Hugh Watkins

University of Oxford, Oxford, England, United Kingdom

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Publications (291)3338.34 Total impact

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    ABSTRACT: Familial hypertrophic cardiomyopathy (HCM) is most commonly caused by mutations in sarcomeric proteins; however, a unifying mechanism of disease pathogenesis has yet to be identified. Beyond the sarcomere, mutations in the gene (PRKAG2) encoding the γ2 subunit of AMP-activated protein kinase (AMPK), an enzyme involved in energy balance regulation and cell signalling, cause ventricular hypertrophy and contractile dysfunction mimicking HCM. These AMPK γ2 mutations also result in glycogen accumulation and aberrant electrical conduction, obfuscating the cause of hypertrophy and dysfunction. Given our recent finding that cardiac troponin I (cTnI) is phosphorylated by AMPK at S150 and this phosphorylation enhances Ca2+ sensitivity of activation, we hypothesise that alterations at the myofilament level may contribute to disease pathogenesis in PRKAG2 cardiomyopathy as they do in HCM. To test this, we have used a mouse model possessing an AMPK γ2 mutation (R299Q knock-in) and measured demembranated trabeculae mechanics and cardiomyocyte contractility using heterozygous and homozygous male mice, along with littermate wild type controls, between 6-8 weeks of age (prior to hypertrophy and significant glycogen accumulation). In trabeculae, we observed increased Ca2+ sensitivity of force production in fibres from mutant mice (ΔpCa50 = +0.05 (Het) and +0.06 (Homo), p < 0.01). After treating fibres with protein kinase A (PKA), no differences in Ca2+ sensitivity of force production were observed between WT and mutant groups. Intact cardiomyocytes isolated from mutant hearts exhibited little difference in shortening or Ca2+ transient magnitudes but significantly slowed kinetics of both contraction and relaxation. Cardiomyocytes from mutant mice exhibited a greater response to isoproterenol. Biochemical analyses of untreated tissues indicated reduced phosphorylation of cTnI S23/S24 (Δmol P/mol TnI = -0.17 (Het) and -0.28 (Homo), p < 0.05) and phospholamban S16, indicating reduced basal PKA activity in mutant animals. This work provides evidence that the R299Q PRKAG2 mutation causes altered cardiac contractile function irrespective of glycogen accumulation and therefore supports the hypothesis that impaired contractility contributes to disease pathogenesis. Further, the observed Ca2+ sensitization and reduction in phosphorylation of PKA target sites mimics similar alterations found in HCM caused by sarcomeric mutations. The reduction in PKA activity in the mutant hearts may be caused by novel crosstalk between the AMPK and PKA pathways, in particular as this occurs prior to hypertrophy.
    Cardiovascular research. 07/2014; 103(suppl 1):S71.
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    ABSTRACT: Mutations in thin filament regulatory proteins that cause hypertrophic cardiomyopathy (HCM) confer distinct primary alterations of cardiac contractility. We have shown that altered Ca2+-buffering by mutant thin filaments leads to altered Ca2+ handling and results in stimulation of Ca2+-dependent signalling pathways. To do this we have used adenoviral mediated expression of cTnT R92Q, cTnI R145G and α-TM D175N in adult guinea pig cardiomyocytes at a ratio of 1:1 with the endogenous protein. Simultaneous measurement of unloaded sarcomere-shortening and Ca2+ transients using fura-2 loading, showed the HCM mutations caused a significant decrease in the basal sarcomere length coupled with an increase in the diastolic Ca2+ concentration. The mechanism of alterations to EC-coupling was also investigated using tetracaine and caffeine challenging combined with simultaneous whole cell patch clamping. HCM mutant cells displayed reduced SR load (~1.4fold), slowed NCX calcium extrusion (~2.5fold), unchanged SERCA2 activity, increased ryanodine receptor leak (~5fold) and increased calcium buffering (~3fold). This was coupled to an increase in Ca2+ dependent NFAT nuclear localisation. Further studies using the green tea catechin, epigallocatechin gallate (EGCg) and sister compound epicatechin-3-gallate (ECG), have shown that the compounds can partiality reverse the increase in diastolic Ca2+ observed in cardiomyocytes containing HCM causing mutations. The mechanism is thought to be via an interaction with cTnC (measured using intrinsic cTnC tyrosine fluorescence) which in turn causes a reduction of in vitro thin filament Ca2+ affinity (measured using cTnC labelled with IAANS fluorophore at Cys 35). Data acquired so far suggests that catechins and their derivative compounds may provide a possible therapeutic approach for correcting Ca2+ regulation and Ca2+ dependent remodelling in HCM. We have recently obtained library of 37 EGCg analogues which we have screened for cTnC affinity and thin filament Ca2+ affinity. We have now identified several catechins with potentially greater efficacy than the parent compound, and plan to test their ability to rescue the cellular HCM phenotype characterised above.
    Cardiovascular research. 07/2014; 103(suppl 1):S21.
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    ABSTRACT: Atherosclerosis is an inflammatory disease and the main cause of cardiovascular disease. Inflammation promotes plaque instability and clinical disease, such as myocardial infarction, stroke and peripheral vascular disease. Subclinical atherosclerosis begins with thickening of the arterial intimal layer and increased intima-media thickness (IMT) in the carotid artery is a widely used measurement of subclinical atherosclerosis. Activation of CD137 (Tumor Necrosis Factor Receptor SuperFamily 9), promotes inflammation and disease development in murine atherosclerosis. CD137 is expressed in human atherosclerosis, but its role is largely unknown. This study uses a genetic approach to investigate CD137 in human atherosclerotic disease. In publicly available data on genotype and gene expression from the HapMap project, the minor T allele of rs2453021, a single nucleotide polymorphism (SNP) in CD137, was significantly associated with CD137 gene expression. In the PROCARDIS and WTCCC cohorts of 13029 cases and controls, no significant association was detected between the minor T allele of rs2453021 and risk for coronary artery disease or myocardial infarction. However, in the IMPROVE multicenter study of 3418 individuals, the minor T allele of rs2453021 was associated with increased intima-media thickness (IMT) of the common carotid artery (CCA), as measured by ultrasonography, with presence of plaque in CCA, and with increased incidence of adverse non-cardiac vascular events. Taken together, this study shows that the minor T allele of rs2453021 is associated with increased IMT in the CCA and increased risk of incident non-cardiac vascular events, thus providing the first human genetic evidence for involvement of CD137 in atherosclerosis.
    Molecular medicine (Cambridge, Mass.). 07/2014;
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    ABSTRACT: Objective To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease. Design Mendelian randomisation meta-analysis of 56 epidemiological studies. Participants 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers. Main outcome measures Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption. Results Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (−0.88 (−1.19 to −0.56) mm Hg), interleukin-6 levels (−5.2% (−7.8 to −2.4%)), waist circumference (−0.3 (−0.6 to −0.1) cm), and body mass index (−0.17 (−0.24 to −0.10) kg/m2). Rs1229984 A-allele carriers had lower odds of coronary heart disease (odds ratio 0.90 (0.84 to 0.96)). The protective association of the ADH1B rs1229984 A-allele variant remained the same across all categories of alcohol consumption (P=0.83 for heterogeneity). Although no association of rs1229984 was identified with the combined subtypes of stroke, carriers of the A-allele had lower odds of ischaemic stroke (odds ratio 0.83 (0.72 to 0.95)). Conclusions Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.
    BMJ. 07/2014; 349.
