@article {101, title = {Transcriptomic signatures across human tissues identify functional rare genetic variation.}, journal = {Science}, volume = {369}, year = {2020}, month = {2020 09 11}, abstract = {

Rare genetic variants are abundant across the human genome, and identifying their function and phenotypic impact is a major challenge. Measuring aberrant gene expression has aided in identifying functional, large-effect rare variants (RVs). Here, we expanded detection of genetically driven transcriptome abnormalities by analyzing gene expression, allele-specific expression, and alternative splicing from multitissue RNA-sequencing data, and demonstrate that each signal informs unique classes of RVs. We developed Watershed, a probabilistic model that integrates multiple genomic and transcriptomic signals to predict variant function, validated these predictions in additional cohorts and through experimental assays, and used them to assess RVs in the UK Biobank, the Million Veterans Program, and the Jackson Heart Study. Our results link thousands of RVs to diverse molecular effects and provide evidence to associate RVs affecting the transcriptome with human traits.

}, keywords = {Genetic Variation, Genome, Human, Humans, Multifactorial Inheritance, Organ Specificity, Transcriptome}, issn = {1095-9203}, doi = {10.1126/science.aaz5900}, author = {Ferraro, Nicole M and Strober, Benjamin J and Einson, Jonah and Abell, Nathan S and Aguet, Fran{\c c}ois and Barbeira, Alvaro N and Brandt, Margot and Bucan, Maja and Castel, Stephane E and Davis, Joe R and Greenwald, Emily and Hess, Gaelen T and Hilliard, Austin T and Kember, Rachel L and Kotis, Bence and Park, YoSon and Peloso, Gina and Ramdas, Shweta and Scott, Alexandra J and Smail, Craig and Tsang, Emily K and Zekavat, Seyedeh M and Ziosi, Marcello and Ardlie, Kristin G and Assimes, Themistocles L and Bassik, Michael C and Brown, Christopher D and Correa, Adolfo and Hall, Ira and Im, Hae Kyung and Li, Xin and Natarajan, Pradeep and Lappalainen, Tuuli and Mohammadi, Pejman and Montgomery, Stephen B and Battle, Alexis} } @article {21, title = {Polygenic Risk Score Identifies Subgroup With Higher Burden of Atherosclerosis and Greater Relative Benefit From Statin Therapy in the Primary Prevention Setting.}, journal = {Circulation}, volume = {135}, year = {2017}, month = {2017 May 30}, pages = {2091-2101}, abstract = {

BACKGROUND: Relative risk reduction with statin therapy has been consistent across nearly all subgroups studied to date. However, in analyses of 2 randomized controlled primary prevention trials (ASCOT [Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm] and JUPITER [Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin]), statin therapy led to a greater relative risk reduction among a subgroup at high genetic risk. Here, we aimed to confirm this observation in a third primary prevention randomized controlled trial. In addition, we assessed whether those at high genetic risk had a greater burden of subclinical coronary atherosclerosis.

METHODS: We studied participants from a randomized controlled trial of primary prevention with statin therapy (WOSCOPS [West of Scotland Coronary Prevention Study]; n=4910) and 2 observational cohort studies (CARDIA [Coronary Artery Risk Development in Young Adults] and BioImage; n=1154 and 4392, respectively). For each participant, we calculated a polygenic risk score derived from up to 57 common DNA sequence variants previously associated with coronary heart disease. We compared the relative efficacy of statin therapy in those at high genetic risk (top quintile of polygenic risk score) versus all others (WOSCOPS), as well as the association between the polygenic risk score and coronary artery calcification (CARDIA) and carotid artery plaque burden (BioImage).

RESULTS: Among WOSCOPS trial participants at high genetic risk, statin therapy was associated with a relative risk reduction of 44\% (95\% confidence interval [CI], 22-60; <0.001), whereas in all others, the relative risk reduction was 24\% (95\% CI, 8-37; =0.004) despite similar low-density lipoprotein cholesterol lowering. In a study-level meta-analysis across the WOSCOPS, ASCOT, and JUPITER primary prevention, relative risk reduction in those at high genetic risk was 46\% versus 26\% in all others ( for heterogeneity=0.05). Across all 3 studies, the absolute risk reduction with statin therapy was 3.6\% (95\% CI, 2.0-5.1) among those in the high genetic risk group and 1.3\% (95\% CI, 0.6-1.9) in all others. Each 1-SD increase in the polygenic risk score was associated with 1.32-fold (95\% CI, 1.04-1.68) greater likelihood of having coronary artery calcification and 9.7\% higher (95\% CI, 2.2-17.8) burden of carotid plaque.

