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Causal atlas on comorbidities in cardiomyopathy: a Mendelian randomization study of European ancestry
Mengting Sun1, Ming Gao2, Peng Huang3
1Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
Insights
This study reveals that atrial fibrillation and hypertension increase cardiomyopathy risk. Hypertension also lowers dilated cardiomyopathy risk, with atrial fibrillation mediating the hypertension-cardiomyopathy link.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Epidemiology
Background:
- Cardiomyopathy (CM) significantly increases mortality risk, often due to associated comorbidities.
- Understanding the causal links between CM and its subtypes with comorbidities is crucial for risk stratification and management.
Purpose of the Study:
- To investigate the causal associations between various comorbidities and cardiomyopathy (CM), including hypertrophic (HCM), dilated (DCM), and restrictive (RCM) subtypes.
- To explore the mediating role of atrial fibrillation (AF) and hypertension in the relationship between these conditions and CM.
Main Methods:
- Utilized bidirectional Mendelian randomization (MR) to analyze genetic associations between 39 comorbidities and CM.
- Examined causal links between blood pressure parameters (systolic, diastolic, pulse pressure) and CM/DCM.
- Employed MR Mediation analysis to assess AF and hypertension as potential mediators.
Main Results:
- Identified atrial fibrillation (AF) and hypertension as risk factors for CM.
- Found hypertension causally linked to a reduced risk of DCM.
- Discovered AF mediates the causal association between hypertension and CM, accounting for approximately 16.22%.
Conclusions:
- This research establishes novel causal relationships between specific comorbidities and cardiomyopathy, particularly DCM.
- Highlights the mediating role of AF in the hypertension-cardiomyopathy pathway.
- Provides insights into the complex interplay between comorbidities and heart muscle diseases.
Background:
Cardiomyopathy (CM) is often accompanied by comorbidities that increase the risk of death. Our aim is to explore the causal association between CM and its subtypes and various related comorbidities.
Methods:
Bidirectional Mendelian randomization (MR) was used to explore the causal association between 39 comorbidities and CM, 13 comorbidities and hypertrophic cardiomyopathy (HCM), 25 comorbidities and dilated cardiomyopathy (DCM), and 13 comorbidities and restrictive cardiomyopathy (RCM). Besides, we explored the causal associations between systolic, diastolic, and pulse pressure with CM and DCM, respectively. MR Mediation analysis was used to explore whether atrial fibrillation (AF) or hypertension was as mediating variable mediating the causal association between each other and CM.
Results:
By MR analysis, we found that AF (OR = 1.28) and hypertension (OR = 3.58) were associated with an increased risk of CM, and CM was causally associated with an increased risk of heart failure (OR = 1.40). In addition, hypertension was causally associated with a lower risk of DCM (OR = 0.22). The results of the causal association of systolic, diastolic, and pulse pressure with CM and DCM were consistent with the direction of the causal association of hypertension with CM and DCM. Through MR Mediation analysis, we found AF as a mediating factor mediates the causal association between hypertension and CM, with a mediating proportion of about 16.22%.
Conclusions:
This study is the first to reveal the causal association between certain comorbidities and CM and DCM, and to find possible mediating effects among them.
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