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    ABSTRACT: Michael V Holmes, assistant professor (joint first author)123, Caroline E Dale, research fellow (joint first author)4, Luisa Zuccolo, population health scientist fellow5, Richard J Silverwood, lecturer in medical statistics46, Yiran Guo, research associate78, Zheng Ye, investigator scientist9, David Prieto-Merino, lecturer in medical statistics4, Abbas Dehghan, assistant professor10, Stella Trompet, senior researcher11, Andrew Wong, senior study manager12, Alana Cavadino, statistician13, Dagmar Drogan, scientist14, Sandosh Padmanabhan, reader15, Shanshan Li, postdoctoral research fellow16, Ajay Yesupriya, health scientist17, Maarten Leusink, doctoral candidate18, Johan Sundstrom, senior epidemiologist19, Jaroslav A Hubacek, senior scientist20, Hynek Pikhart, senior lecturer21, Daniel I Swerdlow, clinician scientist1, Andrie G Panayiotou, lecturer in public health22, Svetlana A Borinskaya, leading researcher23, Chris Finan, bioinformatician1, Sonia Shah, postdoctoral research fellow24, Karoline B Kuchenbaecker, research associate in genetic epidemiology25, Tina Shah, postdoctoral research fellow1, Jorgen Engmann, data manager1, Lasse Folkersen, postdoctoral research fellow26, Per Eriksson, professor of cardiovascular medicine26, Fulvio Ricceri, epidemiologist, research fellow28, Olle Melander, professor27, Carlotta Sacerdote, medical epidemiologist28, Dale M Gamble, researcher29, Sruti Rayaprolu, researcher30, Owen A Ross, associate professor30, Stela McLachlan, data manager31, Olga Vikhireva, research associate21, Ivonne Sluijs, assistant professor32, Robert A Scott, senior investigator scientist9, Vera Adamkova, head of department33, Leon Flicker, professor of geriatric medicine34, Frank M van Bockxmeer, director of cardiovascular genetics laboratory35, Christine Power, professor of epidemiology and public health13, Pedro Marques-Vidal, associate professor of internal medicine36, Tom Meade, emeritus professor of epidemiology4, Michael G Marmot, director of UCL institute of Health Equity37, Jose M Ferro, professor of neurology3839, Sofia Paulos-Pinheiro, masters student4041, Steve E Humphries, professor of cardiovascular genetics at UCL42, Philippa J Talmud, professor of cardiovascular genetics42, Irene Mateo Leach, postdoctoral research fellow43, Niek Verweij, doctoral candidate43, Allan Linneberg, professor44, Tea Skaaby, doctoral candidate44, Pieter A Doevendans, chief cardiologist45, Maarten J Cramer, consultant cardiologist45, Pim van der Harst, cardiologist434647, Olaf H Klungel, associate professor of pharmacoepidemiologic methods18, Nicole F Dowling, epidemiologist17, Anna F Dominiczak, regius professor of medicine15, Meena Kumari, professor of biological and social epidemiology1, Andrew N Nicolaides, emeritus professor of vascular surgery, professor emeritus484950, Cornelia Weikert, scientist, group head14, Heiner Boeing, professor and head of department14, Shah Ebrahim, professor of public health4, Tom R Gaunt, senior lecturer in bioinformatics and molecular genetics5, Jackie F Price, clinical reader in epidemiology31, Lars Lannfelt, professor51, Anne Peasey, teaching fellow in social epidemiology21, Ruzena Kubinova, head of centre52, Andrzej Pajak, professor and head of department53, Sofia Malyutina, professor and head of laboratory5455, Mikhail I Voevoda, professor and director5456, Abdonas Tamosiunas, senior researcher57, Anke H Maitland-van der Zee, associate professor18, Paul E Norman, winthrop professor58, Graeme J Hankey, winthrop professor of neurology5960, Manuela M Bergmann, scientist14, Albert Hofman, professor of epidemiology10, Oscar H Franco, professor of preventative medicine10, Jackie Cooper, senior research fellow61, Jutta Palmen, senior research fellow42, Wilko Spiering, vascular medicine internist62, Pim A de Jong, radiologist63, Diana Kuh, professor of life course epidemiology and MRC unit director12, Rebecca Hardy, professor of epidemiology and medical statistics and MRC programme leader12, Andre G Uitterlinden, professor of complex genetics10, M Arfan Ikram, associate professor of neuroepidemiology10, Ian Ford, professor of biostatistics64, Elina Hyppönen, professor of nutritional and genetic epidemiology136566, Osvaldo P Almeida, director of research, professor and Winthrop chair of geriatric psychiatry346768, Nicholas J Wareham, professor and director of the MRC epidemiology unit9, Kay-Tee Khaw, professor of clinical gerontology69, Anders Hamsten, professor and team leader on behalf of IMPROVE study group*2670, Lise Lotte N Husemoen, senior research fellow44, Anne Tjønneland, research leader71, Janne S Tolstrup, research programme director72, Eric Rimm, associate professor of epidemiology and nutrition7374, Joline W J Beulens, assistant professor32, W M Monique Verschuren, deputy head75, N Charlotte Onland-Moret, assistant professor of genetic epidemiology32, Marten H Hofker, professor of molecular genetics76, S Goya Wannamethee, professor of epidemiology77, Peter H Whincup, professor of cardiovascular epidemiology78, Richard Morris, professor of medical statistics and epidemiology77, Astrid M Vicente, head of department407980, Hugh Watkins, professor of cardiovascular medicine and head of department8182, Martin Farrall, professor of cardiovascular genetics8182, J Wouter Jukema, professor of cardiology11, James Meschia, physician investigator29, L Adrienne Cupples, professor of biostatistics8384, Stephen J Sharp, senior statistician9, Myriam Fornage, professor of molecular medicine and human genetics85, Charles Kooperberg, full member86, Andrea Z LaCroix, professor of epidemiology86, James Y Dai, associate member of biostatistics86, Matthew B Lanktree, postdoctoral research fellow87, David S Siscovick, senior vice-president for research88, Eric Jorgenson, research scientist89, Bonnie Spring, professor of preventive medicine and director90, Josef Coresh, professor of epidemiology91, Yun R Li, medical and doctoral trainee7, Sarah G Buxbaum, assistant professor92, Pamela J Schreiner, professor93, R Curtis Ellison, professor of medicine and public health94, Michael Y Tsai, professor95, Sanjay R Patel, associate professor of medicine96104, Susan Redline, professor96, Andrew D Johnson, principal investigator84, Ron C Hoogeveen, assistant professor of medicine97, Hakon Hakonarson, associate professor of paediatrics and director of genomics7, Jerome I Rotter, director and professor98, Eric Boerwinkle, professor and director99, Paul I W de Bakker, professor of genetic epidemiology and bioinformatics32100, Mika Kivimaki, professor of social epidemiology21, Folkert W Asselbergs, consultant cardiologist4547101, Naveed Sattar, professor of metabolic medicine102, Debbie A Lawlor, professor of epidemiology5, John Whittaker, professor and vice president of statistical platforms and technologies at GSK4103, George Davey Smith, director of MRC integrative epidemiology unit5, Kenneth Mukamal, general internalist104, Bruce M Psaty, professor105106, James G Wilson, professor of physiology and biophysics107, Leslie A Lange, associate professor108, Ajna Hamidovic, assistant professor109, Aroon D Hingorani, professor of genetic epidemiology1, Børge G Nordestgaard, professor110111112, Martin Bobak, professor of epidemiology21, David A Leon, professor of epidemiology4, Claudia Langenberg, academic clinical lecturer9, Tom M Palmer, assistant professor in medical statistics113, Alex P Reiner, research professor86, Brendan J Keating, assistant professor in paediatrics and surgery27, Frank Dudbridge, professor of statistical genetics4, Juan P Casas, professor of epidemiology14 on behalf of The InterAct Consortium1Genetic Epidemiology Group, Institute of Cardiovascular Science, Department of Epidemiology and Public Health, University College London, UK2Department of Surgery, Penn Transplant Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104, USA3Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA4Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK5MRC Integrative Epidemiology Unit (IEU) at the Universty of Bristol, Oakfield House, Bristol BS8 2BN, UK6Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK7Center for Applied Genomics, Abramson Research Center, The Childrentextquoterights Hospital of Philadelphia, Philadelphia, USA8BGI-Shenzhen, Beishan Industrial Zone, Yantian District, Shenzhen 518083, China9MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooketextquoterights Hospital, Cambridge, UK10Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands11Department of Cardiology, Leiden University Medical Center, the Netherlands12MRC Unit for Lifelong Health and Ageing at UCL, London, UK13Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK14German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany15Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK16Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA17Office of Public Health Genomics, Office of