CONCLUSIONS: Those at high genetic risk have a greater burden of subclinical atherosclerosis and derive greater relative and absolute benefit from statin therapy to prevent a first coronary heart disease event.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00738725 (BioImage) and NCT00005130 (CARDIA). WOSCOPS was carried out and completed before the requirement for clinical trial registration.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Atherosclerosis, Cohort Studies, Cost of Illness, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Multifactorial Inheritance, Primary Prevention, Risk Factors, Young Adult}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.116.024436}, author = {Natarajan, Pradeep and Young, Robin and Stitziel, Nathan O and Padmanabhan, Sandosh and Baber, Usman and Mehran, Roxana and Sartori, Samantha and Fuster, Valentin and Reilly, Dermot F and Butterworth, Adam and Rader, Daniel J and Ford, Ian and Sattar, Naveed and Kathiresan, Sekar} } @article {8, title = {Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease.}, journal = {N Engl J Med}, volume = {375}, year = {2016}, month = {2016 Dec 15}, pages = {2349-2358}, abstract = {

BACKGROUND: Both genetic and lifestyle factors contribute to individual-level risk of coronary artery disease. The extent to which increased genetic risk can be offset by a healthy lifestyle is unknown.

METHODS: Using a polygenic score of DNA sequence polymorphisms, we quantified genetic risk for coronary artery disease in three prospective cohorts - 7814 participants in the Atherosclerosis Risk in Communities (ARIC) study, 21,222 in the Women{\textquoteright}s Genome Health Study (WGHS), and 22,389 in the Malm{\"o} Diet and Cancer Study (MDCS) - and in 4260 participants in the cross-sectional BioImage Study for whom genotype and covariate data were available. We also determined adherence to a healthy lifestyle among the participants using a scoring system consisting of four factors: no current smoking, no obesity, regular physical activity, and a healthy diet.

RESULTS: The relative risk of incident coronary events was 91\% higher among participants at high genetic risk (top quintile of polygenic scores) than among those at low genetic risk (bottom quintile of polygenic scores) (hazard ratio, 1.91; 95\% confidence interval [CI], 1.75 to 2.09). A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor), regardless of the genetic risk category. Among participants at high genetic risk, a favorable lifestyle was associated with a 46\% lower relative risk of coronary events than an unfavorable lifestyle (hazard ratio, 0.54; 95\% CI, 0.47 to 0.63). This finding corresponded to a reduction in the standardized 10-year incidence of coronary events from 10.7\% for an unfavorable lifestyle to 5.1\% for a favorable lifestyle in ARIC, from 4.6\% to 2.0\% in WGHS, and from 8.2\% to 5.3\% in MDCS. In the BioImage Study, a favorable lifestyle was associated with significantly less coronary-artery calcification within each genetic risk category.

CONCLUSIONS: Across four studies involving 55,685 participants, genetic and lifestyle factors were independently associated with susceptibility to coronary artery disease. Among participants at high genetic risk, a favorable lifestyle was associated with a nearly 50\% lower relative risk of coronary artery disease than was an unfavorable lifestyle. (Funded by the National Institutes of Health and others.).

}, keywords = {Aged, Cohort Studies, Coronary Disease, Cross-Sectional Studies, Female, Genetic Predisposition to Disease, Healthy Lifestyle, Humans, Incidence, Male, Middle Aged, Multifactorial Inheritance, Patient Compliance, Polymorphism, Genetic, Risk}, issn = {1533-4406}, doi = {10.1056/NEJMoa1605086}, author = {Khera, Amit V and Emdin, Connor A and Drake, Isabel and Natarajan, Pradeep and Bick, Alexander G and Cook, Nancy R and Chasman, Daniel I and Baber, Usman and Mehran, Roxana and Rader, Daniel J and Fuster, Valentin and Boerwinkle, Eric and Melander, Olle and Orho-Melander, Marju and Ridker, Paul M and Kathiresan, Sekar} }