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Item Ankle-Brachial Index and Risk of Sudden Cardiac Death in the Community: The ARIC Study(American Heart Association, 2024) Suzuki, Takeki; Zhu, Xiaoqian; Adabag, Selcuk; Matsushita, Kunihiro; Butler, Kenneth R.; Griswold, Michael E.; Alonso, Alvaro; Rosamond, Wayne; Sotoodehnia, Nona; Mosley, Thomas H.; Medicine, School of MedicineBackground: Sudden cardiac death (SCD) is a significant global public health problem accounting for 15% to 20% of all deaths. A great majority of SCD is associated with coronary heart disease, which may first be detected at autopsy. The ankle-brachial index (ABI) is a simple, noninvasive measure of subclinical atherosclerosis. The purpose of this study was to examine the relationship between ABI and SCD in a middle-aged biracial general population. Methods and results: Participants of the ARIC (Atherosclerosis Risk in Communities) study with an ABI measurement between 1987 and 1989 were included. ABI was categorized as low (≤0.90), borderline (0.90-1.00), normal (1.00-1.40), and noncompressible (>1.40). SCD was defined as a sudden pulseless condition presumed to be caused by a ventricular tachyarrhythmia in a previously stable individual and was adjudicated by a committee of cardiac electrophysiologists, cardiologists, and internists. Cox proportional hazards models were used to evaluate the associations between baseline ABI and incident SCD. Of the 15 081 participants followed for a median of 23.5 years, 556 (3.7%) developed SCD (1.96 cases per 1000 person-years). Low and borderline ABIs were associated with an increased risk of SCD (demographically adjusted hazard ratios [ HRs ], 2.27 [ 95% CI, 1.64-3.14 ] and 1.52 [ 95% CI, 1.17-1.96 ], respectively) compared with normal ABI. The association between low ABI and SCD remained significant after adjustment for traditional cardiovascular risk factors (HR, 1.63 [ 95% CI, 1.15-2.32 ]). Conclusions: Low ABI is independently associated with an increased risk of SCD in a middle-aged biracial general population. ABI could be incorporated into future SCD risk prediction models.Item Carotid Intima‐Media Thickness and the Risk of Sudden Cardiac Death: The ARIC Study and the CHS(American Heart Association, 2020-10-20) Suzuki, Takeki; Wang, Wanmei; Wilsdon, Anthony; Butler, Kenneth R.; Adabag, Selcuk; Griswold, Michael E.; Nambi, Vijay; Rosamond, Wayne; Sotoodehnia, Nona; Mosley, Thomas H.; Medicine, School of MedicineBackground: Sudden cardiac death (SCD) is associated with severe coronary heart disease in the great majority of cases. Whether carotid intima-media thickness (C-IMT), a known surrogate marker of subclinical atherosclerosis, is associated with risk of SCD in a general population remains unknown. The objective of this study was to investigate the association between C-IMT and risk of SCD. Methods and Results We examined a total of 20 862 participants: 15 307 participants of the ARIC (Atherosclerosis Risk in Communities) study and 5555 participants of the CHS (Cardiovascular Health Study). C-IMT and common carotid artery intima-media thickness was measured at baseline by ultrasound. Presence of plaque was judged by trained readers. Over a median of 23.5 years of follow-up, 569 participants had SCD (1.81 cases per 1000 person-years) in the ARIC study. Mean C-IMT and common carotid artery intima-media thickness were associated with risk of SCD after adjustment for traditional risk factors and time-varying adjustors: hazard ratios (HRs) with 95% CIs for fourth versus first quartile were 1.64 (1.15-2.63) and 1.49 (1.05-2.11), respectively. In CHS, 302 participants developed SCD (4.64 cases per 1000 person-years) over 13.1 years. Maximum C-IMT was associated with risk of SCD after adjustment: HR (95% CI) for fourth versus first quartile was 1.75 (1.22-2.51). Presence of plaque was associated with 35% increased risk of SCD: HR (95% CI) of 1.37 (1.13-1.67) in the ARIC study and 1.32 (1.04-1.68) in CHS. Conclusions C-IMT was associated with risk of SCD in 2 biracial community-based cohorts. C-IMT