Epidemiology, Surveillance, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA18Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands19Department of Medical Sciences, Uppsala University, Uppsala University Hospital, SE-751 85 Uppsala, Sweden20Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague 4, 14021, Czech Republic21Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK22Cyprus International Institute for Environmental and Public Health in association with the Harvard School of Public Health, Cyprus University of Technology, 3603 Limassol, Cyprus23Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, Russia24UCL Genetics Institute, Department of Genetics Environment and Evolution, London, WC1E 6BT, UK25Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK26Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden27Department of Clinical Sciences, Lund University, Malmö, Sweden28Unit of Cancer Epidemiology, San Giovanni Battista Hospital and Center for Cancer Prevention (CPO-Piemonte), 10129, Torino, Italy29Mayo Clinic Department of Neurology, Jacksonville, FL 32224, USA30Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA31Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK32Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands33Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague 4, 14021, Czech Republic34Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia35Department of Clinical Biochemistry, Royal Perth Hospital and School of Surgery, the University of Western Australia36Department of Internal Medicine, Internal Medicine, CHUV, Lausanne, Switzerland37UCL Institute of Health Equity, Department of Epidemiology & Public Health, London WC1E 7HB, UK38Instituto Medicina Molecular, Faculdade de Medicina Universidade de Lisboa, 1649-028 Lisbon, Portugal39Servico Neurologia, Hospital de Santa Maria, 1649-035 Lisbon, Portugal40Instituto Nacional de Saude Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal41Faculdade Ciencias Universidade Lisboa, 1749-016 Lisbon, Portugal42Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK43Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands44Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup University Hospital, Glostrup, Denmark45Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands46Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands47Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands48Vascular Screening and Diagnostic Centre, Ayios Dometios, Nicosia, Cyprus49Deparment of Vascular Surgery, Imperial College, London, SW7 2BX, UK50Cyprus Cardiovascular Disease Educational and Research trust, Nicosia, Cyprus51Department of Public Health & Caring Sciences, Uppsala University, Uppsala University Hospital, SE-75185 Uppsala, Sweden52Centre for Health Monitoring, National Institute of Public Health, 100 42 Prague, Czech Republic53Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-531 Krakow, Poland54Institute of Internal and Preventative Medicine, Siberian Branch of Russian Academy of Medical Sciences, Novosibirsk, Russia, 63008955Dept of Internal Medicine, Novosibirsk State Medical University, Novosibirsk, Russia, 63009156Faculty of Medicine, Novosibirsk State University, Novosibirsk, Russia, 63009057Department of Population Studies, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas LT-50161, Lithuania58School of Surgery, University of Western Australia, Perth, Australia59Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia60School of Medicine and Pharmacology, The University of Western Australia, Nedlands, Perth, Australia61Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, UK WC1E 6JF62Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands63Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands64Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK65School of Population Health and Sansom Institute for Health Research, University of South Australia, Adelaide SA 5000, Australia66South Australian Health and Medical Research Institute, Adelaide SA5000, Australia67School of Psychiatry & Clinical Neurosciences (M573), University of Western Australia, Perth 6009, Australia68Department of Psychiatry, Royal Perth Hospital, Perth, Australia69Department of Primary Care and Public Health and Primary Care, University of Cambridge, Cambridge, UK70Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden71Danish Cancer Society, Strandboulevarden, Copenhagen, Denmark72National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark73Department of Epidemiology and Department of Nutrition, Harvard School of Public Health, Boston, MA, USA74Channing Division of Network Medicine, Brigham and Womentextquoterights Hospital and Harvard Medical School, Boston, MA, USA75National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands76Dept Pathology and Medical Biology, Medical Biology division, Molecular Genetics, University Medical Center Groningen and Groningen University, Groningen, The Netherlands77Department of Primary Care & Population Health, UCL, London, UK78Population Health Research Institute, St Georgetextquoterights, University of London, London, UK79Instituto Gulbenkian Ciencia, P-2780-156 Oeiras, Portugal80Biofig - Center for Biodiversity, Functional and Integrative Genomics, Campus da FCUL, 1749-016 Lisboa, Portugal81Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK82Department of Cardiovascular Medicine, University of Oxford, Oxford, UK83Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA84National Heart, Lung, and Blood Institutetextquoterights The Framingham Heart Study, Framingham, Massachusetts, USA85Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Texas, USA86Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA87Department of Medicine, McMaster University, Hamilton, Ontario, Canada L8S4L888New York Academy of Medicine, New York, NY 10021, USA89Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA90Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL, USA91Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA92School of Health Sciences, Jackson State University, Jackson, MS, USA93School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA94Preventive Medicine and Epidemiology, Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA95Department of Laboratory Medicine and Pathology, University of Minnesota, USA96Division of Sleep and Circadian Disorders, Brigham and Womentextquoterights Hospital; Harvard Medical School, Boston USA97Baylor College of Medicine, Department of Medicine, Division of Atherosclerosis & Vascular Medicine, Houston, Texas 77030, USA98Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, Calif, USA99Division of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Texas, USA100Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands101Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK102British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK103Genetics, R&D, GlaxoSmithKline, Stevenage, UK104Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA105Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA,USA106Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA107Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA108Department of Genetics, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina 27514, USA109College of Pharmacy, The University of New Mexico, Albuquerque, NM, USA110The Copenhagen General Population Study, Herlev Hospital, Copenhagen, Denmark111Faculty of Health Sciences, Copenhagen University Hospital, University of Copenhagen,Copenhagen, Denmark112Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Denmark113Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UKCorrespondence to: J P Casas, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK Juan-P.Casasatlshtm.ac.ukAccepted 21 May 2014Abstract Objective To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease. Design Mendelian randomisation meta-analysis of 56 epidemiological studies. Participants 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers. Main outcome measures Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption. Results Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (-0.88 (-1.19 to -0.56) mm Hg), interleukin-6 levels (-5.2% (-7.8 to -2.4%)), waist circumference (-0.3 (-0.6 to -0.1) cm), and body mass index (-0.17 (-0.24 to -0.10) kg/m2). Rs1229984 A-allele carriers had lower odds of coronary heart disease (odds ratio 0.90 (0.84 to 0.96)). The protective association of the ADH1B rs1229984 A-allele variant remained the same across all categories of alcohol consumption (P=0.83 for heterogeneity). Although no association of rs1229984 was identified with the combined subtypes of stroke, carriers of the A-allele had lower odds of ischaemic stroke (odds ratio 0.83 (0.72 to 0.95)). Conclusions Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health. Footnotes Members of the InterAct Consortium and IMPROVE study group are listed in the supplementary appendix. We thank Dr Kieran McCaul (Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia) for help with analysis of the Health in Men Study (HIMS) cohort. Contributors: All coauthors satisfy the recommendations outlined in the ICMJE Recommendations 2013. All coauthors provided substantial contributions to the conception or design of the work or acquisition, analysis, or interpretation of data for the work, and helped with drafting the work or revising it critically for important intellectual content. All coauthors approve this version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MVH, CED, and JPC are guarantors for the study, had full access to all of the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. Funding of individuals Dr Michael V. Holmes is funded by a UK Medical Research Council (MRC) population health scientist fellowship (G0802432). Dr Abbas Dehghan is supported by NWO grant (veni, 916.12.154) and the EUR Fellowship. Dr James Meschia receives support from a Clinical Investigator grant from the Mayo Foundation for Medical Education and Research. Prof Mika Kivimaki was supported by the Medical Research Council; the British Heart Foundation; the Economic and Social Research Council; the National Heart Lung and Blood Institute (NHLBI: HL36310); and the National Institute on Aging (AG13196), US, NIH. Prof. Dr. J. W. Jukema is an Established Clinical Investigator of the Netherlands Heart Foundation (grant 2001 D 032). Dr Owen Ross is funded by the James and Ester King Foundation and the Florida State Department of Health, the American Heart Association and the Myron and Jane Hanley Award in Stroke research. Prof Sir Michael Marmot is supported by a Medical Research Council Professorship. Dr Johan Sundstrom is supported by the Swedish Heart-Lung Foundation (grant 20041151), the Swedish Research Council (grant 2007-5942). Dr. Alex Reiner was supported by a contract HHSN268200900009C from the NIH National Heart Lung and Blood Institute. Dr James Y. Dai was supported by a R01 grant from the National Heart Lung and Blood Institute (HL 114901). Prof Hugh Watkins and Prof Martin Farrall are members of the Oxford British Heart Foundation (BHF) Centre of Research Excellence. Dr Daniel Swerdlow was supported by a MRC doctoral training award, and acknowledges support of the UCL MBPhD programme. Prof Frank Dudbridge is supported by a MRC grant (G1000718). Dr Jaroslav Hubacek was supported by MH CZ - DRO (quotedblbaseInstitute for Clinical and Experimental Medicine - IKEM, IN 00023001textquotedblleft). Dr Richard Silverwood is supported by the UK Economic and Social Research Council (NCRM Pathways node, ES/I025561/2). Professor Steve E. Humphries is supported by the British Heart Foundation (PG/2008/008). Prof Kuh, Prof Hardy and Dr Wong were supported by the Medical Research Council (MC_UU_12019/1). Dr Folkert W. Asselbergs is supported by National Institute of Health Research University College London Hospitals Biomedical Research Centre and Netherlands Heart Foundation (2014T001). Dr. Jorgenson is supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA: AA021223-01). Ajna Hamidovic was funded by MD Scientist Fellowship in Genetic Medicine (Northwestern Memorial Foundation) and the National Research Service Award F32DA024920 (NIH/NIDA; Ajna Hamidovic). Dr. Springtextquoterights work is supported by NIH HL075451. This work was supported in part by BHF Programme Grant RG/10/12/28456. Professors Lawlor and Davey Smith and Dr Zuccolo work in a research unit that receives funding from the UK Medical Research Council (MC_UU_12013/1 and MC_UU_12013/5). Dr. Buxbaumtextquoterights research is supported in part by P20MD006899 awarded by the National Institute on Minority Health and Health Disparities of the National Institutes of Health. Professors Aroon D. Hingorani and Juan P Casas are supported by the National Institute of Health Research University College London Hospitals Biomedical Research Centre. Funding of studies ALSPAC: We are extremely grateful to all of the families who took part in this study, the midwives for recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The research leading to the specific results from ALSPAC in this paper received funding from the Wellcome Trust (WT088806 and WT087997MA). The UK Medical Research Council and Wellcome Trust (092731), together with the University of Bristol, provide core support for the ALSPAC study. ARIC: The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C), R01HL087641, R01HL59367 and R01HL086694; National Human Genome Research Institute contract U01HG004402; and National Institutes of Health contract HHSN268200625226C. The authors thank the staff and participants of the ARIC study for their important contributions. Infrastructure was partly supported by Grant Number UL1RR025005, a component of the National Institutes of Health and NIH Roadmap for Medical Research; BWHHS: The British Womentextquoterights Heart and Health Study has been supported by funding from the British Heart Foundation (BHF) (grant PG/09/022) and the UK Department of Health Policy Research Programme (England) (grant 0090049). The BWHHS HumanCVD data were funded by the BHF (PG/07/131/24254); We thank all BWHHS participants, the general practitioners and their staff who have supported data collection since the study inception; BRHS: The British Regional Heart Study has been supported by programme grant funding from the British Heart Foundation (RG/08/013/25942); CARe: wishes to acknowledge the support of the National Heart, Lung and Blood Institute and the contributions of the research institutions, study investigators, field staff, and study participants in creating this resource for biomedical research (NHLBI contract number HHSN268200960009C); CARDIA: CARDIA is supported by contracts N01-HC-48047, N01-HC-48048, N01-HC-48049, N01-HC-48050 and N01-HC-95095 from the National Heart, Lung, and Blood Institute/National Institutes of Health; CFS: The Cleveland Family Study (CFS) was supported by grant HL46380 from the National Heart, Lung, and Blood Institute (NHLBI); CGPS: This study was supported by Herlev Hospital, Copenhagen University Hospital, The Copenhagen County Research Fund, and The Danish Medical Research Council; CHS: This research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01 HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, N01HC65226, and grant HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org; Cyprus: The Cyprus Study has been supported by the Cyprus Cardiovascular Disease Educational and Research Trust (CCDERT) and Joint Cyprus Research Promotion Foundation, Ministry of Health and Cyprus Heart Foundation grant No 41/5PE as well as Research Promotion Foundation grants (PENEK 05/04 and YGEIA 04/06); EAS: The EAS was funded by the British Heart Foundation (Programme Grant RG/98002); ELSA: Samples from the English Longitudinal Study of Ageing (ELSA) DNA Repository (EDNAR), received support under a grant (AG1764406S1) awarded by the National Institute on Ageing (NIA). ELSA was developed by a team of researchers based at the National Centre for Social Research, University College London and the Institute of Fiscal Studies. The data were collected by the National Centre for Social Research.; EPIC InterAct: We thank all EPIC participants and staff for their contribution to the study. We thank staff from the Technical, Field Epidemiology and Data Functional Group Teams of the MRC Epidemiology Unit in Cambridge, UK, for carrying out sample preparation, DNA provision and quality control, genotyping and data-handling work. The InterAct study received funding from the European Union (Integrated Project LSHM-CT-2006-037197 in the Framework Programme 6 of the European Community); EPIC Netherlands: We thank Statistics Netherlands and Netherlands Cancer Registry (NKR) for follow-up data on cancer, cardiovascular disease, vital status and causes of death. Supported by the European Commission: Public Health and Consumer Protection Directorate 1993-2004; Research Directorate-General 2005; Dutch Ministry of Public Health, Welfare and Sports; Netherlands Cancer Registry; LK Research Funds; Dutch Prevention Funds; Dutch Zorg Onderzoek Nederland; and World Cancer Research Fund (The Netherlands) (to the European Prospective Investigation into Cancer and Nutrition-Netherlands study). The EPIC-NL study was funded by textquoteleftEurope against Cancertextquoteright Programme of the European Commission (SANCO), Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch Cancer Society; ZonMW the Netherlands Organisation for Health Research and Development, World Cancer Research Fund (WCRF) (The Netherlands). Genotyping was funded by IOP Genomics grant IGE05012 from Agentschap NL; EPIC Norfolk: We thank all study participants and the general practitioners and the EPIC-Norfolk study team for their helpful input. The EPIC-Norfolk study is supported by programme grants from the Medical Research Council and Cancer Research UK; EPIC Potsdam: The recruitment phase