Association study of polymorphic variants in 9p21 locus and the manifestation of coronary artery disease in Bulgarians

Authors

  • R. Tzveova Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences – Sofia, Bulgaria Author https://orcid.org/0000-0001-5045-8165
  • G. Naydenova Department of Propaedeutics of Internal Diseases, Medical University – Pleven, Bulgaria Author
  • T. Yaneva-Sirakova Clinic of Cardiology, ICU, Medical Institute of Ministry of Interior – Sofia, Bulgaria Author
  • S. Vandeva Clinical Center of Endocrinology and Gerontology, Medical University – Sofia, Bulgaria Author
  • P. Atanasov National Sports Academy – Sofia, Bulgaria Author
  • V. Mitev Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University – Sofia, Bulgaria Author
  • R. Kaneva Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University – Sofia, Bulgaria Author
  • D. Pendicheva-Duhlenska Department of Pharmacology, Faculty of Pharmacy, Medical University – Pleven, Bulgaria Author

DOI:

https://doi.org/10.2478/AMB-2025-0005

Keywords:

9p21, polymorphic variants, coronary artery disease, Bulgarians

Abstract

Objective: The variant 9p21 is correlated with coronary artery disease (CAD) in multiple studies in the European population, but we lack information for the Eastern Europeans (Caucasian). We aimed at investigating the potential association of six common polymorphic variants in 9p21 locus (rs7865618, rs1537378, rs7857345, rs10757274, rs2383206, and rs10757278) with CAD in the Bulgarian population. Materials and methods: The current analysis included 261 patients with angiographically documented CAD (153 with myocardial infarction and 108 without myocardial infarction) and 496 population controls. Genomic DNA was isolated from peripheral venous blood. The selected polymorphic variants in 9p21 locus were genotyped by high resolution melting (HRM) analyses (Rotor Gene, Qiagen). Allelic and genotypic frequencies for studied variants were compared between cases and controls using the χ2 test. Results: No deviation from the Hardy-Weinberg was observed for all polymorphic variants in both patient’ and control’ groups (p > 0.05). Polymorphic allele A for rs7865618 was found to be higher in the patient group than in the population controls (65.08% vs 58.28%). The carrier of this allele poses a 1.4-fold higher risk of myocardial infarction development than wild-type alleles` carriers (OR 1.40 (A) CI 1.04-1.70, p = 0.019), and this dependence is not related with gender. In female, an association between the allele C of rs7857345 and a 1.64-fold increased risk of myocardial infarction was observed (OR 1.64, CI95: 1.03-2.61, 
p = 0.03). For the other studied polymorphisms, no statistically significant association with disease risk was found. Also, our study found a positive association between rs2383206 and decreased serum triglyceride levels and with serum level of LDL cholesterol. Conclusion: Further studies with a larger number of cases and controls will be needed in order to evaluate the possible association between the six studied polymorphisms and CAD/MI in Bulgarians.

References

McPherson R, Pertsemlidis A, Kavaslar N, et al. A common allele on chromosome 9 associated with coronary heart disease. Science, 2007. 316(5830): p. 1488-91.

Helgadottir A, Thorleifsson G, Manolescu A, et al. A common variant on chromosome 9p21 affects the risk of myocardial infarction. Science, 2007. 316(5830): p. 1491-3.

Pasmant E, Laurendeau I, Heron D, et al. Characterization of a germ-line deletion, including the entire INK4/ARF locus, in a melanoma-neural system tumor family: identification of ANRIL, an antisense noncoding RNA whose expression co-clusters with ARF. Cancer Res, 2007. 67(8): p. 3963-9.

Anderson JL, Horne BD, Kolek MJ, et al. Genetic variation at the 9p21 locus predicts angiographic coronary artery disease prevalence but not extent and has clinical utility. Am Heart J, 2008. 156(6): p. 1155-1162 e2.

Chen Z, Qian Q, Ma G, et al. A common variant on chromosome 9p21 affects the risk of early-onset coronary artery disease. Mol Biol Rep, 2009. 36(5): p. 889-93.

Chen SN, Ballantyne CM, Gotto AM Jr, et al. The 9p21 susceptibility locus for coronary artery disease and the severity of coronary atherosclerosis. BMC Cardiovasc Disord, 2009. 9: p. 3.

Hoppmann P, Erl A, Turk S, et al. No association of chromosome 9p21.3 variation with clinical and angiographic outcomes after placement of drug-eluting stents. JACC Cardiovasc Interv, 2009. 2(11): p. 1149-55.