may be used as a marker of SCD risk and potentially to initiate early therapeutic interventions to mitigate the risk.Item Sequencing of 53,831 diverse genomes from the NHLBI TOPMed Program(Springer Nature, 2021) Taliun, Daniel; Harris, Daniel N.; Kessler, Michael D.; Carlson, Jedidiah; Szpiech, Zachary A.; Torres, Raul; Gagliano Taliun, Sarah A.; Corvelo, André; Gogarten, Stephanie M.; Kang, Hyun Min; Pitsillides, Achilleas N.; LeFaive, Jonathon; Lee, Seung-Been; Tian, Xiaowen; Browning, Brian L.; Das, Sayantan; Emde, Anne-Katrin; Clarke, Wayne E.; Loesch, Douglas P.; Shetty, Amol C.; Blackwell, Thomas W.; Smith, Albert V.; Wong, Quenna; Liu, Xiaoming; Conomos, Matthew P.; Bobo, Dean M.; Aguet, François; Albert, Christine; Alonso, Alvaro; Ardlie, Kristin G.; Arking, Dan E.; Aslibekyan, Stella; Auer, Paul L.; Barnard, John; Barr, R. Graham; Barwick, Lucas; Becker, Lewis C.; Beer, Rebecca L.; Benjamin, Emelia J.; Bielak, Lawrence F.; Blangero, John; Boehnke, Michael; Bowden, Donald W.; Brody, Jennifer A.; Burchard, Esteban G.; Cade, Brian E.; Casella, James F.; Chalazan, Brandon; Chasman, Daniel I.; Chen, Yii-Der Ida; Cho, Michael H.; Choi, Seung Hoan; Chung, Mina K.; Clish, Clary B.; Correa, Adolfo; Curran, Joanne E.; Custer, Brian; Darbar, Dawood; Daya, Michelle; de Andrade, Mariza; DeMeo, Dawn L.; Dutcher, Susan K.; Ellinor, Patrick T.; Emery, Leslie S.; Eng, Celeste; Fatkin, Diane; Fingerlin, Tasha; Forer, Lukas; Fornage, Myriam; Franceschini, Nora; Fuchsberger, Christian; Fullerton, Stephanie M.; Germer, Soren; Gladwin, Mark T.; Gottlieb, Daniel J.; Guo, Xiuqing; Hall, Michael E.; He, Jiang; Heard-Costa, Nancy L.; Heckbert, Susan R.; Irvin, Marguerite R.; Johnsen, Jill M.; Johnson, Andrew D.; Kaplan, Robert; Kardia, Sharon L. R.; Kelly, Tanika; Kelly, Shannon; Kenny, Eimear E.; Kiel, Douglas P.; Klemmer, Robert; Konkle, Barbara A.; Kooperberg, Charles; Köttgen, Anna; Lange, Leslie A.; Lasky-Su, Jessica; Levy, Daniel; Lin, Xihong; Lin, Keng-Han; Liu, Chunyu; Loos, Ruth J. F.; Garman, Lori; Gerszten, Robert; Lubitz, Steven A.; Lunetta, Kathryn L.; Mak, Angel C. Y.; Manichaikul, Ani; Manning, Alisa K.; Mathias, Rasika A.; McManus, David D.; McGarvey, Stephen T.; Meigs, James B.; Meyers, Deborah A.; Mikulla, Julie L.; Minear, Mollie A.; Mitchell, Braxton D.; Mohanty, Sanghamitra; Montasser, May E.; Montgomery, Courtney; Morrison, Alanna C.; Murabito, Joanne M.; Natale, Andrea; Natarajan, Pradeep; Nelson, Sarah C.; North, Kari E.; O'Connell, Jeffrey R.; Palmer, Nicholette D.; Pankratz, Nathan; Peloso, Gina M.; Peyser, Patricia A.; Pleiness, Jacob; Post, Wendy S.; Psaty, Bruce M.; Rao, D. C.; Redline, Susan; Reiner, Alexander P.; Roden, Dan; Rotter, Jerome I.; Ruczinski, Ingo; Sarnowski, Chloé; Schoenherr, Sebastian; Schwartz, David A.; Seo, Jeong-Sun; Seshadri, Sudha; Sheehan, Vivien A.; Sheu, Wayne H.; Shoemaker, M. Benjamin; Smith, Nicholas L.; Smith, Jennifer A.; Sotoodehnia, Nona; Stilp, Adrienne M.; Tang, Weihong; Taylor, Kent D.; Telen, Marilyn; Thornton, Timothy A.; Tracy, Russell P.; Van Den Berg, David J.; Vasan, Ramachandran S.; Viaud-Martinez, Karine A.; Vrieze, Scott; Weeks, Daniel E.; Weir, Bruce S.; Weiss, Scott T.; Weng, Lu-Chen; Willer, Cristen J.; Zhang, Yingze; Zhao, Xutong; Arnett, Donna K.; Ashley-Koch, Allison E.; Barnes, Kathleen C.; Boerwinkle, Eric; Gabriel, Stacey; Gibbs, Richard; Rice, Kenneth M.; Rich, Stephen S.; Silverman, Edwin K.; Qasba, Pankaj; Gan, Weiniu; NHLBI Trans-Omics for Precision Medicine (TOPMed) Consortium; Papanicolaou, George J.; Nickerson, Deborah A.; Browning, Sharon R.; Zody, Michael C.; Zöllner, Sebastian; Wilson, James G.; Cupples, L. Adrienne; Laurie, Cathy C.; Jaquish, Cashell E.; Hernandez, Ryan D.; O'Connor, Timothy D.; Abecasis, Gonçalo R.; Epidemiology, Richard M. Fairbanks School of Public HealthThe Trans-Omics for Precision Medicine (TOPMed) programme seeks to elucidate the genetic architecture and biology of heart, lung, blood and sleep disorders, with the ultimate goal of improving diagnosis, treatment and prevention of these diseases. The initial phases