of the EPIC-Potsdam Study was supported by the Federal Ministry of Science, Germany (01 EA 9401), and the European Union (SOC 95201408 05F02). The follow-up was supported by the German Cancer Aid (70-2488-Ha I) and the European Community (SOC 98200769 05F02). The present study was supported by the Federal Ministry of Education and Research (0312750B). Mercodia provided the oxLDL kits free of charge. JS and AFHP were supported by German Research Federal Ministry (BMBF), JS was supported by a Heisenberg-Professorship (SP716/1-1) and clinical research groups of the German Research Foundation (DFG; KFO192/1 and 218/1). JS, AFHP and MM were also supported by a graduate school of the DFG (GK1208); EPIC Turin: The EPIC Turin study is funded by grants from the Associazione Italiana per le Ricerche sul Cancro, Italy and grants from the Compagnia di San Paolo, Turin, Italy; FHS: The Framingham Heart Study began in 1948 with the recruitment of an original cohort of 5,209 men and women (mean age 44 years; 55 percent women). In 1971 a second generation of study participants was enrolled; this cohort consisted of 5,124 children and spouses of children of the original cohort. The mean age of the offspring cohort was 37 years; 52 percent were women. A third generation cohort of 4,095 children of offspring cohort participants (mean age 40 years; 53 percent women) was enrolled beginning in 2002. At each clinic visit, a medical history was obtained with a focus on cardiovascular content, and participants underwent a physical examination including measurement of height and weight from which BMI was calculated; HAPIEE: This study was supported by Wellcome Trust textquoteleftDeterminants of Cardiovascular Diseases in Eastern Europe: A multi-centre cohort studytextquoteright [grants 064947/Z/01/Z; and 081081/Z/06/Z]; the MacArthur Foundation textquoteleftMacArthur Initiative on Social Upheaval and Healthtextquoteright [grant 712058]; the National Institute on Ageing textquoteleftHealth disparities and aging in societies in transition (the HAPIEE study)textquoteright [grant 1R01 AG23522]; and a project from the Ministry of Health, Czech Republic, for the development of the research organization No. 00023001 (IKEM, Prague, Czech Republic). We would like to thank researchers, interviewers and participants in Novosibirsk, Krakow, Kaunas, Hav'iv rov/Karviná, Jihlava, Úst'i nad Labem, Liberec, Hradec Králové, and Kromev r'iz.; HIMS: National Health and Medical Research Council (NHMRC) project grants 279408, 379600, 403963, 513823 and 634492; HPFS/NHS: We would like to thank Hardeep Ranu and Pati Soule from the DF/HCC Genotyping Core for genotyping and data management. This study was supported by research grants HL35464, CA55075, CA87969, AA11181, and HL34594 from the National Institute of Health, Bethesda; M.D; IMPROVE: This study was supported by the European Commission (Contract number: QLG1- CT- 2002- 00896), Ministero della Salute Ricerca Corrente, Italy, the Swedish Heart-Lung Foundation, the Swedish Research Council (projects 8691 and 0593), the Foundation for Strategic Research, the Stockholm County Council (project 562183), the Foundation for Strategic Research, the Academy of Finland (Grant $#$110413) and the British Heart Foundation (RG2008/014). None of the aforementioned funding organizations or sponsors has had a specific role in design or conduct of the study, collection, management, analysis, or interpretation of the data, or preparation, review, or approval of the manuscript; Inter99: The Inter99 study was supported by the Danish Medical Research Council, the Danish Centre for Evaluation and Health Technology Assessment, Copenhagen County, the Danish Heart Foundation, the Danish Pharmaceutical Association, the Health Insurance Foundation, the Augustinus Foundation, the Ib Henriksens foundation and the Beckett Foundation. The present study was further supported by the Danish Diabetes Association (grant No. 32, December 2005) and the Health Insurance Foundation (grant No. 2010 B 131); ISGS/SWISS: ISGS (Grant Number R01 42733) and SWISS (R01 NS39987) were funded by grants from the National Institute of Neurological Disorders and Stroke (US); Izhevsk: The Izhevsk Family Studies was funded by a UK Wellcome Trust programme grant (078557); MDC: This work was supported by the Swedish Medical Research Council; by the Swedish Heart and Lung Foundation; by the Medical Faculty of Lund University, Malmo University Hospital; by the Albert Pahlsson Research Foundation; by the Crafoord foundation; by the Ernhold Lundstroms Research Foundation, the Region Skane; by the Hulda and Conrad Mossfelt Foundation; by the King Gustaf V and Queen Victoria Foundation; by the Lennart Hanssons Memorial Fund; and by the Marianne and Marcus Wallenberg Foundation. Genotyping was supported by the British Heart Foundation (grant number CH/98001 to A.F.D., RG/07/005/23633 to A.F.D., S.P.); MESA: The Multi-Ethnic Study of Atherosclerosis Study (MESA) is a multicenter prospective cohort study initiated to study the development of subclinical cardiovascular disease. A total of 6814 women and men between the age of 45 and 84 year were recruited for the first examination between 2000 and 2002. Participants were recruited in six US cities (Baltimore, MD; Chicago, IL; Forsyth County, NC; Los Angeles County, CA; Northern Manhattan, NY; and St. Paul, MN). This study was approved by the institutional review boards of each study site, and written informed consent was obtained from all participants. This cohort was genotyped as part of the National Heart Lung and Blood Institutetextquoterights (NHLBI) Candidate Gene Association Resource (CARe) (Musunuru, K., Lettre, G., Young, T., Farlow, D.N., Pirruccello, J.P., Ejebe, K.G., Keating, B.J., Yang, Q., Chen, M.H., Lapchyk, N. et al. Candidate gene association resource (CARe): design, methods, and proof of concept. Circ. Cardiovasc. Genet, 3, 267-275.); MRC 1958BC: Dr Sue Ring and Dr Wendy McArdle (University of Bristol) and Mr Jon Johnson (Centre for Longitudinal Studies, Institute of Education, London) are thanked for help with data linkage. The study was supported by the Academy of Finland (12926) and the Medical Research Council (MRC G0601653 and SALVE/PrevMedsyn). The Medical Research Council funded the 2002-2004 clinical follow-up of the 1958 birth cohort (grant G0000934). This research used resources provided by the Type 1 Diabetes Genetics Consortium, a collaborative clinical study sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute of Allergy and Infectious Diseases, National Human Genome Research Institute, National Institute of Child Health and Human Development, and Juvenile Diabetes Research Foundation International (JDRF) and supported by U01 DK062418. This study makes use of data generated by the Wellcome Trust Case-Control Consortium. A full list of investigators who contributed to generation of the data is available from the Wellcome Trust Case-Control Consortium website(www.wtccc.org.uk). Funding for the project was provided by the Wellcome Trust under award 076113. Work at the Centre for Paediatric Epidemiology and Biostatistics benefits from funding support from the MRC in its capacity as the MRC Centre of Epidemiology for Child Health. Research at the University College London Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust benefits from R&D funding received from the NHS Executive; MRC NSHD: Supported by Medical Research Council -- MC_UU_12019/1. We are very grateful to the members of this birth cohort for their continuing interest and participation in the study. We would like to acknowledge the Swallow group, UCL, who performed the DNA extractions; NHANES III: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention; NORDIL: This work was supported by the British Heart Foundation (grant number CH/98001 to A.F.D., RG/07/005/23633 to A.F.D., S.P.) and a Special Project, for genotyping of the Swedish extremes from the NORDIL and MDC cohorts; and by Pharmacia. We thank Professor Thomas Hedner (Department of Clinical Pharmacology, Sahlgrenska Academy, Gotheburg, Sweden) and Professor Sverre Kjeldsen (Ullevaal University Hospital, University of Oslo, Oslo, Norway), who are investigators of the NORDIL study. Professor Kjeldsen is also an investigator of the ASCOT trial; NPHS II: NPHS-II was supported by the British Medical Research Council, the US National Institutes of Health (grant NHLBI 33014), and Du Pont Pharma, Wilmington, Delaware; Portuguese stroke: Instituto Nacional de Saude Doutor Ricardo Jorge; PREVEND: PREVEND genetics is supported by the Dutch Kidney Foundation (Grant E033), The Netherlands organisation for health research and development (ZonMw grant 90.700.441), and the Dutch Inter University Cardiology Institute Netherlands (ICIN); PROCARDIS: PROCARDIS was supported by the EU FP7 Program (LSHM-CT-2007-037273), AstraZeneca, the British Heart Foundation, the Oxford BHF Centre of Research Excellence, the Wellcome