Peng WH, Lu L, Zhang Q, et al., Chromosome 9p21 polymorphism is associated with myocardial infarction but not with clinical outcome in Han Chinese. Clin Chem Lab Med, 2009. 47(8): p. 917-22.

Newton-Cheh C, Cook NR, VanDenburgh M, et al. A common variant at 9p21 is associated with sudden and arrhythmic cardiac death. Circulation, 2009. 120(21): p. 2062-8.

Ellis KL, Pilbrow AC, Frampton CM, et al. A common variant at chromosome 9P21.3 is associated with age of onset of coronary disease but not subsequent mortality. Circ Cardiovasc Genet, 2010. 3(3): p. 286-93.

Buysschaert I, Carruthers KF, Dunbar DR, et al. A variant at chromosome 9p21 is associated with recurrent myocardial infarction and cardiac death after acute coronary syndrome: the GRACE Genetics Study. Eur Heart J, 2010. 31(9): p. 1132-41.

Patel RS, Su S, Neeland IJ, et al. The chromosome 9p21 risk locus is associated with angiographic severity and progression of coronary artery disease. Eur Heart J, 2010. 31(24): p. 3017-23.

Muehlschlegel JD, Liu KY, Perry TE, et al. Chromosome 9p21 variant predicts mortality after coronary artery bypass graft surgery. Circulation, 2010. 122(11 Suppl): p. S60-5.

Liu KY, Muehlschlegel JD, Perry TE, et al. Common genetic variants on chromosome 9p21 predict perioperative myocardial injury after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2010. 139(2): p. 483-8, 488 e1-2.

Dandona S, Stewart AF, Chen L, et al. Gene dosage of the common variant 9p21 predicts severity of coronary artery disease. J Am Coll Cardiol, 2010. 56(6): p. 479-86.

Wang W, Peng W, Zhang X, et al. Chromosome 9p21.3 polymorphism in a Chinese Han population is associated with angiographic coronary plaque progression in non-diabetic but not in type 2 diabetic patients. Cardiovasc Diabetol, 2010. 9: p. 33.

Ardissino D, Berzuini C, Merlini PA, et al. Influence of 9p21.3 genetic variants on clinical and angiographic outcomes in early-onset myocardial infarction. J Am Coll Cardiol, 2011. 58(4): p. 426-34.

Wang W, Peng W, Lu L, et al. Polymorphism on chromosome 9p21.3 contributes to early-onset and severity of coronary artery disease in non-diabetic and type 2 diabetic patients. Chin Med J (Engl), 2011. 124(1): p. 66-71.

Chan K, Motterle A, Laxton RC, et al. Common variant on chromosome 9p21 predicts severity of coronary artery disease. J Am Coll Cardiol, 2011. 57(13): p. 1497-8; author reply 1498-9.

Dutta A, Henley W, Lang IA, et al. The coronary artery disease-associated 9p21 variant and later life 20-year survival to cohort extinction. Circ Cardiovasc Genet, 2011. 4(5): p. 542-8.

Kiliszek M, Szpakowicz A, Franaszczyk M, et al. The 9p21 polymorphism is linked with atrial fibrillation during acute phase of ST-segment elevation myocardial infarction. Heart Vessels, 2011. 31(10): p. 1590-4.

Gioli-Pereira L, Santos PC, Ferreira NE, et al. Higher incidence of death in multi-vessel coronary artery disease patients associated with polymorphisms in chromosome 9p21. BMC Cardiovasc Disord, 2012. 12: p. 61.

Virani SS, Brautbar AA, Lee VV, et al. Chromosome 9p21 single nucleotide polymorphisms are not associated with recurrent myocardial infarction in patients with established coronary artery disease. Circ J, 2012. 76(4): p. 950-6.

Xu JJ, Jiang L, Xu LJ, et al. Association of CDKN2B-AS1 Polymorphisms with Premature Triple-vessel Coronary Disease and Their Sex Specificity in the Chinese Population. Biomed Environ Sci, 2018. 31(11): p. 787-796.

Almontashiri NAM. The 9p21.3 risk locus for coronary artery disease: A 10-year search for its mechanism. J Taibah Univ Med Sci, 2017. 12(3): p. 199-204.

