Key result
Possessing two APOL1 renal-risk variants was not significantly associated with incident cardiovascular disease compared to zero or one variant in high-risk hypertensive African American adults (HR 1.20).
Why the study?
Does the presence of APOL1 renal-risk variants associate with incident cardiovascular disease or mortality in high-risk hypertensive, nondiabetic African American patients?
Cohort (n=2,568)
Yes
Does the presence of APOL1 renal-risk variants associate with incident cardiovascular disease or mortality in high-risk hypertensive, nondiabetic African American patients?
APOL1 renal-risk variants are not associated with an increased risk of incident cardiovascular disease or mortality in high-risk hypertensive, nondiabetic African American patients.
Answers are grounded in this paper and cite their sources.
No association of APOL1 RRVs with CVD or mortality in this cohort; leaves open generalizability and requires prospective validation before clinical consideration.
Introduction Relationships between apolipoprotein L1 gene ( APOL1 ) renal-risk variants (RRVs) and cardiovascular disease (CVD) remain controversial. To clarify associations between APOL1 and CVD, a total of 2568 African American Systolic Blood Pressure Intervention Trial (SPRINT) participants were assessed for the incidence of CVD events (primary composite including nonfatal myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and CVD death), renal outcomes, and all-cause mortality. Methods Cox proportional hazards regression models were used, adjusting for age, sex, African ancestry proportion, and treatment group (systolic blood pressure target of <120 mm Hg vs. <140 mm Hg). Results Of the participants, 14% had 2 APOL1 RRVs; these individuals also had lower baseline estimated GFR and higher levels of albuminuria and BMI. After a median follow-up of 39 months, no significant association was observed between APOL1 RRVs and the primary composite CVD outcome, any of its components, or all-cause mortality (recessive or additive genetic models). APOL1 demonstrated a trend toward association with sustained 30% reduction in estimated GFR to <60 ml/min/1.73 m 2 in those with normal kidney function at baseline (hazard ratio 1.64; 95% confidence interval = 0.85−2.93; P = 0.114, recessive model). Discussion APOL1 RRVs were not associated with incident CVD in high-risk hypertensive, nondiabetic African American participants in SPRINT.
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Freedman et al. (2017) conducted a cohort in Hypertension and increased cardiovascular risk (n=2,568). APOL1 renal-risk variants (2 variants) vs. 0 or 1 APOL1 renal-risk variant was evaluated on Incident cardiovascular disease (composite of nonfatal MI, acute coronary syndrome, nonfatal stroke, nonfatal acute decompensated heart failure, and CVD death) (HR 1.20, 95% CI 0.76-1.92, p=0.435). Possessing two APOL1 renal-risk variants was not significantly associated with incident cardiovascular disease compared to zero or one variant in high-risk hypertensive African American adults (HR 1.20).
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