Clonal Hematopoiesis Associates with Prevalent and Incident Cardiometabolic Disease in High-Risk Individuals
Authors: Regan Jessica A. , Kwee Lydia Coulter , Nafissi Navid A. , Bick Alexander G. , Kraus William E. , Natarajan Pradeep , Jaiswal Sidd , Shah Svati H. 
Published: January 2025

Background

Clonal hematopoiesis of indeterminate potential (CHIP) is the age-related presence of expanded somatic clones secondary to leukemogenic driver mutations and is associated with cardiovascular (CV) disease and mortality. We sought to evaluate relationships between CHIP with cardiometabolic diseases and incident outcomes in high-risk individuals.

Methods

CHIP genotyping was performed in 8469 individuals referred for cardiac catheterization at Duke University (CATHGEN study) to identify variants present at a variant allele fraction (VAF) ≥2%. Associations were tested among any CHIP variant, large CHIP clones (VAF ≥10%) and individual CHIP genes with prevalent cardiometabolic traits. Cox proportional hazard models tested CHIP associations with time-to-overall mortality and Fine-Gray analyses tested CHIP associations with incident cardiovascular outcomes.

Results

We identified 463 CHIP variants in 427 individuals (5.0%) of which 268 (3.2%) harbored large CHIP clones. CHIP and large CHIP were associated with lower odds of obesity (OR 0.79 [95% CI 0.65-0.98], p=0.03; OR 0.76 [95% CI 0.57-0.99], p=0.04, respectively). CHIP was associated with prevalent HF (OR 1.25 [95% CI 1.01 - 1.55], p=0.04; especially for non-DNMT3ACHIP (OR 1.38 [95% CI 1.04-1.82], p=0.02). CHIP was also associated with incident events: Non-DNMT3ACHIP was associated with increased risk of time-to-HF hospitalization (HR 1.29 [95% CI 1.02-1.63], p=0.03).

Conclusions

In high-risk individuals referred for cardiac catheterization, large CHIP and non-DNTM3ACHIP were associated with obesity, prevalent HF, incident CV events. These findings strengthen the importance of CHIP as a biomarker for CV disease and highlight the contributing risk of large CHIP clones and non-DNMT3ACHIP variants.

Condensed Abstract

CHIP, the presence of somatic expanded mutations in myeloid driver genes in hematopoietic cells, is an emerging CVD biomarker. Using whole exome sequencing of peripheral blood derived DNA from participants in the CATHGEN cohort, we identified significant associations with obesity, prevalent HF, incident mortality, HF hospitalization and AF after adjusting for established clinical risk factors. These findings add strength to the growing literature of CHIP as a CVD biomarker, emphasizing large CHIP and non-DNMT3ACHIP variants for driving risk. Future studies should aim to further elucidate gene-specific risk and the inflammatory and metabolic mechanisms possibly mediating these relationships.

Clinical Perspective

What Is New?

In a cohort with high prevalence of CAD, CHIP is inversely associated with obesity and associated with higher odds of prevalent HF and subsequent mortality, even after adjustment for relevant clinical comorbidities. Risk of incident events of mortality, HF hospitalization and AF were driven by large CHIP variants (VAF≥10%) and CHIP variants in genes other thanDNMT3A.

What are the Clinical Implications?

Though more research is needed, as the evidence around the risk associated with specific CHIP variants continues to grow, clinicians should be prepared to provide gene- specific counseling for cardiometabolic disease risk.