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Causal associations between blood pressure and the risk of myocardial infarction: A bidirectional Mendelian

Zhi-Qiang Yang1, Ting-Ting Fan1, Zheng Wang1

  • 1Department of Cardiovascular Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.

Frontiers in Cardiovascular Medicine
|November 28, 2022
PubMed

Insights

Elevated systolic and diastolic blood pressure causally increase myocardial infarction risk. However, myocardial infarction does not influence blood pressure. Optimal blood pressure control is key for preventing heart attacks.

Area of Science:

  • Cardiovascular Genetics
  • Epidemiology
  • Biostatistics

Background:

  • Observational studies suggest elevated blood pressure (BP) is a major risk factor for myocardial infarction (MI).
  • The causal nature of the association between BP and MI risk remains uncertain.
  • Mendelian randomization (MR) offers a powerful tool to investigate causal relationships using genetic variants.

Purpose of the Study:

  • To investigate the potential causal association between blood pressure levels and the risk of myocardial infarction.
  • To examine the potential bidirectional causal relationship between systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) with MI.

Main Methods:

  • Utilized a two-sample Mendelian randomization (TSMR) approach.
  • Employed genetic variants associated with BP and MI traits from large-scale consortia (International Consortium of Blood Pressure and UK Biobank).
  • Conducted bidirectional analyses to assess causality in both directions (BP to MI, and MI to BP).

Main Results:

  • Forward MR analysis indicated a significant causal association between elevated SBP and DBP with increased MI risk (ORSBP: 1.0008, P < 2 × 10-22; ORDBP: 1.0014, P < 2 × 10-28).
  • Pulse pressure (PP) did not show a significant causal association with MI in the forward analysis (ORPP: 1.0092, P = 0.179).
  • Reverse MR analyses demonstrated no significant causal relationship between MI and SBP, DBP, or PP (all P > 0.58). Sensitivity analyses confirmed the robustness of these findings and found no evidence of horizontal pleiotropy.

Conclusions:

  • Elevated systolic and diastolic blood pressure causally increase the risk of myocardial infarction.
  • There is no evidence of a causal relationship where myocardial infarction influences blood pressure levels.
  • Optimal blood pressure control is a crucial therapeutic target for preventing myocardial infarction in the general population, independent of other risk factors.
Abstract

Keywords:
bidirectional Mendelian randomizationblood pressurecausationgenome-wide association studymyocardial infarction

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