Broadbent HM, Peden JF, Lorkowski S, et al., Susceptibility to coronary artery disease and diabetes is encoded by distinct, tightly linked SNPs in the ANRIL locus on chromosome 9p. Hum Mol Genet, 2008. 17(6): p. 806-14.

Reifenberg K, Cheng F, Orning C, et al. Overexpression of TGF-ss1 in macrophages reduces and stabilizes atherosclerotic plaques in ApoE-deficient mice. PLoS One, 2012. 7(7): p. e40990.

Roberts R, Stewart AF. 9p21 and the genetic revolution for coronary artery disease. Clin Chem, 2012. 58(1): p. 104-12.

Lu Z, Zhang Y, Maimaiti Y, et al. Variants on Chromosome 9p21 Confer Risks of Noncardioembolic Cerebral Infarction and Carotid Plaque in the Chinese Han Population. J Atheroscler Thromb, 2015. 22(10): p. 1061-70.

Gschwendtner A, Bevan S, Cole JW, et al. Sequence variants on chromosome 9p21.3 confer risk for atherosclerotic stroke. Ann Neurol, 2009. 65(5): p. 531-9.

Matarin M, Brown WM, Singleton A, et al. Whole genome analyses suggest ischemic stroke and heart disease share an association with polymorphisms on chromosome 9p21. Stroke, 2008. 39(5): p. 1586-9.

Smith JG, Melander O, Lovkvist H, et al. Common genetic variants on chromosome 9p21 confers risk of ischemic stroke: a large-scale genetic association study. Circ Cardiovasc Genet, 2009. 2(2): p. 159-64.

Wahlstrand B, Orho-Melander M, Delling L, et al. The myocardial infarction associated CDKN2A/CDKN2B locus on chromosome 9p21 is associated with stroke independently of coronary events in patients with hypertension. J Hypertens, 2009. 27(4): p. 769-73.

Tian LB, Fang H, Gao L, et al. 9p21 polymorphisms increase the risk of peripheral artery disease in the Han Chinese population. J Int Med Res, 2013. 41(1): p. 106-14.

Downing KP, Nead KT, Kojima Y, et al. The combination of 9p21.3 genotype and biomarker profile improves a peripheral artery disease risk prediction model. Vasc Med, 2014. 19(1): p. 3-8.

Cluett C, McDermott MM, Guralnik J, et al. The 9p21 myocardial infarction risk allele increases risk of peripheral artery disease in older people. Circ Cardiovasc Genet, 2009. 2(4): p. 347-53.

Yamagishi K, Folsom AR, Rosamond WD, et al. A genetic variant on chromosome 9p21 and incident heart failure in the ARIC study. Eur Heart J, 2009. 30(10): p. 1222-8.

Lee IT, Liang KW, Wang JS, et al. Value of Chromosome 9p21 Polymorphism for Prediction of Cardiovascular Mortality in Han Chinese Without Coronary Lesions: An Observational Study. Medicine (Baltimore), 2015. 94(39): p. e1538.

Lee IT, Goodarzi MO, Lee WJ, et al. The chromosome 9p21 variant not predicting long-term cardiovascular mortality in Chinese with established coronary artery disease: an eleven-year follow-up study. Biomed Res Int, 2014. 2014: p. 626907.

Bilguvar K, Yasuno K, Niemela M, et al. Susceptibility loci for intracranial aneurysm in European and Japanese populations. Nat Genet, 2008. 40(12): p. 1472-7.

Helgadottir A, Thorleifsson G, Magnusson KP, et al. The same sequence variant on 9p21 associates with myocardial infarction, abdominal aortic aneurysm and intracranial aneurysm. Nat Genet, 2008. 40(2): p. 217-24.

Yasuno K, Bilguvar K, Bijlenga P, et al., Genome-wide association study of intracranial aneurysm identifies three new risk loci. Nat Genet, 2010. 42(5): p. 420-5.

Trenkwalder T, Nelson CP, Musameh MD, et al. Effects of the coronary artery disease associated LPA and 9p21 loci on risk of aortic valve stenosis. Int J Cardiol, 2018. 276: p. 212-217.

Assimes TL, Knowles JW, Basu A, et al. Susceptibility locus for clinical and subclinical coronary artery disease at chromosome 9p21 in the multi-ethnic ADVANCE study. Hum Mol Genet, 2008. 17(15): p. 2320-8.

