Genetically determined serum urate levels and cardiovascular and other diseases in UK Biobank cohort: A phenome-wide mendelian randomization study

Autoři: Xue Li aff001;  Xiangrui Meng aff001;  Yazhou He aff001;  Athina Spiliopoulou aff002;  Maria Timofeeva aff003;  Wei-Qi Wei aff004;  Aliya Gifford aff004;  Tian Yang aff001;  Tim Varley aff005;  Ioanna Tzoulaki aff006;  Peter Joshi aff001;  Joshua C. Denny aff004;  Paul Mckeigue aff002;  Harry Campbell aff001;  Evropi Theodoratou aff001
Působiště autorů: Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom aff001;  Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom aff002;  Colon Cancer Genetics Group, Medical Research Council Human Genetics Unit, Medical Research Council, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom aff003;  Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America aff004;  Public Health and Intelligence, NHS National Services Scotland, Edinburgh, United Kingdom aff005;  Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom aff006;  Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece aff007;  Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom aff008
Vyšlo v časopise: Genetically determined serum urate levels and cardiovascular and other diseases in UK Biobank cohort: A phenome-wide mendelian randomization study. PLoS Med 16(10): e32767. doi:10.1371/journal.pmed.1002937
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002937



The role of urate in cardiovascular diseases (CVDs) has been extensively investigated in observational studies; however, the extent of any causal effect remains unclear, making it difficult to evaluate its clinical relevance.

Methods and findings

A phenome-wide association study (PheWAS) together with a Bayesian analysis of tree-structured phenotypic model (TreeWAS) was performed to examine disease outcomes related to genetically determined serum urate levels in 339,256 unrelated White British individuals (54% female) in the UK Biobank who were aged 40–69 years (mean age, 56.87; SD, 7.99) when recruited from 2006 to 2010. Mendelian randomization (MR) analyses were performed to replicate significant findings using various genome-wide association study (GWAS) consortia data. Sensitivity analyses were conducted to examine possible pleiotropic effects on metabolic traits of the genetic variants used as instruments for urate. PheWAS analysis, examining the association with 1,431 disease outcomes, identified 13 distinct phecodes representing 4 disease groups (inflammatory polyarthropathies, hypertensive disease, circulatory disease, and metabolic disorders) and 9 disease outcomes (gout, gouty arthropathy, pyogenic arthritis, essential hypertension, coronary atherosclerosis, ischemic heart disease, chronic ischemic heart disease, myocardial infarction, and hypercholesterolemia) that were associated with genetically determined serum urate levels after multiple testing correction (p < 3.35 × 10−4). TreeWAS analysis, examining 10,750 ICD-10 diagnostic terms, identified more sub-phenotypes of cardiovascular and cerebrovascular diseases (e.g., angina pectoris, heart failure, cerebral infarction). MR analysis successfully replicated the association with gout, hypertension, heart diseases, and blood lipid levels but indicated the existence of genetic pleiotropy. Sensitivity analyses support an inference that pleiotropic effects of genetic variants on urate and metabolic traits contribute to the observational associations with CVDs. The main limitations of this study relate to possible bias from pleiotropic effects of the considered genetic variants and possible misclassification of cases for mild disease that did not require hospitalization.


In this study, high serum urate levels were found to be associated with increased risk of different types of cardiac events. The finding of genetic pleiotropy indicates the existence of common upstream pathological elements influencing both urate and metabolic traits, and this may suggest new opportunities and challenges for developing drugs targeting a common mediator that would be beneficial for both the treatment of gout and the prevention of cardiovascular comorbidities.

Klíčová slova:

Cardiovascular diseases – Consortia – Coronary heart disease – Genetic loci – Genetics of disease – Genome-wide association studies – Hypertension – Gout


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PLOS Medicine

2019 Číslo 10

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