Genetic architecture of abdominal aortic aneurysm in the million veteran program

Derek Klarin, Shefali Setia Verma, Renae Judy, Ozan Dikilitas, Brooke N. Wolford, Ishan Paranjpe, Michael G. Levin, Cuiping Pan, Catherine Tcheandjieu, Joshua M. Spin, Julie Lynch, Themistocles L. Assimes, Linn Åldstedt Nyrønning, Erney Mattsson, Todd L. Edwards, Josh Denny, Eric Larson, Ming Ta Michael Lee, David Carrell, Yanfei ZhangGail P. Jarvik, Ali G. Gharavi, John Harley, Frank Mentch, Jennifer A. Pacheco, Hakon Hakonarson, Anne Heidi Skogholt, Laurent Thomas, Maiken Elvestad Gabrielsen, Kristian Hveem, Jonas Bille Nielsen, Wei Zhou, Lars Fritsche, Jie Huang, Pradeep Natarajan, Yan V. Sun, Scott L. Duvall, Daniel J. Rader, Kelly Cho, Kyong Mi Chang, Peter W.F. Wilson, Christopher J. O'Donnell, Sekar Kathiresan, Salvatore T. Scali, Scott A. Berceli, Cristen Willer, Gregory T. Jones, Matthew J. Bown, Girish Nadkarni, Iftikhar J. Kullo, Marylyn Ritchie, Scott M. Damrauer, Philip S. Tsao

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Abdominal aortic aneurysm (AAA) is an important cause of cardiovascular mortality; however, its genetic determinants remain incompletely defined. In total, 10 previously identified risk loci explain a small fraction of AAA heritability. Methods: We performed a genome-wide association study in the Million Veteran Program testing ≈18 million DNA sequence variants with AAA (7642 cases and 172 172 controls) in veterans of European ancestry with independent replication in up to 4972 cases and 99 858 controls. We then used mendelian randomization to examine the causal effects of blood pressure on AAA. We examined the association of AAA risk variants with aneurysms in the lower extremity, cerebral, and iliac arterial beds, and derived a genome-wide polygenic risk score (PRS) to identify a subset of the population at greater risk for disease. Results: Through a genome-wide association study, we identified 14 novel loci, bringing the total number of known significant AAA loci to 24. In our mendelian randomization analysis, we demonstrate that a genetic increase of 10 mm Hg in diastolic blood pressure (odds ratio, 1.43 [95% CI, 1.24-1.66]; P=1.6×10-6), as opposed to systolic blood pressure (odds ratio, 1.06 [95% CI, 0.97-1.15]; P=0.2), likely has a causal relationship with AAA development. We observed that 19 of 24 AAA risk variants associate with aneurysms in at least 1 other vascular territory. A 29-variant PRS was strongly associated with AAA (odds ratioPRS, 1.26 [95% CI, 1.18-1.36]; PPRS=2.7×10-11per SD increase in PRS), independent of family history and smoking risk factors (odds ratioPRS+family history+smoking, 1.24 [95% CI, 1.14-1.35]; PPRS=1.27×10-6). Using this PRS, we identified a subset of the population with AAA prevalence greater than that observed in screening trials informing current guidelines. Conclusions: We identify novel AAA genetic associations with therapeutic implications and identify a subset of the population at significantly increased genetic risk of AAA independent of family history. Our data suggest that extending current screening guidelines to include testing to identify those with high polygenic AAA risk, once the cost of genotyping becomes comparable with that of screening ultrasound, would significantly increase the yield of current screening at reasonable cost.

Original languageEnglish (US)
Pages (from-to)1633-1646
Number of pages14
StateAccepted/In press - 2020


  • aneurysm
  • aortic diseases
  • genome-wide association study
  • humans

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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