Association of mitochondrial DNA copy number with cardiovascular disease

Foram N. Ashar, Yiyi Zhang, Ryan J. Longchamps, John Lane, Anna Moes, Megan L. Grove, Josyf C. Mychaleckyj, Kent D. Taylor, Josef Coresh, Jerome I. Rotter, Eric Boerwinkle, Nathan Pankratz, Eliseo Guallar, Dan Arking

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Mitochondrial dysfunction is a core component of the aging process and may play a key role in atherosclerotic cardiovascular disease. Mitochondrial DNA copy number (mtDNA-CN), which represents the number of mitochondria per cell and number of mitochondrial genomes per mitochondrion, is an indirect biomarker of mitochondrial function. OBJECTIVE: To determine whether mtDNA-CN, measured in an easily accessible tissue (buffy coat/circulating leukocytes), can improve risk classification for cardiovascular disease (CVD) and help guide initiation of statin therapy for primary prevention of CVD. DESIGN, SETTING, AND PARTICIPANTS: Prospective, population-based cohort analysis including 21 870 participants (20 163 free from CVD at baseline) from 3 studies: Cardiovascular Health Study (CHS), Atherosclerosis Risk in Communities Study (ARIC), and Multiethnic Study of Atherosclerosis (MESA). The mean follow-up was 13.5 years. The study included 11 153 participants from ARIC, 4830 from CHS, and 5887 from MESA. Analysis of the data was conducted from March 10, 2014, to January 29, 2017. EXPOSURES: Mitochondrial DNA-CN measured from buffy coat/circulating leukocytes. MAIN OUTCOMES AND MEASURES: Incident CVD, which combines coronary heart disease, defined as the first incident myocardial infarction or death owing to coronary heart disease, and stroke, defined as the first nonfatal stroke or death owing to stroke. RESULTS: Of the 21 870 participants, the mean age was 62.4 years (ARIC, 57.9 years; MESA, 62.4 years; and CHS, 72.5 years), and 54.7% of participants were women. The hazard ratios for incident coronary heart disease, stroke, and CVD associated with a 1-SD decrease in mtDNA-CN were 1.29 (95% CI, 1.24-1.33), 1.11 (95% CI, 1.06-1.16), and 1.23 (95% CI, 1.19-1.26). The associations persisted after adjustment for traditional CVD risk factors. Addition of mtDNA-CN to the 2013 American College of Cardiology/American Heart Association Pooled Cohorts Equations for estimating 10-year hard atherosclerosis CVD risk was associated with improved risk classification (continuous net reclassification index, 0.194; 95% CI, 0.130-0.258; P < .001). Mitochondrial DNA-CN further improved sensitivity and specificity for the 2013 American College of Cardiology/American Heart Association recommendations on initiating statin therapy for primary prevention of ASCVD (net 221 individuals appropriately downclassified and net 15 individuals appropriately upclassified). CONCLUSIONS AND RELEVANCE: Mitochondrial DNA-CN was independently associated with incident CVD in 3 large prospective studies and may have potential clinical utility in improving CVD risk classification.

Original languageEnglish (US)
Pages (from-to)1247-1255
Number of pages9
JournalJAMA Cardiology
Volume2
Issue number11
DOIs
StatePublished - Nov 1 2017

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Mitochondrial DNA
Cardiovascular Diseases
Atherosclerosis
Stroke
Coronary Disease
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Primary Prevention
Health
Mitochondria
Leukocytes
Mitochondrial Genome
Cohort Studies
Cell Count
Biomarkers
Myocardial Infarction
Prospective Studies
Sensitivity and Specificity
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ashar, F. N., Zhang, Y., Longchamps, R. J., Lane, J., Moes, A., Grove, M. L., ... Arking, D. (2017). Association of mitochondrial DNA copy number with cardiovascular disease. JAMA Cardiology, 2(11), 1247-1255. https://doi.org/10.1001/jamacardio.2017.3683

Association of mitochondrial DNA copy number with cardiovascular disease. / Ashar, Foram N.; Zhang, Yiyi; Longchamps, Ryan J.; Lane, John; Moes, Anna; Grove, Megan L.; Mychaleckyj, Josyf C.; Taylor, Kent D.; Coresh, Josef; Rotter, Jerome I.; Boerwinkle, Eric; Pankratz, Nathan; Guallar, Eliseo; Arking, Dan.

