Key result
Aspirin allocation increased incident CVD risk in women with the COMT rs4680 valine/valine genotype compared with placebo (HR 1.85; 95% CI 1.05-3.25), but lowered risk in methionine/methionine women.
Why the study?
Do COMT polymorphisms modify the treatment effects of aspirin on the risk of incident cardiovascular disease in women?
RCT
Randomized allocation
Yes
Do COMT polymorphisms modify the treatment effects of aspirin on the risk of incident cardiovascular disease in women?
Hazard Ratio: 1.85 (95% CI 1.05–3.25)
p-value: p=0.033
Common COMT polymorphisms may modify the cardiovascular prevention efficacy of aspirin, suggesting a potential pharmacogenomic interaction.
May warrant caution interpreting COMT-guided aspirin use; leaves open whether this pharmacogenomic interaction requires prospective validation.
OBJECTIVE: Catechol-O-methyltransferase (COMT), a key enzyme in catecholamine metabolism, is implicated in cardiovascular, sympathetic, and endocrine pathways. This study aimed to confirm preliminary association of COMT genetic variation with incident cardiovascular disease (CVD). It further aimed to evaluate whether aspirin, a commonly used CVD prevention agent, modified the potential association of COMT with incident CVD. APPROACH AND RESULTS: We examined COMT polymorphism rs4680 (MAF [minor allele frequency], 0.47), encoding a nonsynonymous methionine-to-valine substitution, in the Women's Genome Health Study (WGHS), a large population-based cohort of women with randomized allocation to aspirin or vitamin E when compared with placebo and 10-year follow-up. Rs4680 effects were confirmed with COMT polymorphism rs4818 and also examined in Coronary ARtery DIsease Genome-wide Replication and Meta-analysis/The Coronary Artery Disease Genetics Consortium, consortia for genome-wide association studies of coronary artery disease. Among WGHS women allocated to placebo (135 events/n=5811), the rs4680 valine allele was protective against incident CVD relative to the methionine (hazard ratio [HR; 95% confidence interval {CI}], 0.66 [0.51-0.84]; P=0.0007); an association also observed in Coronary ARtery DIsease Genome-wide Replication and Meta-analysis and The Coronary Artery Disease Genetics Consortium (combined P=2.4×10(-5)). In the WGHS, the rs4680 association was abolished by randomized allocation to aspirin, such that valine/valine women experienced higher CVD rates with aspirin allocation when compared with placebo (HR [95% CI], 1.85 [1.05-3.25]; P=0.033), whereas methionine/methionine women experienced lower rates (HR [95% CI], 0.60 [0.39-0.93]; P=0.023). Allocation to vitamin E also conferred higher but nonsignificant CVD rates on valine/valine (HR [95% CI], 1.50 [0.83-2.70]; P=0.180) when compared with significantly lower rates on methionine/methionine (HR [95% CI], 0.53 [0.34-0.84]; P=0.006) women. Rs4818 results were similar. CONCLUSIONS: Common COMT polymorphisms were associated with incident CVD, and this association was modified by randomized allocation to aspirin or vitamin E. Replication of these findings is required.
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Hall et al. (2014) conducted an RCT in Incident cardiovascular disease. Aspirin vs. Placebo was evaluated on Incident cardiovascular disease (HR 1.85, 95% CI 1.05-3.25, p=0.033). Aspirin allocation increased incident CVD risk in women with the COMT rs4680 valine/valine genotype compared with placebo (HR 1.85; 95% CI 1.05-3.25), but lowered risk in methionine/methionine women.
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