American Journal of Epidemiology Advance Access originally published online on February 10, 2007
American Journal of Epidemiology 2007 165(9):973-984; doi:10.1093/aje/kwk085
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Genetic Effects versus Bias for Candidate Polymorphisms in Myocardial Infarction: Case Study and Overview of Large-Scale Evidence
1 Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
2 The Internal Medicine Clinic, University Hospital, Ioannina, Greece
3 Biomedical Research Institute, Foundation for Research and Technology-Hellas, Ioannina, Greece
4 Department of Medicine, Tufts University School of Medicine, Boston, MA
Correspondence to Dr. John P. A. Ioannidis, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece (e-mail: jioannid{at}cc.uoi.gr).
Received for publication May 16, 2006. Accepted for publication November 5, 2006.
Several genetic polymorphisms have been proposed to be associated with myocardial infarction (MI). The authors examined the evidence and biases underlying such associations using a case-study meta-analysis and an overview of large-scale data. In a meta-analysis of 27 studies addressing the association of the angiotensin type 1 receptor (AT1R)+1166A/C polymorphism with MI (10,180 cases, 17,129 controls), the *C allele conferred an increase in MI risk (odds ratio = 1.13 per allele, p = 0.005). However, there was large between-study heterogeneity; the largest study showed no effect, contradicting smaller studies; and studies with blinded genotyping showed no effect. The authors conducted an overview of meta-analyses of genetic associations for MI or coronary artery disease, including at least three studies and 3,000 subjects. In their latest meta-analysis, another 14 polymorphisms were found to have formally significant associations. If true, these associations would already explain 42% of the MI risk for Caucasian populations. Significant between-study heterogeneity was common. Across the 32 largest studies, only two found formally significant results (nine would be expected if each meta-analysis showed a true association). Even with large-scale evidence from meta-analyses, significant associations for MI may be subject to bias. Large-scale single studies and prospective consortia should be used for detecting and validating the genetic determinants of MI.
angiotensin II; AT1R; bias (epidemiology); epidemiology; genes; meta-analysis; myocardial infarction; polymorphism, genetic
Abbreviations: AT1R, angiotensin type 1 receptor gene; CAD, coronary artery disease; CI, confidence interval; MI, myocardial infarction; OR, odds ratio
Editor's note: This paper is also available on the website of the Human Genome Epidemiology Network (http://www.cdc.gov/genomics/hugenet/).
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