Gong L, Chen J, Lu J, et al. The 9p21 locus is associated with coronary artery disease and cardiovascular events in the presence (but not in the absence) of coronary calcification. PLoS One, 2014. 9(4): p. e94823.

Domienik-Karlowicz J, Kupczynska K, Michalski B, et al. Fourth universal definition of myocardial infarction. Selected messages from the European Society of Cardiology document and lessons learned from the new guidelines on ST-segment elevation myocardial infarction and non-ST-segment elevation-acute coronary syndrome. Cardiol J, 2021. 28(2): p. 195-201.

Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction. Circulation, 2018. 138(20): p. e618-e651.

Knopfholz J, Disserol CC, Pierin AJ, et al. Validation of the friedewald formula in patients with metabolic syndrome. Cholesterol, 2014: p. 261878.

Jarinova O, Stewart AF, Roberts R, et al. Functional analysis of the chromosome 9p21.3 coronary artery disease risk locus. Arterioscler Thromb Vasc Biol, 2009. 29(10): p. 1671-7.

Niemiec P, Gorczynska-Kosiorz S, Iwanicki T, et al. The rs10757278 polymorphism of the 9p21.3 locus is associated with premature coronary artery disease in Polish patients. Genet Test Mol Biomarkers, 2012. 16(9): p. 1080-5.

Hinohara K, Nakajima T, Takahashi M, et al. Replication of the association between a chromosome 9p21 polymorphism and coronary artery disease in Japanese and Korean populations. J Hum Genet, 2008. 53(4): p. 357-9.

Abdullah KG, Li L, Shen GQ, et al. Four SNPS on chromosome 9p21 confer risk to premature, familial CAD and MI in an American Caucasian population (GeneQuest). Ann Hum Genet, 2008. 72(Pt 5): p. 654-7.

Hiura Y, Fukushima Y, Yuno M, et al. Validation of the association of genetic variants on chromosome 9p21 and 1q41 with myocardial infarction in a Japanese population. Circ J, 2008. 72(8): p. 1213-7.

Li, Q., W. Peng, H. Li, et al., Association of the single nucleotide polymorphism in chromosome 9p21 and chromosome 9q33 with coronary artery disease in Chinese population. BMC Cardiovasc Disord, 2017. 17(1): p. 255.

Yan JJ, Zeng ZX, et al., Association of rs10811656 on 9P21.3 with the risk of coronary artery disease in a Chinese population. Lipids Health Dis, 2016. 15(1): p. 126.

Pignataro, P., L. Pezone, G. Di Gioia, et al., Association Study Between Coronary Artery Disease and rs1333049 Polymorphism at 9p21.3 Locus in Italian Population. J Cardiovasc Transl Res, 2017. 10(5-6): p. 455-458.

Shen GQ, Rao S, Martinelli N, et al. Association between four SNPs on chromosome 9p21 and myocardial infarction is replicated in an Italian population. J Hum Genet, 2008. 53(2): p. 144-50.

AbdulAzeez S, Al-Nafie AN, Al-Shehri A, et al. Intronic Polymorphisms in the CDKN2B-AS1 Gene Are Strongly Associated with the Risk of Myocardial Infarction and Coronary Artery Disease in the Saudi Population. Int J Mol Sci, 2016. 17(3): p. 395.

El-Menyar AA, Rizk NM, Al-Qahtani A, et al. The cardiovascular implication of single nucleotide polymorphisms of chromosome 9p21 locus among Arab population. J Res Med Sci, 2015. 20(4): p. 346-52.

Helgeland O, Hertel JK, Molven A, et al. The Chromosome 9p21 CVD- and T2D-Associated Regions in a Norwegian Population (The HUNT2 Survey). Int J Endocrinol, 2015. 2015: p. 164652.

Zheng Y, Li Y, Huang T, et al. Sugar-sweetened beverage intake, chromosome 9p21 variants, and risk of myocardial infarction in Hispanics. Am J Clin Nutr, 2016. 103(4): p. 1179-84.

Yayla C, Okyay K, Yilmaz A, et al. Association of rs10757274 and rs2383206 Polymorphisms on 9p21 locus with Coronary Artery Disease in Turkish Population. Korean Circ J, 2016. 46(5): p. 615-621.

Temel SG, Ergoren MC. The association between the chromosome 9p21 CDKN2B-AS1 gene variants and the lipid metabolism: A pre-diagnostic biomarker for coronary artery disease. Anatol J Cardiol, 2018. 21(1): p. 31-38.

