Association between leucocyte telomere length and cardiovascular disease in a large general population in the United States
Authors: Xiaoqi Su
Min Da
Zhaocong Yang
Zhiqi Wang
Xuming Mo
Cheng Xu
Weiwei Duan
Journal: Scientific Reports (2020)
Discipline: Multidisciplinary
Keywords: Leucocyte telomere length; CVD risk; NHANES; logistic regression; interaction effects
Affiliations: Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China., Department of Bioinformatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, 211166, China. ., Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China. .

Abstract:  Leucocyte telomere length (LTL) has been reported to be linked to ageing, cancer and cardiovascular disease (CVD). This study aimed to explore the association between LTL and CVD risk in a nationally representative sample of U.S. adults. Complex associations, including nonlinearity and interaction, were also examined. A total of 7,378 subjects from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 were collected. Telomere length was detected from DNA samples and expressed as the mean T/S ratio (telomere repeats per single-copy gene). We performed multiple logistic regression models and interactive analysis to explore the associations between LTL and CVD risk by adjusting for potential confounders. We also performed a sensitivity analysis to investigate the robustness of our results. Among all participants, LTL was associated with the risk of CVD (OR = 0.79, 95% CI: 0.63~0.98, P = 0.033) in a linear manner rather than in a nonlinear manner (P = 0.874). Interaction effects of LTL with both education (P = 0.017) and hypertension (P = 0.007) were observed. Furthermore, using subgroup analyses, protective effects of LTL on CVD risk were found in females and in individuals who were college graduates or above, had serum cotinine &gt;10 ng/ml, did not have hypertension, or had normal white blood cell levels. LTL is linearly inversely associated with CVD risk in the general population of the United States. 

Retracted: No

PubPeer comments:
  Method: Study population The subjects were from the NHANES 1999u20132000 and 2001u20132002 cycles. The NHANES 1999u20132000 and 2001u20132002 protocols were approved by the National Center for Health Statistics Research Ethics Review Board (ERB) of the Centers for Disease Control and Prevention (Protocol #98u201312). Provided sample weights in NHANES were used to account for the complex sampling of the NHANES data and reflect the non-institutionalized population of the United States. A total of 21,004 subjects were obtained from the NHANES 1999u20132002. We, in sequence, excluded data from participants with pregnancy status (nu2009=u2009676), those missing data for LTL detection (nu2009=u200912,948), those missing data for CVD outcome (nu2009=u20091), and LTLu2009 u200920 kilobase pairs (kbp, nu2009=u20091). The detailed flow chart is summarized in Fig. 3. All cycles of the NHANES protocols were approved by the NCHS Research Ethics Review Board55, and the data user agreement was online . All data were retrieved from the website of the National Center for Health Statistics56. Written informed consent of all participants was obtained. This is an interesting analysis. All the authors are affiliated to universities in China. The study population is in the USA. Is this a meta-analysis paper? It doesn t appear like that as the methods for telomere length measurements are provided? How did they do this kind of study remotely? How the ethical approval was obtained in the USA. The previous study by the same authors were on US adults as well . ,