In: JAMA Cardiology, Vol. 2, No. 11, 01.11.2017, p. 1247-1255.

Research output: Contribution to journalArticle

Ashar, FN, Zhang, Y, Longchamps, RJ, Lane, J, Moes, A, Grove, ML, Mychaleckyj, JC, Taylor, KD, Coresh, J, Rotter, JI, Boerwinkle, E, Pankratz, N, Guallar, E & Arking, D 2017, 'Association of mitochondrial DNA copy number with cardiovascular disease', JAMA Cardiology, vol. 2, no. 11, pp. 1247-1255. https://doi.org/10.1001/jamacardio.2017.3683
Ashar FN, Zhang Y, Longchamps RJ, Lane J, Moes A, Grove ML et al. Association of mitochondrial DNA copy number with cardiovascular disease. JAMA Cardiology. 2017 Nov 1;2(11):1247-1255. https://doi.org/10.1001/jamacardio.2017.3683
Ashar, Foram N. ; Zhang, Yiyi ; Longchamps, Ryan J. ; Lane, John ; Moes, Anna ; Grove, Megan L. ; Mychaleckyj, Josyf C. ; Taylor, Kent D. ; Coresh, Josef ; Rotter, Jerome I. ; Boerwinkle, Eric ; Pankratz, Nathan ; Guallar, Eliseo ; Arking, Dan. / Association of mitochondrial DNA copy number with cardiovascular disease. In: JAMA Cardiology. 2017 ; Vol. 2, No. 11. pp. 1247-1255.
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T1 - Association of mitochondrial DNA copy number with cardiovascular disease

AU - Ashar, Foram N.

AU - Zhang, Yiyi

AU - Longchamps, Ryan J.

AU - Lane, John

AU - Moes, Anna

AU - Grove, Megan L.

AU - Mychaleckyj, Josyf C.

AU - Taylor, Kent D.

AU - Coresh, Josef

AU - Rotter, Jerome I.

AU - Boerwinkle, Eric

AU - Pankratz, Nathan

AU - Guallar, Eliseo

AU - Arking, Dan

PY - 2017/11/1

Y1 - 2017/11/1

N2 - IMPORTANCE: Mitochondrial dysfunction is a core component of the aging process and may play a key role in atherosclerotic cardiovascular disease. Mitochondrial DNA copy number (mtDNA-CN), which represents the number of mitochondria per cell and number of mitochondrial genomes per mitochondrion, is an indirect biomarker of mitochondrial function. OBJECTIVE: To determine whether mtDNA-CN, measured in an easily accessible tissue (buffy coat/circulating leukocytes), can improve risk classification for cardiovascular disease (CVD) and help guide initiation of statin therapy for primary prevention of CVD. DESIGN, SETTING, AND PARTICIPANTS: Prospective, population-based cohort analysis including 21 870 participants (20 163 free from CVD at baseline) from 3 studies: Cardiovascular Health Study (CHS), Atherosclerosis Risk in Communities Study (ARIC), and Multiethnic Study of Atherosclerosis (MESA). The mean follow-up was 13.5 years. The study included 11 153 participants from ARIC, 4830 from CHS, and 5887 from MESA. Analysis of the data was conducted from March 10, 2014, to January 29, 2017. EXPOSURES: Mitochondrial DNA-CN measured from buffy coat/circulating leukocytes. MAIN OUTCOMES AND MEASURES: Incident CVD, which combines coronary heart disease, defined as the first incident myocardial infarction or death owing to coronary heart disease, and stroke, defined as the first nonfatal stroke or death owing to stroke. RESULTS: Of the 21 870 participants, the mean age was 62.4 years (ARIC, 57.9 years; MESA, 62.4 years; and CHS, 72.5 years), and 54.7% of participants were women. The hazard ratios for incident coronary heart disease, stroke, and CVD associated with a 1-SD decrease in mtDNA-CN were 1.29 (95% CI, 1.24-1.33), 1.11 (95% CI, 1.06-1.16), and 1.23 (95% CI, 1.19-1.26). The associations persisted after adjustment for traditional CVD risk factors. Addition of mtDNA-CN to the 2013 American College of Cardiology/American Heart Association Pooled Cohorts Equations for estimating 10-year hard atherosclerosis CVD risk was associated with improved risk classification (continuous net reclassification index, 0.194; 95% CI, 0.130-0.258; P < .001). Mitochondrial DNA-CN further improved sensitivity and specificity for the 2013 American College of Cardiology/American Heart Association recommendations on initiating statin therapy for primary prevention of ASCVD (net 221 individuals appropriately downclassified and net 15 individuals appropriately upclassified). CONCLUSIONS AND RELEVANCE: Mitochondrial DNA-CN was independently associated with incident CVD in 3 large prospective studies and may have potential clinical utility in improving CVD risk classification.

