMI might affect a wide range of health-related attributes and also highlights notable sex differences in its impact, including opposite associations for certain attributes, such as ApoB; and stronger effects in men, such as for cardiovascular diseases. Our findings underscore the need for nuanced, sex-specific policy related to BMI to address inequities in health. None. Show less

Dehydroepiandrosterone (DHEA) and DHEA-sulfate (-s) fall with age and are implicated in aging. Observational studies suggest DHEA/DHEA-s could lengthen life in specifically older men. No trial has established the role of DHEA/DHEA-s in aging or lifespan. We assessed the role of DHEA-s in lifespan and key biological determinants, (blood pressure, Apolipoprotein B (ApoB), and haemoglobin A1C (HbA1c)), for men and women in a two-sample mendelian randomization (MR) study using naturally occurring genetic randomization to obviate confounding. We assessed associations of sex-specific DHEA-s from Life-Adult/Life-Heart (men = 4327, women = 3501) with lifespan, based on paternal (n = 415311) and maternal (n = 412937) attained age, and with blood pressure, ApoB and Hba1c (men = 167020, women = 194,174) from the UK Biobank. We used inverse variance weighted (IVW) estimates with sensitivity analysis. DHEA-s was unrelated to lifespan in women using IVW, 0.04 years per logged μmol/L DHEA-s, 95 % confidence interval (CI) -0.50 to 0.58, DHEA-s was associated with shorter lifespan in men (-1.15 years, 95 % CI -1.72 to -0.58) with a difference by sex (p = 0.0017), sensitivity analysis gave similar estimates. DHEA-s was unrelated to blood pressure in women and positively associated with systolic and diastolic blood pressure in men with a difference by sex for diastolic blood pressure. DHEA-s was possibly associated with lower ApoB in men. DHEA-s has different associations with lifespan and blood pressure in men and women. In settings where DHEA is an unregulated supplement, such as the United States, whether public health benefits might accrue from more regulation could be considered. Show less

Establishing the sex-specific efficacy of cardiovascular medications is pivotal to evidence-based clinical practice, potentially closing the gender gap in longevity. Trials large enough to establish sex differences are unavailable. This study evaluated sex-specific effects of commonly prescribed cardiovascular medications on lifespan. In a two-sample Mendelian randomization study, established genetic variants mimicking effects of lipid-lowering drugs, antihypertensives, and diabetes drugs were applied to genetic associations with lifespan proxied by UK Biobank maternal (n=412 937) and paternal (n=415 311) attained age. Estimates were obtained using inverse variance weighting, with sensitivity analyses where possible. For lipid-lowering drugs, genetically mimicked PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors were associated with longer lifespan, particularly in men (2.39 years per SD low-density lipoprotein cholesterol reduction [95% CI, 0.42-4.36], PCSK9 inhibitors, β-blockers, and calcium channel blockers may prolong lifespan in the general population, particularly men. Treatments targeting Show less

Statins have long been suspected to have pleiotropic effects via thrombotic factors. Randomized controlled trials are too limited to be definitive. We examined the associations of genetically mimicking effects of statins, PCSK9 inhibitors, and alternative lipid targets (in genes We assessed the effect of established genetic mimics of effects of lipid modifiers and alternative lipid treatment targets on PT ( Genetically mimicked effects of statins increased PT by 0.31 standard deviation (SD) per SD increase in low-density lipoprotein (95% confidence interval [CI]: 0.10-0.51) based on rs12916 but did not affect aPTT. Genetically mimicking effects of targeting Statins, and possibly targeting Show less

To determine whether endogenous testosterone has a causal role in thromboembolism, heart failure, and myocardial infarction. Two sample mendelian randomisation study using genetic variants as instrumental variables, randomly allocated at conception, to infer causality as additional randomised evidence. Reduction by Dutasteride of Prostate Cancer Events (REDUCE) randomised controlled trial, UK Biobank, and CARDIoGRAMplusC4D 1000 Genomes based genome wide association study. 3225 men of European ancestry aged 50-75 in REDUCE; 392 038 white British men and women aged 40-69 from the UK Biobank; and 171 875 participants of about 77% European descent, from CARDIoGRAMplusC4D 1000 Genomes based study for validation. Thromboembolism, heart failure, and myocardial infarction based on self reports, hospital episodes, and death. Of the UK Biobank participants, 13 691 had thromboembolism (6208 men, 7483 women), 1688 had heart failure (1186, 502), and 12 882 had myocardial infarction (10 136, 2746). In men, endogenous testosterone genetically predicted by variants in the Endogenous testosterone was positively associated with thromboembolism, heart failure, and myocardial infarction in men. Rates of these conditions are higher in men than women. Endogenous testosterone can be controlled with existing treatments and could be a modifiable risk factor for thromboembolism and heart failure. Show less

