Format

Send to

Choose Destination
JAMA Cardiol. 2018 Aug 1;3(8):712-720. doi: 10.1001/jamacardio.2018.1827.

Association of APOL1 With Heart Failure With Preserved Ejection Fraction in Postmenopausal African American Women.

Author information

1
Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill.
2
Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
3
MedStar Heart and Vascular Institute, Washington, DC.
4
Cardiology Division, George Washington University School of Medicine and Health Sciences, Washington, DC.
5
Department of Statistics and Operations Research, University of North Carolina, Chapel Hill.
6
University of Washington School of Public Health, Seattle.
7
Division of Nephrology, Harvard Medical School, Boston, Massachusetts.
8
Department of Epidemiology, University of Iowa College of Public Health, Iowa City.
9
Molecular Genetic Epidemiology Section, Basic Research Laboratory, Basic Science Program, National Cancer Institute Leidos Biomedical Research, Frederick National Laboratory, Frederick, Maryland.

Abstract

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.

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.

Design, Setting, and Participants:

The Women's Health Initiative is a prospective cohort that enrolled 161 838 postmenopausal women into clinical trials and an observational study between 1993 and 1998. This study includes 11 137 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.

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.

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.

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.

PMID:
29971324
PMCID:
PMC6143074
[Available on 2019-07-03]
DOI:
10.1001/jamacardio.2018.1827

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center