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. 2022 Apr 25:9:821068.
doi: 10.3389/fcvm.2022.821068. eCollection 2022.

Genetically Determined Lifestyle and Cardiometabolic Risk Factors Mediate the Association of Genetically Predicted Age at Menarche With Genetic Predisposition to Myocardial Infarction: A Two-Step, Two-Sample Mendelian Randomization Study

Jilin Zheng  1   2 , Ken Chen  1   2 , Tao Huang  3 , Chunli Shao  4 , Ping Li  1 , Jingjia Wang  4 , Wenyao Wang  4 , Kuo Zhang  1 , Xiangbin Meng  4 , Jun Gao  4 , Xuliang Wang  1   2 , Yupeng Liu  1   2 , Jingjing Song  1   2 , Eran Dong  5   6 , Yi-Da Tang  1   2   4
Affiliations

Genetically Determined Lifestyle and Cardiometabolic Risk Factors Mediate the Association of Genetically Predicted Age at Menarche With Genetic Predisposition to Myocardial Infarction: A Two-Step, Two-Sample Mendelian Randomization Study

Jilin Zheng et al. Front Cardiovasc Med. .

Abstract

Background: Observational studies have shown an association between early age at menarche (AAM) and myocardial infarction (MI) with recorded cases. In this Mendelian randomization (MR) study, we used large amounts of summary data from genome-wide association studies (GWASs) to further estimate the association of genetically predicted AAM with genetically predicated risk of MI and investigate to what extent this association is mediated by genetically determined lifestyles, cardiometabolic factors, and estrogen exposure.

Methods: A two-step, two-sample MR study was performed by mediation analysis. Genetic variants identified by GWAS meta-analysis of reproductive genetics consortium (n = 182,416) were selected for genetically predicted AAM. Genetic variants identified by the Coronary ARtery DIsease Genome-wide Replication and Meta-analysis plus The Coronary Artery Disease Genetics Consortium (n = 184,305) were selected for genetically predicted risk of MI. Genetic variants from other international GWAS summary data were selected for genetically determined mediators.

Results: This MR study showed that increase in genetically predicted AAM was associated with lower risk of genetically predicted MI (odds ratio 0.91, 95% confidence interval 0.84-0.98). Inverse variance weighted (IVW) MR analysis also showed that decrease in genetically predicted AAM was associated with higher genetically predicted alcohol intake frequency, current smoking behavior, higher waist-to-hip ratio, and higher levels of systolic blood pressure (SBP), fasting blood glucose, hemoglobin A1c (HbA1c), and triglycerides (TGs). Furthermore, increase in genetically predicted AAM was associated with genetically predicted longer sleep duration, higher levels of high-density lipoproteins, and older age at which hormone replacement therapy was started. The most essential mediators identified were genetically predicted current smoking behavior and levels of HbA1c, SBP, and TGs, which were estimated to genetically mediate 13.9, 12.2, 10.5, and 9.2%, respectively, with a combined mediation proportion of 37.5% in the association of genetically predicted AAM with genetically predicted increased risk of MI in an MR framework.

Conclusion: Our MR analysis showed that increase in genetically predicted AAM was associated with lower genetically predicted risk of MI, which was substantially mediated by genetically determined current smoking behavior and levels of HbA1c, SBP, and TGs. Intervening on the above mediators may reduce the risk of MI.

Keywords: Mendelian randomization; age at menarche; cardiometabolic risk factors; lifestyle; mediation analysis; myocardial infarction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Estimate of associations of genetically predicted AAM with genetically predicted MI. IVW was applied as main analysis for estimating the association of genetically predicted AAM with genetically predicted MI. AAM, age at menarche; MI, myocardial infarction; IVW, inverse variance weighted.
FIGURE 2
FIGURE 2
Estimate of the association of genetically predicted AAM with each genetically determined potential mediator. IVW was applied as main analysis. The results showed that increase in genetically predicted AAM was associated with genetically determined longer sleep duration, higher levels of HDL and older at which HRT was started. The results also showed that increase in genetically predicted AAM was inversely associated genetically determined alcohol intake frequency, current smoking behavior, WHR, FBG, HbA1c, SBP, and TGs. AAM, age at menarche; IVW, inverse variance weighted; HDL, high-density lipoprotein; HRT, hormone replacement therapy; WHR, waist-hip-ratio; FBG, fasting blood glucose; HbA1c, hemoglobin A1c; SBP, systolic blood pressure; TG, triglycerides.
FIGURE 3
FIGURE 3
Estimate of the association of each genetically determined potential mediator with genetically predicted MI. The association of genetically determined potential mediators with genetically predicted MI was estimated by linear regression-based MR method. MI, myocardial infarction; HDL, high-density lipoprotein; HRT, hormone replacement therapy; WHR, waist-hip-ratio; FBG, fasting blood glucose; HbA1c, hemoglobin A1c; SBP, systolic blood pressure; TG, triglycerides.
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