Development of pharmacological treatments to mitigate ischemic heart disease (IHD) has encompassed disappointing results and expensive failures, which has discouraged investment in new approaches to prevention and control. New treatments are most likely to be successful if they act on genetically validated targets. We assessed whether existing pharmacological treatments for IHD reduction are acting on genetically validated targets and whether all such targets for IHD are currently being exploited. Genes associated with IHD were obtained from the loci of single nucleotide polymorphisms reported in either of two recent genome wide association studies supplemented by a gene-based analysis (accounting for linkage disequilibrium) of CARDIoGRAMplusC4D 1000 Genomes, a large IHD case (n=60,801)-control (n=123,504) study. Treatments targeting the products of these IHD genes and genes with products targeted by current IHD treatments were obtained from Kyoto Encyclopedia of Genes and Genomes and Drugbank. Cohen's kappa was used to assess agreement. We identified 173 autosomal genes associated with IHD and 236 autosomal genes with products targeted by current IHD treatments, only 8 genes (PCSK9, EDNRA, PLG, LPL, CXCL12, LRP1, CETP and ADORA2A) overlapped, i.e. were both associated with IHD and had products targeted by current IHD treatments. The Cohen's kappa was 0.03. Interventions related to another 29 IHD genes exist, including dietary factors, environmental exposures and existing treatments for other indications. Closer alignment of IHD treatments with genetically validated physiological targets may represent a major opportunity for combating a leading cause of global morbidity and mortality through repurposing existing interventions. Show less

Testosterone supplementation has been linked to increased cardiovascular disease risk in some observational studies. The causal role of testosterone can be investigated using a Mendelian randomization approach. We assessed genetic associations of variants in two gene regions (SHBG and JMJD1C) with several cardiovascular risk factors (lipids, adiponectin, blood pressure, anthropometric traits) plus male pattern baldness, including control outcomes and potential mediators. We assessed genetic associations with coronary artery disease (CAD) risk in the CARDIoGRAMplusC4D consortium (171,191 individuals including 60,801 cases), and associations with CAD and ischaemic stroke risk in the UK Biobank (367,643 individuals including 25,352 CAD cases and 3650 ischaemic stroke cases). Genetic predictors of increased serum testosterone were associated with lipids, blood pressure, and height. There was some evidence of an association with risk of CAD (SHBG gene region: odds ratio (OR) 0.95 per 1 unit increase in log-transformed testosterone [95% confidence interval: 0.81-1.12, p = 0.55]; JMJD1C gene region: OR 1.24 [1.01-1.51, p = 0.04]) and ischaemic stroke both overall (SHBG: OR 1.05 [0.64, 1.73, p = 0.83]; JMJD1C: OR 2.52 [1.33, 4.77, p = 0.005]) and in men. However, associations with some control outcomes were in the opposite direction to that expected. Sex hormone-related mechanisms appear to be relevant to cardiovascular risk factors and for stroke (particularly for men). However, the extent that these findings are specifically informative about endogenous testosterone or testosterone supplementation is unclear. These findings underline a fundamental limitation for the use of Mendelian randomization where biological knowledge about the function of genetic variants is uncertain. Show less

Vascular endothelial growth factor (VEGF) has angiogenic and possibly proatherosclerotic properties. Observationally it is positively associated with cardiovascular disease, although these observations could be confounded or due to reverse causation. We assessed ischemic heart disease (IHD) risk by genetically predicted VEGF, ie, using Mendelian randomization. Single nucleotide polymorphisms (SNPs) predicting VEGF level, at genome-wide significance, were applied to the CARDIoGRAMplusC4D 1000 Genomes-based genome-wide association study IHD case (n=60 801)-control (n=123 504) study. We obtained unconfounded estimates using instrumental variable analysis by combining the Wald estimates for each SNP using inverse variance weighting and Mendelian randomization-Egger regression. Based on 9 SNPs independently predicting VEGF (rs1740073 [ Our study does not provide strong evidence for a positive effect of VEGF on IHD but does not rule out the possibility that some specific types of VEGF, for which genetic predictors have not yet been identified, might play a role. Show less