Nawaz SK, Noreen A, Rani A, et al. Association of the rs10757274 SNP with coronary artery disease in a small group of a Pakistani population. Anatol J Cardiol, 2015. 15(9): p. 709-15.

Shanker J, Arvind P, Jambunathan S, et al. Genetic analysis of the 9p21.3 CAD risk locus in Asian Indians. Thromb Haemost, 2014. 111(5): p. 960-9.

Aleyasin SA, Navidi T, Davoudi S. Association between rs10757274 and rs2383206 SNPs as Genetic Risk Factors in Iranian Patients with Coronary Artery Disease. J Tehran Heart Cent, 2017. 12(3): p. 114-118.

Bhanushali AA, Parmar N, Contractor A, et al., Variant on 9p21 is strongly associated with coronary artery disease but lacks association with myocardial infarction and disease severity in a population in Western India. Arch Med Res, 2011. 42(6): p. 469-74.

Schunkert H, Gotz A, Braund P, et al. Repeated replication and a prospective meta-analysis of the association between chromosome 9p21.3 and coronary artery disease. Circulation, 2008. 117(13): p. 1675-84.

Consortium WTCC. Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls. Nature, 2007. 447(7145): p. 661-78.

Samani NJ, Erdmann J, Hall AS, et al. Genomewide association analysis of coronary artery disease. N Engl J Med, 2007. 357(5): p. 443-53.

Talmud PJ, Cooper JA, Palmen J, et al. Chromosome 9p21.3 coronary heart disease locus genotype and prospective risk of CHD in healthy middle-aged men. Clin Chem, 2008. 54(3): p. 467-74.

Palomaki GE, Melillo S, Bradley LA. Association between 9p21 genomic markers and heart disease: a meta-analysis. Jama, 2010. 303(7): p. 648-56.

AshokKumar M, Emmanuel C, Dhandapany PS, et al. Haplotypes on 9p21 modify the risk for coronary artery disease among Indians. DNA Cell Biol, 2011. 30(2): p. 105-10.

Burd CE, Jeck WR, Liu Y, et al. Expression of linear and novel circular forms of an INK4/ARF-associated non-coding RNA correlates with atherosclerosis risk. PLoS Genet, 2010. 6(12): p. e1001233.

Folkersen L, Kyriakou T, Goel A, et al. Relationship between CAD risk genotype in the chromosome 9p21 locus and gene expression. Identification of eight new ANRIL splice variants. PLoS One, 2009. 4(11): p. e7677.

Holdt LM, Sass K, Gabel G, et al. Expression of Chr9p21 genes CDKN2B (p15(INK4b)), CDKN2A (p16(INK4a), p14(ARF)) and MTAP in human atherosclerotic plaque. Atherosclerosis, 2011. 214(2): p. 264-70.

Holdt LM, Beutner F, Scholz M, et al. ANRIL expression is associated with atherosclerosis risk at chromosome 9p21. Arterioscler Thromb Vasc Biol, 2010. 30(3): p. 620-7.

Motterle A, Pu X, Wood H, et al. Functional analyses of coronary artery disease associated variation on chromosome 9p21 in vascular smooth muscle cells. Hum Mol Genet, 2012. 21(18): p. 4021-9.

Holdt LM, Teupser D. Recent studies of the human chromosome 9p21 locus, which is associated with atherosclerosis in human populations. Arterioscler Thromb Vasc Biol, 2012. 32(2): p. 196-206.

Yap KL, Li S, Munoz-Cabello AM, et al. Molecular interplay of the noncoding RNA ANRIL and methylated histone H3 lysine 27 by polycomb CBX7 in transcriptional silencing of INK4a. Mol Cell, 2010. 38(5): p. 662-74.

Harismendy O, Notani D, Song X, et al. 9p21 DNA variants associated with coronary artery disease impairs interferon-gamma signalling response. Nature, 2011. 470(7333): p. 264-8.

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Published

21.03.2025

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ORIGINAL ARTICLES

How to Cite

Tzveova, R., Naydenova, G., Yaneva-Sirakova, T., Vandeva, S., Atanasov, P., Mitev, V., Kaneva, R., & Pendicheva-Duhlenska, D. (2025). Association study of polymorphic variants in 9p21 locus and the manifestation of coronary artery disease in Bulgarians. Acta Medica Bulgarica, 52(1), 29-40. https://doi.org/10.2478/AMB-2025-0005