AB - IMPORTANCE: Mitochondrial dysfunction is a core component of the aging process and may play a key role in atherosclerotic cardiovascular disease. Mitochondrial DNA copy number (mtDNA-CN), which represents the number of mitochondria per cell and number of mitochondrial genomes per mitochondrion, is an indirect biomarker of mitochondrial function. OBJECTIVE: To determine whether mtDNA-CN, measured in an easily accessible tissue (buffy coat/circulating leukocytes), can improve risk classification for cardiovascular disease (CVD) and help guide initiation of statin therapy for primary prevention of CVD. DESIGN, SETTING, AND PARTICIPANTS: Prospective, population-based cohort analysis including 21 870 participants (20 163 free from CVD at baseline) from 3 studies: Cardiovascular Health Study (CHS), Atherosclerosis Risk in Communities Study (ARIC), and Multiethnic Study of Atherosclerosis (MESA). The mean follow-up was 13.5 years. The study included 11 153 participants from ARIC, 4830 from CHS, and 5887 from MESA. Analysis of the data was conducted from March 10, 2014, to January 29, 2017. EXPOSURES: Mitochondrial DNA-CN measured from buffy coat/circulating leukocytes. MAIN OUTCOMES AND MEASURES: Incident CVD, which combines coronary heart disease, defined as the first incident myocardial infarction or death owing to coronary heart disease, and stroke, defined as the first nonfatal stroke or death owing to stroke. RESULTS: Of the 21 870 participants, the mean age was 62.4 years (ARIC, 57.9 years; MESA, 62.4 years; and CHS, 72.5 years), and 54.7% of participants were women. The hazard ratios for incident coronary heart disease, stroke, and CVD associated with a 1-SD decrease in mtDNA-CN were 1.29 (95% CI, 1.24-1.33), 1.11 (95% CI, 1.06-1.16), and 1.23 (95% CI, 1.19-1.26). The associations persisted after adjustment for traditional CVD risk factors. Addition of mtDNA-CN to the 2013 American College of Cardiology/American Heart Association Pooled Cohorts Equations for estimating 10-year hard atherosclerosis CVD risk was associated with improved risk classification (continuous net reclassification index, 0.194; 95% CI, 0.130-0.258; P < .001). Mitochondrial DNA-CN further improved sensitivity and specificity for the 2013 American College of Cardiology/American Heart Association recommendations on initiating statin therapy for primary prevention of ASCVD (net 221 individuals appropriately downclassified and net 15 individuals appropriately upclassified). CONCLUSIONS AND RELEVANCE: Mitochondrial DNA-CN was independently associated with incident CVD in 3 large prospective studies and may have potential clinical utility in improving CVD risk classification.

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