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Published on: January 26, 2024
Genetic Associations of Circulating Cardiovascular Proteins With Gestational Hypertension and Preeclampsia
Art Schuermans1,2,3, Buu Truong1,2, Maddalena Ardissino4,5
1Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts.
Insights
This study identified specific cardiovascular disease-related proteins associated with hypertensive disorders of pregnancy (HDPs). Findings suggest potential therapeutic targets for reducing HDP risk and long-term cardiovascular disease in affected women.
Area of Science:
- Cardiovascular Disease Research
- Reproductive Health
- Genetics and Genomics
Background:
- Hypertensive disorders of pregnancy (HDPs) significantly contribute to maternal morbidity and mortality globally.
- Women with HDPs have an increased risk of long-term cardiovascular disease.
Purpose of the Study:
- To identify circulating proteins associated with hypertensive disorders of pregnancy (HDPs).
- To explore potential therapeutic targets for HDPs and associated cardiovascular risks.
Main Methods:
- Two-sample Mendelian randomization (MR) was used to test associations between genetic instruments for cardiovascular disease-related proteins and HDPs.
- Downstream analyses included a systematic review of observational data and phenome-wide MR analyses.
Main Results:
- Genetic associations were found for 4 proteins with gestational hypertension and 2 proteins with preeclampsia.
- Observational data supported findings for NT-proBNP, HSP27, and ECP in relation to HDP risk.
- Phenome-wide MR identified 37 unique non-HDP-related protein-disease associations.
Conclusions:
- The study suggests genetic links between specific cardiovascular proteins and HDPs.
- Further research is needed to evaluate the efficacy of targeting these protein pathways to mitigate HDP risk.
Importance:
Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and preeclampsia, are important contributors to maternal morbidity and mortality worldwide. In addition, women with HDPs face an elevated long-term risk of cardiovascular disease.
Objective:
To identify proteins in the circulation associated with HDPs.
Design, Setting, And Participants:
Two-sample mendelian randomization (MR) tested the associations of genetic instruments for cardiovascular disease-related proteins with gestational hypertension and preeclampsia. In downstream analyses, a systematic review of observational data was conducted to evaluate the identified proteins' dynamics across gestation in hypertensive vs normotensive pregnancies, and phenome-wide MR analyses were performed to identify potential non-HDP-related effects associated with the prioritized proteins. Genetic association data for cardiovascular disease-related proteins were obtained from the Systematic and Combined Analysis of Olink Proteins (SCALLOP) consortium. Genetic association data for the HDPs were obtained from recent European-ancestry genome-wide association study meta-analyses for gestational hypertension and preeclampsia. Study data were analyzed October 2022 to October 2023.
Exposures:
Genetic instruments for 90 candidate proteins implicated in cardiovascular diseases, constructed using cis-protein quantitative trait loci (cis-pQTLs).
Main Outcomes And Measures:
Gestational hypertension and preeclampsia.
Results:
Genetic association data for cardiovascular disease-related proteins were obtained from 21 758 participants from the SCALLOP consortium. Genetic association data for the HDPs were obtained from 393 238 female individuals (8636 cases and 384 602 controls) for gestational hypertension and 606 903 female individuals (16 032 cases and 590 871 controls) for preeclampsia. Seventy-five of 90 proteins (83.3%) had at least 1 valid cis-pQTL. Of those, 10 proteins (13.3%) were significantly associated with HDPs. Four were robust to sensitivity analyses for gestational hypertension (cluster of differentiation 40, eosinophil cationic protein [ECP], galectin 3, N-terminal pro-brain natriuretic peptide [NT-proBNP]), and 2 were robust for preeclampsia (cystatin B, heat shock protein 27 [HSP27]). Consistent with the MR findings, observational data revealed that lower NT-proBNP (0.76- to 0.88-fold difference vs no HDPs) and higher HSP27 (2.40-fold difference vs no HDPs) levels during the first trimester of pregnancy were associated with increased risk of HDPs, as were higher levels of ECP (1.60-fold difference vs no HDPs). Phenome-wide MR analyses identified 37 unique non-HDP-related protein-disease associations, suggesting potential on-target effects associated with interventions lowering HDP risk through the identified proteins.
Conclusions And Relevance:
Study findings suggest genetic associations of 4 cardiovascular disease-related proteins with gestational hypertension and 2 associated with preeclampsia. Future studies are required to test the efficacy of targeting the corresponding pathways to reduce HDP risk.
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