Trust core award (090532/Z/09/Z), the Swedish Research Council, the Knut and Alice Wallenberg Foundation, the Swedish Heart-Lung Foundation, the Torsten and Ragnar Söderberg Foundation, the Strategic Cardiovascular Program of Karolinska Institutet and Stockholm County Council, the Foundation for Strategic Research and the Stockholm County Council (560283); PROSPER: The PROSPER study was supported by an investigator initiated grant obtained from Bristol-Myers Squibb and by grants from the Interuniversity Cardiology Institute of the Netherlands (ICIN) and the Durrer Center for Cardiogenetic Research both Institutes of the Netherlands Royal Academy of Arts and Sciences (KNAW), the Netherlands Heart Foundation, the Center for Medical Systems Biology (CMSB), a center of excellence approved by the Netherlands Genomics Initiative/Netherlands Organisation for Scientific Research (NWO), the Netherlands Consortium for Healthy Ageing (NCHA). The research leading to these results has received funding from the European Uniontextquoterights Seventh Framework Programme (FP7/2007-2013) under grant agreement ntextdegree HEALTH-F2-2009-223004 and by the Netherlands Genomics Initiative (Netherlands Consortium for Healthy Aging grant 050-060-810); Rotterdam: The Rotterdam Study is supported by the Erasmus Medical Center and Erasmus University Rotterdam; the Netherlands Organization for Scientific Research (NWO); the Netherlands Organization for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Netherlands Heart Foundation; the Ministry of Education, Culture and Science; the Ministry of Health Welfare and Sports; the European Commission; and the Municipality of Rotterdam. Support for genotyping was provided by the Netherlands Organisation of Scientific Research NWO Investments (nr. 175.010.2005.011, 911-03-012), the Research Institute for Diseases in the Elderly (014-93-015; RIDE2), the Netherlands Genomics Initiative (NGI)/Netherlands Consortium for Healthy Aging (NCHA) project nr. 050-060-810; SMART: SMART GENETICS was financially supported by BBMRI-NL, a Research Infrastructure financed by the Dutch government (NWO 184.021.007); TPT: TPT was funded by the Medical Research Council, the British Heart Foundation, DuPont Pharma and Bayer Corporation; UCP: The UCP study was funded by Veni grant Organization for Scientific Research (NWO), Grant no. 2001.064 Netherlands Heart Foundation (NHS), and TI Pharma Grant T6-101 Mondriaan. The department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, has received unrestricted research funding from the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the Royal Dutch Pharmacists Association (KNMP), the private-public funded Top Institute Pharma (www.tipharma.nl, includes co-funding from universities, government, and industry), the EU Innovative Medicines Initiative (IMI), EU 7th Framework Program (FP7), the Dutch Medicines Evaluation Board, the Dutch Ministry of Health and industry (including GlaxoSmithKline, Pfizer, and others); Whitehall II: The Whitehall II study and Mika Kivimaki were supported by the Medical Research Council; the British Heart Foundation; the Economic and Social Research Council; the National Heart Lung and Blood Institute (NHLBI: HL36310); and the National Institute on Aging (AG13196), US, NIH; WHI: The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C. A listing of WHI investigators can be found at https://cleo.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Short%20List.pdf. Statement of independence from funders: All researchers acted independently of study funders. The study funders played no role in study design and the collection, analysis, and interpretation of data and the writing of the article and the decision to submit it for publication. None of the funders influenced the data analysis or interpretation of results. The comments made in this paper are those of the authors and not necessarily those of any funders. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: Prof Whittaker is 90% employed by GlaxoSmithKline and own shares in GlaxoSmithKline. All other coauthors report no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Data sharing statement: No additional data available Transparency declaration: The lead authors, MVH, CED, and JPC (the manuscripttextquoterights guarantors) affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
    BMJ. 07/2014; 349.
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    ABSTRACT: Exome sequencing studies in complex diseases are challenged by the allelic heterogeneity, large number and modest effect sizes of associated variants on disease risk and the presence of large numbers of neutral variants, even in phenotypically relevant genes. Isolated populations with recent bottlenecks offer advantages for studying rare variants in complex diseases as they have deleterious variants that are present at higher frequencies as well as a substantial reduction in rare neutral variation. To explore the potential of the Finnish founder population for studying low-frequency (0.5-5%) variants in complex diseases, we compared exome sequence data on 3,000 Finns to the same number of non-Finnish Europeans and discovered that, despite having fewer variable sites overall, the average Finn has more low-frequency loss-of-function variants and complete gene knockouts. We then used several well-characterized Finnish population cohorts to study the phenotypic effects of 83 enriched loss-of-function variants across 60 phenotypes in 36,262 Finns. Using a deep set of quantitative traits collected on these cohorts, we show 5 associations (p<5×10-8) including splice variants in LPA that lowered plasma lipoprotein(a) levels (P = 1.5×10-117). Through accessing the national medical records of these participants, we evaluate the LPA finding via Mendelian randomization and confirm that these splice variants confer protection from cardiovascular disease (OR = 0.84, P = 3×10-4), demonstrating for the first time the correlation between very low levels of LPA in humans with potential therapeutic implications for cardiovascular diseases. More generally, this study articulates substantial advantages for studying the role of rare variation in complex phenotypes in founder populations like the Finns and by combining a unique population genetic history with data from large population cohorts and centralized research access to National Health Registers.
    PLoS Genetics 07/2014; 10(7):e1004494. · 8.52 Impact Factor
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    ABSTRACT: Although age-dependent effects on blood pressure (BP) have been reported, they have not been systematically investigated in large-scale genome-wide association studies (GWASs). We leveraged the infrastructure of three well-established consortia (CHARGE, GBPgen, and ICBP) and a nonstandard approach (age stratification and metaregression) to conduct a genome-wide search of common variants with age-dependent effects on systolic (SBP), diastolic (DBP), mean arterial (MAP), and pulse (PP) pressure. In a two-staged design using 99,241 individuals of European ancestry, we identified 20 genome-wide significant (p ≤ 5 × 10(-8)) loci by using joint tests of the SNP main effect and SNP-age interaction. Nine of the significant loci demonstrated nominal evidence of age-dependent effects on BP by tests of the interactions alone. Index SNPs in the EHBP1L1 (DBP and MAP), CASZ1 (SBP and MAP), and GOSR2 (PP) loci exhibited the largest age interactions, with opposite directions of effect in the young versus the old. The changes in the genetic effects over time were small but nonnegligible (up to 1.58 mm Hg over 60 years). The EHBP1L1 locus was discovered through gene-age interactions only in whites but had DBP main effects replicated (p = 8.3 × 10(-4)) in 8,682 Asians from Singapore, indicating potential interethnic heterogeneity. A secondary analysis revealed 22 loci with evidence of age-specific effects (e.g., only in 20 to 29-year-olds). Age can be used to select samples with larger genetic effect sizes and more homogenous phenotypes, which may increase statistical power. Age-dependent effects identified through novel statistical approaches can provide insight into the biology and temporal regulation underlying BP associations.
    The American Journal of Human Genetics 06/2014; · 11.20 Impact Factor
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    ABSTRACT: Increased levels of lipoprotein(a) are a highly heritable risk factor for coronary artery disease (CAD). The genetic determinants of lipoprotein(a) levels are mainly because of genetic variation in the apolipoprotein(a) gene (LPA). We have tested the association of a relatively common null allele of LPA with lipoprotein(a) levels and CAD risk in a large case-control cohort. We have also examined how null allele genotyping complements apolipoprotein(a) isoform typing to refine the relationship between LPA isoform size and circulating lipoprotein(a) levels.
