Impact of gallstone disease on the risk of stroke and coronary artery disease: evidence from prospective observational studies and genetic analyses

Li Zhang; Wenqiang Zhang; Lin He; Huijie Cui; Yutong Wang; Xueyao Wu; Xunying Zhao; Peijing Yan; Chao Yang; Changfeng Xiao; Mingshuang Tang; Lin Chen; Chenghan Xiao; Yanqiu Zou; Yunjie Liu; Yanfang Yang; Ling Zhang; Yuqin Yao; Jiayuan Li; Zhenmi Liu; Chunxia Yang; Xia Jiang; Ben Zhang

doi:10.1186/s12916-023-03072-6

Impact of gallstone disease on the risk of stroke and coronary artery disease: evidence from prospective observational studies and genetic analyses

BMC Med. 2023 Sep 13;21(1):353. doi: 10.1186/s12916-023-03072-6.

Authors

Li Zhang^#¹, Wenqiang Zhang^#¹, Lin He¹, Huijie Cui¹, Yutong Wang¹, Xueyao Wu¹, Xunying Zhao¹, Peijing Yan¹, Chao Yang¹, Changfeng Xiao¹, Mingshuang Tang¹, Lin Chen¹, Chenghan Xiao², Yanqiu Zou¹, Yunjie Liu¹, Yanfang Yang¹, Ling Zhang³, Yuqin Yao⁴, Jiayuan Li¹, Zhenmi Liu², Chunxia Yang¹, Xia Jiang^{5

6

7}, Ben Zhang^{8

9}

Affiliations

¹ Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China.
² Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
³ Department of Iatrical Polymer Material and Artificial Apparatus, School of Polymer Science and Engineering, Sichuan University, Chengdu, China.
⁴ Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
⁵ Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China. xiajiang@scu.edu.cn.
⁶ Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. xiajiang@scu.edu.cn.
⁷ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. xiajiang@scu.edu.cn.
⁸ Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China. wcsphwcfh@vip.163.com.
⁹ Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. wcsphwcfh@vip.163.com.

^# Contributed equally.

Abstract

Background: Despite epidemiological evidence associating gallstone disease (GSD) with cardiovascular disease (CVD), a dilemma remains on the role of cholecystectomy in modifying the risk of CVD. We aimed to characterize the phenotypic and genetic relationships between GSD and two CVD events - stroke and coronary artery disease (CAD).

Methods: We first performed a meta-analysis of cohort studies to quantify an overall phenotypic association between GSD and CVD. We then investigated the genetic relationship leveraging the largest genome-wide genetic summary statistics. We finally examined the phenotypic association using the comprehensive data from UK Biobank (UKB).

Results: An overall significant effect of GSD on CVD was found in meta-analysis (relative risk [RR] = 1.26, 95% confidence interval [CI] = 1.19-1.34). Genetically, a positive shared genetic basis was observed for GSD with stroke ([Formula: see text]=0.16, P = 6.00 × 10^-4) and CAD ([Formula: see text]=0.27, P = 2.27 × 10^-15), corroborated by local signals. The shared genetic architecture was largely explained by the multiple pleiotropic loci identified in cross-phenotype association study and the shared gene-tissue pairs detected by transcriptome-wide association study, but not a causal relationship (GSD to CVD) examined through Mendelian randomization (MR) (GSD-stroke: odds ratio [OR] = 1.00, 95%CI = 0.97-1.03; GSD-CAD: OR = 1.01, 95%CI = 0.98-1.04). After a careful adjustment of confounders or considering lag time using UKB data, no significant phenotypic effect of GSD on CVD was detected (GSD-stroke: hazard ratio [HR] = 0.95, 95%CI = 0.83-1.09; GSD-CAD: HR = 0.98, 95%CI = 0.91-1.06), further supporting MR findings.

Conclusions: Our work demonstrates a phenotypic and genetic relationship between GSD and CVD, highlighting a shared biological mechanism rather than a direct causal effect. These findings may provide insight into clinical and public health applications.

Keywords: Cardiovascular disease; Gallstone disease; Genetic correlation; Mendelian randomization; Phenotypic association.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Coronary Artery Disease* / epidemiology
Coronary Artery Disease* / genetics
Humans
Myocardial Infarction*
Observational Studies as Topic
Odds Ratio
Prospective Studies
Stroke* / epidemiology
Stroke* / genetics