Tingting Geng1,2, Xuling Chang3,4, Ling Wang5, Gang Liu2, Jianjun Liu5,6, Chiea Chuen Khor5,7, Nithya Neelakantan8, Jian-Min Yuan9,10, Woon-Puay Koh11,12, An Pan1, Rajkumar Dorajoo5,13, Chew-Kiat Heng3,4. 1. Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 2. Department of Nutrition and Food Hygiene, Ministry of Education Key Lab of Environment and Health and School of Public Health, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China. 3. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 4. Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore. 5. Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore. 6. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 7. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. 8. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. 9. Division of Cancer Control and Population Sciences, University of Pittsburgh Medical Center Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA. 10. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 11. Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 12. Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore. 13. Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore.
Abstract
BACKGROUND: Understanding the genetic predisposition to cardiovascular disease (CVD) may help to improve clinical intervention strategies. Lifestyle factors, such as diet, may differ among ethnic groups and may, in turn, modify individuals' risks to diseases. OBJECTIVES: We examined the genetic predisposition to ever smoking in relation to CVD mortality and assessed whether such an association could be modified by dietary intake. METHODS: A total of 23,760 Chinese adults from the Singapore Chinese Heath Study who were free of cancer and CVD at recruitment (1993-1998) were included in the study. A weighted genetic risk score (wGRS) was calculated to define the genetically determined regular smoking behavior (never or ever). Multivariable-adjusted Cox regression models were used to assess the association between the wGRS and CVD mortality. We also conducted a 1-sample Mendelian randomization analysis for ever smoking and CVD mortality. RESULTS: Over a mean of 22.6 years of follow-up, 2301 CVD deaths were identified. A genetic predisposition to ever smoking was significantly associated with CVD mortality; the multivariable-adjusted HR of CVD mortality was 1.07 (95% CI: 1.03-1.12), with a per-SD increment in the wGRS. However, the Mendelian randomization analysis did not support a causal relationship between ever smoking and CVD mortality (OR, 1.13; 95% CI: 0.87-1.45). Additionally, the Dietary Approaches to Stop Hypertension (DASH) score significantly modified the association between the smoking wGRS and CVD mortality; the association between a genetic predisposition to smoking and CVD mortality was only observed among individuals with a low DASH score (P-interaction = 0.004). CONCLUSIONS: A genetic predisposition to smoking was associated with CVD mortality in the Chinese population. In addition, we detected a significant interaction showing higher CVD mortality related to genetically determined smoking among those with lower DASH scores.
BACKGROUND: Understanding the genetic predisposition to cardiovascular disease (CVD) may help to improve clinical intervention strategies. Lifestyle factors, such as diet, may differ among ethnic groups and may, in turn, modify individuals' risks to diseases. OBJECTIVES: We examined the genetic predisposition to ever smoking in relation to CVD mortality and assessed whether such an association could be modified by dietary intake. METHODS: A total of 23,760 Chinese adults from the Singapore Chinese Heath Study who were free of cancer and CVD at recruitment (1993-1998) were included in the study. A weighted genetic risk score (wGRS) was calculated to define the genetically determined regular smoking behavior (never or ever). Multivariable-adjusted Cox regression models were used to assess the association between the wGRS and CVD mortality. We also conducted a 1-sample Mendelian randomization analysis for ever smoking and CVD mortality. RESULTS: Over a mean of 22.6 years of follow-up, 2301 CVD deaths were identified. A genetic predisposition to ever smoking was significantly associated with CVD mortality; the multivariable-adjusted HR of CVD mortality was 1.07 (95% CI: 1.03-1.12), with a per-SD increment in the wGRS. However, the Mendelian randomization analysis did not support a causal relationship between ever smoking and CVD mortality (OR, 1.13; 95% CI: 0.87-1.45). Additionally, the Dietary Approaches to Stop Hypertension (DASH) score significantly modified the association between the smoking wGRS and CVD mortality; the association between a genetic predisposition to smoking and CVD mortality was only observed among individuals with a low DASH score (P-interaction = 0.004). CONCLUSIONS: A genetic predisposition to smoking was associated with CVD mortality in the Chinese population. In addition, we detected a significant interaction showing higher CVD mortality related to genetically determined smoking among those with lower DASH scores.
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Authors: Ute Mons; Aysel Müezzinler; Carolin Gellert; Ben Schöttker; Christian C Abnet; Martin Bobak; Lisette de Groot; Neal D Freedman; Eugène Jansen; Frank Kee; Daan Kromhout; Kari Kuulasmaa; Tiina Laatikainen; Mark G O'Doherty; Bas Bueno-de-Mesquita; Philippos Orfanos; Annette Peters; Yvonne T van der Schouw; Tom Wilsgaard; Alicja Wolk; Antonia Trichopoulou; Paolo Boffetta; Hermann Brenner Journal: BMJ Date: 2015-04-20
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