Steven A Lubitz1,2, Kathryn L Lunetta3,4, Honghuang Lin3,5, Dan E Arking6, Stella Trompet7,8, Guo Li9, Bouwe P Krijthe10,11, Daniel I Chasman12,13, John Barnard14, Marcus E Kleber15, Marcus Dörr16,17, Kouichi Ozaki18, Albert V Smith19, Martina Müller-Nurasyid20,21,22, Stefan Walter23, Joanne M Murabito3,24, Moritz F Sinner20, Vilmundur Gudnason19, Stephan B Felix16,17, Winfried März15,25,26, Mina Chung27,28, Christine M Albert12,29,30, Bruno H Stricker10,11,31,32, Toshihiro Tanaka18,33, Susan R Heckbert9,34,35, J Wouter Jukema36, Alvaro Alonso37, Emelia J Benjamin3,38,39,40, Patrick T Ellinor1,2, Sunil K Agarwal41, Joshua C Bis9, Jennifer A Brody9, Lin Y Chen42, Brendan M Everett12,29, Ian Ford43, Oscar H Franco10,11, Tamara B Harris44, Albert Hofman10,11, Stefan Kääb20,45, Saagar Mahida46, Sekar Kathiresan47, Michiaki Kubo48, Lenore J Launer44, Peter W MacFarlane49, Jared W Magnani3,38, Barbara McKnight50, David D McManus51, Annette Peters45,52, Bruce M Psaty9,53,34,35, Lynda M Rose30, Jerome I Rotter54, Guenther Silbernagel55, Jonathan D Smith56, Nona Sotoodehnia9,57, David J Stott58, Kent D Taylor59, Andreas Tomaschitz60, Tatsuhiko Tsunoda61, Andre G Uitterlinden10,11,31, David R Van Wagoner27, Uwe Völker17,62, Henry Völzke17,63. 1. Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA. 2. Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA. 3. Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA. 4. Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA. 5. Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. 6. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 7. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. 8. Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands. 9. Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA. 10. Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands. 11. Netherlands Consortium on Healthy Aging (NCHA), The Netherlands. 12. Harvard Medical School, Boston, Massachusetts, USA. 13. Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. 14. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA. 15. Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany. 16. Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany. 17. DZHK (German Centre for Cardiovascular Research), Partner site Greifswald, Germany. 18. Laboratory for Cardiovascular Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan. 19. Icelandic Heart Association, Kopavogur Iceland and University of Iceland Reykjavik, Iceland. 20. Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany. 21. Institute of Genetic Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Neuherberg, Germany. 22. Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians University, Munich, Germany. 23. Department of Society, Human Development & Health, Harvard School of Public Health, Boston, Massachusetts, USA. 24. Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. 25. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. 26. Synlab Academy, Synlab Services GmbH, Mannheim, Germany. 27. Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA. 28. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA. 29. Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA. 30. Division of Preventive Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. 31. Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. 32. Inspectorate for Health Care, the Hague, The Netherlands. 33. Department of Human Genetics and Disease Diversity, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. 34. Department of Epidemiology, University of Washington, Seattle, Washington, USA. 35. Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA. 36. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands and Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. 37. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA. 38. Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. 39. Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA. 40. Preventive Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. 41. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. 42. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA. 43. Robertson Center for Biostatistics, University of Glasgow, United Kingdom. 44. Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA. 45. Deutsches Forschungszentrum für Herz-Kreislauferkrankungen (DZHK), Partner site Munich Heart Alliance, Munich, Germany. 46. Leeds General Infirmary, Great George Street, Leeds, UK. 47. Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA. 48. Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan. 49. Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom. 50. Department of Biostatistics, University of Washington, Seattle, Washington, USA. 51. Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA. 52. Institute of Epidemiology II, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Neuherberg, Germany. 53. Department of Health Services, University of Washington, Seattle, Washington, USA. 54. Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif, USA. 55. Department of Angiology, Swiss Cardiovascular Centre, Bern University Hospital, Bern, Switzerland. 56. Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA. 57. Division of Cardiology, University of Washington, Seattle, Washington, USA. 58. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom. 59. Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. 60. Department of Cardiology, Medical University of Graz, Graz, Austria. 61. Laboratory for Medical Science Mathematics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan. 62. Interfaculty Institute for Genetics and Functional Genomics, Ernst Moritz Arndt University Greifswald, Greifswald, Germany. 63. Institute for Community Medicine, Ernst Moritz Arndt University Greifswald, Greifswald, Germany.
Abstract
OBJECTIVES: This study sought to identify nonredundant atrial fibrillation (AF) genetic susceptibility signals and examine their cumulative relations with AF risk. BACKGROUND: AF-associated loci span broad genomic regions that may contain multiple susceptibility signals. Whether multiple signals exist at AF loci has not been systematically explored. METHODS: We performed association testing conditioned on the most significant, independently associated genetic markers at 9 established AF loci using 2 complementary techniques in 64,683 individuals of European ancestry (3,869 incident and 3,302 prevalent AF cases). Genetic risk scores were created and tested for association with AF in Europeans and an independent sample of 11,309 individuals of Japanese ancestry (7,916 prevalent AF cases). RESULTS: We observed at least 4 distinct AF susceptibility signals on chromosome 4q25 upstream of PITX2, but not at the remaining 8 AF loci. A multilocus score comprised 12 genetic markers demonstrated an estimated 5-fold gradient in AF risk. We observed a similar spectrum of risk associated with these markers in Japanese. Regions containing AF signals on chromosome 4q25 displayed a greater degree of evolutionary conservation than the remainder of the locus, suggesting that they may tag regulatory elements. CONCLUSIONS: The chromosome 4q25 AF locus is architecturally complex and harbors at least 4 AF susceptibility signals in individuals of European ancestry. Similar polygenic AF susceptibility exists between Europeans and Japanese. Future work is necessary to identify causal variants, determine mechanisms by which associated loci predispose to AF, and explore whether AF susceptibility signals classify individuals at risk for AF and related morbidity.
OBJECTIVES: This study sought to identify nonredundant atrial fibrillation (AF) genetic susceptibility signals and examine their cumulative relations with AF risk. BACKGROUND:AF-associated loci span broad genomic regions that may contain multiple susceptibility signals. Whether multiple signals exist at AF loci has not been systematically explored. METHODS: We performed association testing conditioned on the most significant, independently associated genetic markers at 9 established AF loci using 2 complementary techniques in 64,683 individuals of European ancestry (3,869 incident and 3,302 prevalent AF cases). Genetic risk scores were created and tested for association with AF in Europeans and an independent sample of 11,309 individuals of Japanese ancestry (7,916 prevalent AF cases). RESULTS: We observed at least 4 distinct AF susceptibility signals on chromosome 4q25 upstream of PITX2, but not at the remaining 8 AF loci. A multilocus score comprised 12 genetic markers demonstrated an estimated 5-fold gradient in AF risk. We observed a similar spectrum of risk associated with these markers in Japanese. Regions containing AF signals on chromosome 4q25 displayed a greater degree of evolutionary conservation than the remainder of the locus, suggesting that they may tag regulatory elements. CONCLUSIONS: The chromosome 4q25 AF locus is architecturally complex and harbors at least 4 AF susceptibility signals in individuals of European ancestry. Similar polygenic AF susceptibility exists between Europeans and Japanese. Future work is necessary to identify causal variants, determine mechanisms by which associated loci predispose to AF, and explore whether AF susceptibility signals classify individuals at risk for AF and related morbidity.
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Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
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