    Arteriosclerosis Thrombosis and Vascular Biology 06/2014; · 6.34 Impact Factor
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    ABSTRACT: Congenital heart defects (CHDs) are the most common birth defect worldwide and are a leading cause of neonatal mortality. Nonsyndromic atrioventricular septal defects (AVSDs) are an important subtype of CHDs for which the genetic architecture is poorly understood. We performed exome sequencing in 13 parent-offspring trios and 112 unrelated individuals with nonsyndromic AVSDs and identified five rare missense variants (two of which arose de novo) in the highly conserved gene NR2F2, a very significant enrichment (p = 7.7 × 10(-7)) compared to 5,194 control subjects. We identified three additional CHD-affected families with other variants in NR2F2 including a de novo balanced chromosomal translocation, a de novo substitution disrupting a splice donor site, and a 3 bp duplication that cosegregated in a multiplex family. NR2F2 encodes a pleiotropic developmental transcription factor, and decreased dosage of NR2F2 in mice has been shown to result in abnormal development of atrioventricular septa. Via luciferase assays, we showed that all six coding sequence variants observed in individuals significantly alter the activity of NR2F2 on target promoters.
    The American Journal of Human Genetics 04/2014; 94(4):574-85. · 11.20 Impact Factor
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    ABSTRACT: Blood pressure (BP) is a heritable risk factor for cardiovascular disease. To investigate genetic associations with systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP), we genotyped ∼50,000 SNPs in up to 87,736 individuals of European ancestry and combined these in a meta-analysis. We replicated findings in an independent set of 68,368 individuals of European ancestry. Our analyses identified 11 previously undescribed associations in independent loci containing 31 genes including PDE1A, HLA-DQB1, CDK6, PRKAG2, VCL, H19, NUCB2, RELA, HOXC@ complex, FBN1, and NFAT5 at the Bonferroni-corrected array-wide significance threshold (p < 6 × 10(-7)) and confirmed 27 previously reported associations. Bioinformatic analysis of the 11 loci provided support for a putative role in hypertension of several genes, such as CDK6 and NUCB2. Analysis of potential pharmacological targets in databases of small molecules showed that ten of the genes are predicted to be a target for small molecules. In summary, we identified previously unknown loci associated with BP. Our findings extend our understanding of genes involved in BP regulation, which may provide new targets for therapeutic intervention or drug response stratification.
    The American Journal of Human Genetics 02/2014; · 11.20 Impact Factor
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    ABSTRACT: Low-frequency coding DNA sequence variants in the proprotein convertase subtilisin/kexin type 9 gene (PCSK9) lower plasma low-density lipoprotein cholesterol (LDL-C), protect against risk of coronary heart disease (CHD), and have prompted the development of a new class of therapeutics. It is uncertain whether the PCSK9 example represents a paradigm or an isolated exception. We used the "Exome Array" to genotype >200,000 low-frequency and rare coding sequence variants across the genome in 56,538 individuals (42,208 European ancestry [EA] and 14,330 African ancestry [AA]) and tested these variants for association with LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides. Although we did not identify new genes associated with LDL-C, we did identify four low-frequency (frequencies between 0.1% and 2%) variants (ANGPTL8 rs145464906 [c.361C>T; p.Gln121(∗)], PAFAH1B2 rs186808413 [c.482C>T; p.Ser161Leu], COL18A1 rs114139997 [c.331G>A; p.Gly111Arg], and PCSK7 rs142953140 [c.1511G>A; p.Arg504His]) with large effects on HDL-C and/or triglycerides. None of these four variants was associated with risk for CHD, suggesting that examples of low-frequency coding variants with robust effects on both lipids and CHD will be limited.
    The American Journal of Human Genetics 02/2014; 94(2):223-32. · 11.20 Impact Factor
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    ABSTRACT: Aims To investigate the causal role of high-density lipoprotein cholesterol (HDL-C) and triglycerides in coronary heart disease (CHD) using multiple instrumental variables for Mendelian randomization. Methods and results We developed weighted allele scores based on single nucleotide polymorphisms (SNPs) with established associations with HDL-C, triglycerides, and low-density lipoprotein cholesterol (LDL-C). For each trait, we constructed two scores. The first was unrestricted, including all independent SNPs associated with the lipid trait identified from a prior meta-analysis (threshold P < 2 × 10−6); and the second a restricted score, filtered to remove any SNPs also associated with either of the other two lipid traits at P ≤ 0.01. Mendelian randomization meta-analyses were conducted in 17 studies including 62,199 participants and 12,099 CHD events. Both the unrestricted and restricted allele scores for LDL-C (42 and 19 SNPs, respectively) associated with CHD. For HDL-C, the unrestricted allele score (48 SNPs) was associated with CHD (OR: 0.53; 95% CI: 0.40, 0.70), per 1 mmol/L higher HDL-C, but neither the restricted allele score (19 SNPs; OR: 0.91; 95% CI: 0.42, 1.98) nor the unrestricted HDL-C allele score adjusted for triglycerides, LDL-C, or statin use (OR: 0.81; 95% CI: 0.44, 1.46) showed a robust association. For triglycerides, the unrestricted allele score (67 SNPs) and the restricted allele score (27 SNPs) were both associated with CHD (OR: 1.62; 95% CI: 1.24, 2.11 and 1.61; 95% CI: 1.00, 2.59, respectively) per 1-log unit increment. However, the unrestricted triglyceride score adjusted for HDL-C, LDL-C, and statin use gave an OR for CHD of 1.01 (95% CI: 0.59, 1.75). Conclusion The genetic findings support a causal effect of triglycerides on CHD risk, but a causal role for HDL-C, though possible, remains less certain.
    European Heart Journal 01/2014; · 14.10 Impact Factor
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  • Journal of Cardiovascular Magnetic Resonance 01/2014; · 4.44 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) independently associates with an increased risk of coronary artery disease (CAD), but it has not been fully investigated whether this co-morbidity involves shared pathophysiological mechanisms. To identify potential common pathways across the two diseases, we tested all recently published single nucleotide polymorphisms (SNPs) associated with human lung function (spirometry) for association with carotid intima-media thickness (cIMT) in 3,378 subjects with multiple CAD risk factors, and for association with CAD in a case-control study of 5,775 CAD cases and 7,265 controls. SNPs rs2865531, located in the CFDP1 gene, and rs9978142, located in the KCNE2 gene, were significantly associated with CAD. In addition, SNP rs9978142 and SNP rs3995090 located in the HTR4 gene, were associated with average and maximal cIMT measures. Genetic risk scores combining the most robustly spirometry-associated SNPs from the literature were modestly associated with CAD, (odds ratio (OR) (95% confidence interval (CI95) = 1.06 (1.03, 1.09); P-value = 1.5×10-4, per allele). In conclusion, our study suggests that some genetic loci implicated in determining human lung function also influence cIMT and susceptibility to CAD. The present results should help elucidate the molecular underpinnings of the co-morbidity observed across COPD and CAD.
    PLoS ONE 01/2014; 9(8):e104082. · 3.73 Impact Factor
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    ABSTRACT: The majority of reported complex disease associations for common genetic variants have been identified through meta-analysis, a powerful approach that enables the use of large sample sizes while protecting against common artifacts due to population structure and repeated small-sample analyses sharing individual-level data. As the focus of genetic association studies shifts to rare variants, genes and other functional units are becoming the focus of analysis. Here we propose and evaluate new approaches for performing meta-analysis of rare variant association tests, including burden tests, weighted burden tests, variable-threshold tests and tests that allow variants with opposite effects to be grouped together. We show that our approach retains useful features from single-variant meta-analysis approaches and demonstrate its use in a study of blood lipid levels in ∼18,500 individuals genotyped with exome arrays.
