Franceschini N, et al. - In postmenopausal African American women, who are at high risk for these outcomes, researchers investigated the association of high-risk APOL1 genotypes with cardiovascular disease and stroke. They observed that status as a carrier of a high-risk APOL1 genotype was related to hospitalization for heart failure with preserved ejection fraction (HFpEF), partly accounted for by baseline kidney function. In postmenopausal African American women, no association of high-risk APOL1 genotypes with coronary heart disease, stroke, or mortality, was observed.

Methods

• Participants were 11,137 African American women participants who had a clinical event from enrollment to June 2014 in the Women's Health Initiative, a prospective cohort that enrolled 161,838 postmenopausal women into clinical trials and an observational study between 1993 and 1998.
• From January 2017 to August 2017, researchers completed data analyses.
• From whole-exome sequencing, the variants of APOL1 were genotyped or imputed.
• Incident coronary heart disease, stroke and heart failure subtypes, and overall and cause-specific mortality adjudicated from hospital records and death certificates were assessed.
• They determined estimated incidence rates for each outcome and hazard ratios (HR) and 95% CIs for the associations of APOL1 groups with outcomes.

Results

• According to data, the mean (SD) age of participants was 61.7 (7.1) years.
• Findings showed higher prevalence of hypertension, use of cholesterol-lowering medications, and reduced estimated glomerular filtration rate (eGFR) among carriers of high-risk APOL1 variants (n=1,370; 12.3%).
• After a mean (SD) of 11.0 (3.6) years, they found that carriers of high-risk APOL1 variants vs low-risk carriers demonstrated a higher incidence of hospitalized heart failure with preserved ejection fraction (HFpEF) but did not show differences for other outcomes.
• Carriers of high-risk APOL1 variants vs carriers of low-risk APOL1 variants were shown to have a significant 58% increased hazard of hospitalized HFpEF (HR, 1.58 [95% CI, 1.03-2.41]) in adjusted models.
• They reported a reduction in the association with HFpEF (HR=1.50 [95% CI, 0.98-2.30]) and it was no longer significant when adjusting for baseline eGFR.