of the programme focused on whole-genome sequencing of individuals with rich phenotypic data and diverse backgrounds. Here we describe the TOPMed goals and design as well as the available resources and early insights obtained from the sequence data. The resources include a variant browser, a genotype imputation server, and genomic and phenotypic data that are available through dbGaP (Database of Genotypes and Phenotypes)1. In the first 53,831 TOPMed samples, we detected more than 400 million single-nucleotide and insertion or deletion variants after alignment with the reference genome. Additional previously undescribed variants were detected through assembly of unmapped reads and customized analysis in highly variable loci. Among the more than 400 million detected variants, 97% have frequencies of less than 1% and 46% are singletons that are present in only one individual (53% among unrelated individuals). These rare variants provide insights into mutational processes and recent human evolutionary history. The extensive catalogue of genetic variation in TOPMed studies provides unique opportunities for exploring the contributions of rare and noncoding sequence variants to phenotypic variation. Furthermore, combining TOPMed haplotypes with modern imputation methods improves the power and reach of genome-wide association studies to include variants down to a frequency of approximately 0.01%.Item Variation in a Left Ventricle–Specific Hand1 Enhancer Impairs GATA Transcription Factor Binding and Disrupts Conduction System Development and Function(American Heart Association, 2019-08-01) Vincentz, Joshua W.; Firulli, Beth A.; Toolan, Kevin P.; Arking, Dan E.; Sotoodehnia, Nona; Wan, Juyi; Chen, Peng-Sheng; de Gier-de Vries, Corrie; Christoffels, Vincent M.; Rubart-von der Lohe, Michael; Firulli, Anthony B.; Pediatrics, School of MedicineRationale The ventricular conduction system (VCS) rapidly propagates electrical impulses through the working myocardium of the ventricles to coordinate chamber contraction. Genome-wide association studies (GWAS) have associated nucleotide polymorphisms, most are located within regulatory intergenic or intronic sequences, with variation in VCS function. Two highly correlated polymorphisms (r2>0.99) associated with VCS functional variation (rs13165478 and rs13185595) occur 5’ to the gene encoding the bHLH transcription factor HAND1. Objective Here, we test the hypothesis that these polymorphisms influence HAND1 transcription thereby influencing VCS development and function. Methods and Results We employed transgenic mouse models to identify an enhancer that is sufficient for left ventricle (LV) cis-regulatory activity. Two evolutionarily conserved GATA transcription factor cis-binding elements within this enhancer are bound by GATA4 and are necessary for cis-regulatory activity, as shown by in vitro DNA binding assays. CRISPR/Cas9-mediated deletion of this enhancer dramatically reduces Hand1 expression solely within the LV but does not phenocopy previously published mouse models of cardiac Hand1 loss-of-function. Electrophysiological and morphological analyses reveals that mice homozygous for this deleted enhancer display a morphologically abnormal VCS, and a conduction system phenotype consistent with right bundle branch block. Using 1000 Genomes Project data, we identify three additional SNPs, located within the Hand1 LV enhancer, that compose a haplotype with rs13165478 and rs13185595. One of these SNPs, rs10054375, overlaps with a critical GATA cis-regulatory element within the Hand1 LV enhancer. This SNP, when tested in electrophoretic mobility shift assays (EMSA), disrupts GATA4 DNA-binding. Modeling two of these SNPs in mice causes diminished Hand1 expression and mice present with abnormal VCS function. Conclusions Together, these findings reveal that SNP rs10054375, which is located within a necessary and sufficient LV-specific Hand1 enhancer, exhibits reduces GATA DNA-binding in EMSA and this enhancer in total, is required for VCS development and function in mice and perhaps humans.