APOL1 genotypes, CVD not linked in postmenopausal black women

New research published in the Journal of the American Medical Association suggests an association between black postmenopausal women who are carriers of apolipoprotein L1 (APOL1) genotypes and hospitalizations for heart failure with preserved ejection fraction (HFpEF). The findings, however, do not support an association between APOL1 genotypes and coronary heart disease, stroke or mortality.

APOL1 genotypes are associated with kidney diseases in black populations, which may impact cardiovascular disease (CVD) and mortality risk. But the researchers, led by Nora Franceschini, MD, MPH, of the University of North Carolina in Chapel Hill, say previous research has been inconsistent.

“In this large longitudinal study of postmenopausal African-American women at risk for cardiovascular events, we confirmed the association of high-risk APOL1 status with incident end-stage renal disease (ESRD) and identified an association of high-risk APOL1 variant carriers with hospitalization for heart failure with preserved left ventricular ejection fraction,” Franceschini et al. wrote.

Franceschini and colleagues sought to discern whether APOL1 genotypes are associated with cardiovascular disease and stroke in postmenopausal black women.

The health data of more than 11,000 black women who were part of the Women’s Health Initiative (WHI) was analyzed. Researchers assessed incidences of coronary heart disease, stroke and heart failure subtypes from health records and death certificates.

Post analysis, the researchers found 12 percent of women had higher prevalence of hypertension, use of cholesterol-lowering medications and reduced estimated glomerular filtration rate (eGFR).

After an average of 11 years, carriers of high-risk APOL1 had higher incidences of hospitalized heart failure with HFpEF than low-risk carriers—but showed no differences for other CVD outcomes. The risk of hospitalized HFpEF in the carriers of high-risk APOL1 variants was 58 percent higher than carriers of low-risk APOL1 variants.

After adjusting for baseline eGFR, the association with HFpEF was attenuated to 50 percent and was no longer significant. The association among high-risk APOL1 genotypes and ESRD was reduced from 1.43 to 1.02, which the researchers said was not significant.

“This study does not support a relationship among high-risk APOL1 genotypes and cardiovascular disease in postmenopausal women, except for heart failure with preserved ejection fraction, mechanisms of which might include chronic kidney disease,” the authors concluded.