    Nature Genetics 12/2013; · 35.21 Impact Factor
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    ABSTRACT: Objectives Observational and genetic studies have shown that lipoprotein(a) [Lp(a)] levels and apolipoprotein(a) [apo(a)] isoform size are both associated with coronary heart disease (CHD) risk, but the relative independence of these risk factors remains unclear. Clarification of this uncertainty is relevant to the potential of future Lp(a)-lowering therapies for the prevention of CHD. Methods Plasma Lp(a) levels and apo(a) isoform size, estimated by the number of kringle IV (KIV) repeats, were measured in 995 patients with CHD and 998 control subjects. The associations between CHD risk and fifths of Lp(a) levels were assessed before and after adjustment for KIV repeats and, conversely, the associations between CHD risk and fifths of KIV repeats were assessed before and after adjustment for Lp(a) levels. ResultsIndividuals in the top fifth of Lp(a) levels had more than a 2-fold higher risk of CHD compared with those in the bottom fifth, and this association was materially unaltered after adjustment for KIV repeats [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.38–3.04, P < 0.001). Furthermore, almost all of the excess risk was restricted to the two-fifths of the population with the highest Lp(a) levels. Individuals in the bottom fifth of KIV repeats had about a 2-fold higher risk of CHD compared with those in the top fifth, but this association was no longer significant after adjustment for Lp(a) levels (OR 1.13, 95% CI 0.77–1.66, P = 0.94). Conclusions The effect of KIV repeats on CHD risk is mediated through their impact on Lp(a) levels, suggesting that absolute levels of Lp(a), rather than apo(a) isoform size, are the main determinant of CHD risk.This article is protected by copyright. All rights reserved.
    Journal of Internal Medicine 12/2013; · 6.46 Impact Factor
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    ABSTRACT: Ischemic stroke (IS) and coronary artery disease (CAD) share several risk factors and each has a substantial heritability. We conducted a genome-wide analysis to evaluate the extent of shared genetic determination of the two diseases. Genome-wide association data were obtained from the METASTROKE, Coronary Artery Disease Genome-wide Replication and Meta-analysis (CARDIoGRAM), and Coronary Artery Disease (C4D) Genetics consortia. We first analyzed common variants reaching a nominal threshold of significance (P<0.01) for CAD for their association with IS and vice versa. We then examined specific overlap across phenotypes for variants that reached a high threshold of significance. Finally, we conducted a joint meta-analysis on the combined phenotype of IS or CAD. Corresponding analyses were performed restricted to the 2167 individuals with the ischemic large artery stroke (LAS) subtype. Common variants associated with CAD at P<0.01 were associated with a significant excess risk for IS and for LAS and vice versa. Among the 42 known genome-wide significant loci for CAD, 3 and 5 loci were significantly associated with IS and LAS, respectively. In the joint meta-analyses, 15 loci passed genome-wide significance (P<5×10(-8)) for the combined phenotype of IS or CAD and 17 loci passed genome-wide significance for LAS or CAD. Because these loci had prior evidence for genome-wide significance for CAD, we specifically analyzed the respective signals for IS and LAS and found evidence for association at chr12q24/SH2B3 (PIS=1.62×10(-7)) and ABO (PIS=2.6×10(-4)), as well as at HDAC9 (PLAS=2.32×10(-12)), 9p21 (PLAS=3.70×10(-6)), RAI1-PEMT-RASD1 (PLAS=2.69×10(-5)), EDNRA (PLAS=7.29×10(-4)), and CYP17A1-CNNM2-NT5C2 (PLAS=4.9×10(-4)). Our results demonstrate substantial overlap in the genetic risk of IS and particularly the LAS subtype with CAD.
    Stroke 11/2013; · 6.16 Impact Factor
  • Circulation 11/2013; · 15.20 Impact Factor
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    ABSTRACT: Autosomal recessive hypercholesterolemia is a rare inherited disorder, characterized by extremely high total and low-density lipoprotein cholesterol levels, that has been previously linked to mutations in LDLRAP1. We identified a family with autosomal recessive hypercholesterolemia not explained by mutations in LDLRAP1 or other genes known to cause monogenic hypercholesterolemia. The aim of this study was to identify the molecular pathogenesis of autosomal recessive hypercholesterolemia in this family. We used exome sequencing to assess all protein-coding regions of the genome in 3 family members and identified a homozygous exon 8 splice junction mutation (c.894G>A, also known as E8SJM) in LIPA that segregated with the diagnosis of hypercholesterolemia. Because homozygosity for mutations in LIPA is known to cause cholesterol ester storage disease, we performed directed follow-up phenotyping by noninvasively measuring hepatic cholesterol content. We observed abnormal hepatic accumulation of cholesterol in the homozygote individuals, supporting the diagnosis of cholesterol ester storage disease. Given previous suggestions of cardiovascular disease risk in heterozygous LIPA mutation carriers, we genotyped E8SJM in >27 000 individuals and found no association with plasma lipid levels or risk of myocardial infarction, confirming a true recessive mode of inheritance. By integrating observations from Mendelian and population genetics along with directed clinical phenotyping, we diagnosed clinically unapparent cholesterol ester storage disease in the affected individuals from this kindred and addressed an outstanding question about risk of cardiovascular disease in LIPA E8SJM heterozygous carriers.
    Arteriosclerosis Thrombosis and Vascular Biology 09/2013; · 6.34 Impact Factor

Publication Stats

13k Citations
3,338.34 Total Impact Points

Institutions

  • 1997–2014
    • University of Oxford
      • • Division of Cardiovascular Medicine
      • • Department of Cardiovascular Medicine
      • • Health Economics Research Centre (HERC)
      Oxford, England, United Kingdom
  • 2013
    • London School of Hygiene and Tropical Medicine
      Londinium, England, United Kingdom
    • Karolinska Institutet
      • Institutionen för medicinsk epidemiologi och biostatistik
      Stockholm, Stockholm, Sweden
    • National Cancer Institute (USA)
      Maryland, United States
  • 1999–2013
    • Oxford University Hospitals NHS Trust
      • Department of Cardiovascular Medicine
      Oxford, England, United Kingdom
    • Massachusetts Eye and Ear Infirmary
      • Department of Otolaryngology
      Boston, MA, United States
  • 2012
    • Wellcome Trust Sanger Institute
      Cambridge, England, United Kingdom
    • Karolinska University Hospital
      • Center for Molecular Medicine (CMM)
      Stockholm, Stockholm, Sweden
    • Johns Hopkins Bloomberg School of Public Health
      Baltimore, Maryland, United States
  • 2000–2012
    • National Heart, Lung, and Blood Institute
      Maryland, United States
  • 1992–2012
    • Massachusetts General Hospital
      • Center for Human Genetic Research
      Boston, MA, United States
  • 2008–2011
    • Newcastle University
      • Institute of Genetic Medicine
      Newcastle upon Tyne, ENG, United Kingdom
    • Groote Schuur Hospital
      Kaapstad, Western Cape, South Africa
  • 2010
    • The University of Manchester
      Manchester, England, United Kingdom
  • 2007
    • Mario Negri Institute for Pharmacological Research
      • Department of Cardiovascular Research
      Milano, Lombardy, Italy
  • 2003–2005
    • Imperial College London
      Londinium, England, United Kingdom
  • 2004
    • University of Cambridge
      • Department of Public Health and Primary Care
      Cambridge, ENG, United Kingdom
  • 2002
    • University of Aberdeen
      Aberdeen, Scotland, United Kingdom
  • 1997–2002
    • Stellenbosch University
      • Division of Medical Physiology
      Stellenbosch, Western Cape, South Africa
  • 1998
    • Hospital of the University of Pennsylvania
      • Department of Physiology
      Philadelphia, Pennsylvania, United States
    • University of Pavia
      Ticinum, Lombardy, Italy
  • 1993–1998
    • Harvard Medical School
      • • Department of Genetics
      • • Department of Medicine
      Boston, MA, United States
  • 1995–1997
    • Howard Hughes Medical Institute
      Maryland, United States
  • 1992–1995
    • Brigham and Women's Hospital
      • Department of Medicine
      Boston, MA, United States