Genetic associations with pulmonary embolism among those with a deep vein thrombosis: the International Network Against Venous Thrombosis Consortium.

BACKGROUND

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE), the latter of which often originates from DVT and can be fatal.

OBJECTIVES

The aim of this study was to identify causal genetic factors that alter risk of PE among those with a presumed DVT.

METHODS

Using a case-only design of VTE, we conducted meta-analyses of genome-wide association studies (GWASs) in the International Network Against Venous Thrombosis Consortium. Among participants diagnosed with VTE, each study identified those who had a clinically reported PE, with or without a clinically reported DVT; those remaining had isolated DVT. Logistic regression models (PE as outcome compared with isolated DVT) were used for variant discovery and replication analyses. A polygenic risk score was created from the GWAS findings. Transcriptome-wide association study analyses were conducted using the GWAS discovery estimates.

RESULTS

Our discovery and replication analyses included 126 316 individuals with a VTE across 29 studies: 54 389 who had a PE and the remaining 71 927 who had an isolated DVT. Five variants reached genome-wide significance (P < 5 × 10-8) in discovery, 4 of which replicated: F5 rs6025 (factor V Leiden), odds ratio (OR) 0.66; FGG rs2066864, OR 1.08; F11 rs4253417, OR 1.07; and SLC12A2-DT rs3749748, OR 0.92. Each 1 SD increase in the polygenic risk score was associated with risk (OR: 1.05; 95% CI: 1.003-1.094). Transcriptome-wide association study analysis identified genetic associations with FGG, SLC12A2-DT, and CDHR4 transcripts.

CONCLUSION

Although the overall risk for VTE is strongly heritable, our findings support the hypothesis that PE in the setting of a presumed DVT is regulated by genetics, although the overall effect appears modest.