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BACKGROUND: The hypertensive disorders of pregnancy (HDPs), that is, preeclampsia and gestational hypertension, are characterized by endothelial dysfunction in pregnancy and are epidemiologically and genetically associated with risk for coronary artery disease (CAD). A recent study suggested that endothelial cell (EC)-acting CAD risk variants may identify individuals who benefit from more intensive lipid-lowering treatment. The present study evaluated whether the same EC CAD genetic risk score is also associated with HDPs using comprehensive statistical genetic approaches.METHODS: We examined 35 previously identified EC-acting and 205 non-EC-acting risk variants associated with CAD. First, using the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective, multicenter US pregnancy cohort, we calculated polygenic risk scores (PRS) comprised of either EC-acting or non-EC-acting CAD risk variants in genotyped, unrelated participants across multiple ancestry groups. Scores were adjusted for population genetic structure using 10 principal components, then tested for associations with HDPs using logistic regression models adjusted for age. Second, we tested the genetic association of EC-acting and non-EC-acting CAD variants with preeclampsia and gestational hypertension using 2-sample Mendelian randomization.RESULTS: Among 6782 unrelated nuMoM2b participants (mean [SD] age, 27.0 [5.5] years, 1040 [15.3%] with HDPs in the index pregnancy), participants with higher EC-acting PRS had a higher incidence of HDPs. Each SD of higher EC-acting PRS was associated with 1.09-fold increased odds of HDP (95% CI, 1.02-1.17; =0.008); by contrast, the non-EC-acting PRS was not significantly associated with HDP risk (odds ratio, 1.05 [95% CI, 0.98-1.12]; =0.14). In 2-sample Mendelian randomization, EC-acting CAD variants were strongly associated with both preeclampsia (odds ratio, 1.55 [95% CI, 1.30-1.86]; <0.001) and gestational hypertension (odds ratio, 1.54 [95% CI, 1.29-1.85]; <0.001).CONCLUSIONS: PRS and 2-sample Mendelian randomization approaches suggest enrichment for EC-acting CAD genetic risk variants in women with HDPs. These findings support a shared genetic architecture between HDPs and CAD through endothelial dysfunction.