596S ubclinical cardiovascular risk factors, such as increased blood pressure and left cardiac structural changes, develop from childhood onwards and are known to cluster in families. [1][2][3][4] Although lifestyle and environmental factors strongly contribute to the development of cardiovascular disease throughout the life course, genetic factors also play an important role. Heritability estimates range from 30% for left ventricular mass, 36% for left ventricular end-diastolic diameter (LVEDD), 44% for aortic root diameter (AoD) to 57% for blood pressure.
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Clinical Perspective on p 602Recent genome-wide association studies (GWAS) have identified many single-nucleotide polymorphisms (SNPs) that are associated with cardiovascular disease and its major risk factors in adults. [11][12][13] One GWAS among a total sample of around 16 000 adults identified 2 SNPs related to LVEDD and 5 SNPs related to AoD.11 Two other GWAS, each with a total sample size of >120 000 adults, have identified 29 SNPs related to systolic blood pressure (SBP) or diastolic blood pressure (DBP), 22 SNPs related to mean arterial blood pressure (MAP), and 10 SNPs related to pulse pressure (PP).12,13 Not much is known about the influence of these SNPs on cardiovascular outcomes in childhood.We hypothesized that common genetic variants associated with these subclinical cardiovascular outcomes in adults influence these outcomes from childhood onwards. Therefore, we examined the associations of known genetic variants for cardiac and blood pressure outcomes, identified in adults, with the same outcomes in children. We assessed the role of each SNP individually and of the SNPs combined in trait-specific genetic risk scores.
Methods
Study Design and PopulationThis study was embedded in the Generation R Study, a population-based, prospective cohort study from fetal life onwards. Pregnant women with an expected delivery date between April 2002 and January 2006 and living in the city of Rotterdam, The Netherlands, were eligible to participate. A detailed design of study has been described previously.14 Generation R is a multiethnic cohort study, with participants of European origin constituting the largest ethnic group (56%). The Background-Genome-wide association studies have identified single-nucleotide polymorphisms (SNPs) for subclinical cardiovascular outcomes in adults. We examined the influence of these variants on the same outcomes in childhood. Methods and Results-In a population-based prospective cohort study among 4137 children, we examined the associations of SNPs, individually and incorporated in genetic risk scores, which were identified in adults for cardiac (2 SNPs for left ventricular end-diastolic diameter and 5 SNPs for aortic root diameter) and blood pressure outcomes (29 SNPs for systolic and diastolic blood pressure, 22 SNPs for mean arterial pressure, and 10 SNPs for pulse pressure) with the same outcomes in children (median age of 6.0 years [95% range, 4.5-8.7] 14 The study has been approved by the local Medical Ethics Commit...