This article has Open Peer Review reports available.
Genetic variants of Complement factor H gene are not associated with premature coronary heart disease: a family-based study in the Irish population
© Meng et al; licensee BioMed Central Ltd. 2007
Received: 01 June 2007
Accepted: 18 September 2007
Published: 18 September 2007
The complement factor H (CFH) gene has been recently confirmed to play an essential role in the development of age-related macular degeneration (AMD). There are conflicting reports of its role in coronary heart disease. This study was designed to investigate if, using a family-based approach, there was an association between genetic variants of the CFH gene and risk of early-onset coronary heart disease.
We evaluated 6 SNPs and 5 common haplotypes in the CFH gene amongst 1494 individuals in 580 Irish families with at least one member prematurely affected with coronary heart disease. Genotypes were determined by multiplex SNaPshot technology.
Using the TDT/S-TDT test, we did not find an association between any of the individual SNPs or any of the 5 haplotypes and early-onset coronary heart disease.
In this family-based study, we found no association between the CFH gene and early-onset coronary heart disease.
Coronary heart disease (CHD) remains a leading cause of death worldwide. It is a complex disorder stemming from interactions between multiple genetic and environmental risk factors. There is increasing evidence that one of the key factors generating and maintaining inflammation in the arterial intima is the complement system . Recently, the amount of complement factor H (CFH) was found to be much greater in the superficial layer of human coronary atherosclerotic lesions than in the deeper layers, indicating a potential role of CFH in atherogenesis .
CFH is encoded by a single gene (CFH) on human chromosome 1q32. Polymorphisms in this gene have been confirmed to be strongly associated with age-related macular degeneration (AMD) [3–7]. It is suggested that the variants in this gene influence the levels of CFH expression. For example, the Y402H (rs1061170) polymorphism, which is located within binding sites for heparin and C-reactive protein (CRP) , was found to change the binding properties and have functional implications , whilst the I62V (rs800292) polymorphism is located in exon 2, which contains a C3b binding site . These alterations may lead to complement related damage to blood vessels . CFH variants with more substantial effects may be implicated in the earlier age-of-onset of certain diseases . In 2006, Kardys and colleagues investigated the role of the Y402H polymorphism in the CFH gene and reported an increased risk for myocardial infarction in those who were homozygous for the His variant . However, three subsequent studies have not been able to replicate this result [11–13].
In our study, we investigated the role of CFH gene polymorphisms as risk markers for early-onset CHD in a well-characterised Irish family-based study.
The entry criteria used in this study have been described elsewhere . Between August 1999 and October 2004 we recruited 1494 individuals from 580 families. All subjects were Caucasian whose four grandparents were born in Ireland. Each family had at least one member affected with early-onset CHD (disease onset ≤55 years for males and ≤60 years for females) and at least one unaffected sibling and/or both parents surviving.
The affected individuals were recruited from the cardiology units of the Royal Victoria Hospital and Belfast City Hospital, Northern Ireland. CHD was defined as the presence of one or more of the following features: (1) a history of acute MI (as defined by WHO criteria); (2) a history of unstable angina (typical chest pain with dynamic ECG changes or minor elevations in cardiac markers); (3) coronary artery disease angiographically (≥ 70% luminal stenosis).
Unaffected siblings were required to: (1) be older than the affected sibling was at the onset of CHD; (2) have no symptoms of angina or possible MI by WHO questionnaire assessments ; (3) have no history of CHD diagnosed by a doctor; and (4) have a resting 12 lead ECG lead showing no evidence of ischaemia or previous MI .
All subjects underwent physical examination and provided demographic information and medical history (including CHD risk factors) using standardised questionnaires.
The study was approved by the Research Ethics Committee of Queen's University Belfast and informed consent was obtained from all subjects.
DNA extraction and genotyping
DNA was extracted from peripheral whole blood using a salting out method. Genotype determination was performed using multiplex SNaPshot technology, an ABI fluorescence-based assay allelic discrimination method (Applied Biosystems, USA). Genotyping was repeated in 10% of the samples randomly selected as a quality control measure. Two observers unaware of the subject's disease status read each gel image. GeneMarkerV1.5 (Softgenetics, USA) was used to determine each allele.
The combined TDT/S-TDT test [17, 18] was used to assess the presence of linkage disequilibrium between the 6 SNPs or 5 haplotypes and early-onset CHD by testing for unequal transmission of an allele or haplotype from parents to affected offspring or unequal sharing of an allele or haplotype within disease-discordant sibships.
The combined TDT/S-TDT combines the TDT with the sibling TDT (S-TDT). Trios are informative for the TDT if there is an affected child and at least one parent is heterozygous. Sib pairs are informative for the S-TDT if there is at least one affected and one unaffected sibling with different marker genotypes.
Analysis of variance was used to compare means for quantitative variables and the chi-squared test was used for qualitative variables. SPSS 14.0 (SPSS Inc, USA) was used for these statistical analyses.
All statistical tests were performed at the 5% significance level (two-tailed).
Family structures of 1494 subjects in 580 families
Number of families
Number of individuals
Proband + parents + 0 sibling
Proband + parents + 1 sibling
Proband + parents + 2 sibling
Risk factors in the probands and their siblings with premature onset CHD
Probands (n = 580)
Siblings (n = 786)
52.0(SD = 7.4)
56.0(SD = 7.8)
Systolic BP ≥ 140 mmHg
Diastolic BP ≥ 95 mmHg
Total cholesterol (mmol/l)*
4.9(SD = 1.1)
5.8(SD = 1.1)
Association tests between 6 SNPs and premature heart disease performed using the Transmission Disequilibrium Test/sibling Transmission Disequilibrium Test (TDT/S-TDT)
Number of informative families
Association between 5 CFH haplotypes and premature heart disease
There is evidence that polymorphisms in the CFH gene may be involved in atherogenesis . The CFH gene is a member of the Regulator of Complement Activation (RCA) gene cluster . The activation of the complement system is an important link between inflammation and atherogenesis. It has been postulated that variants in the CFH gene may be associated with CHD through modulation of inflammatory pathways, as has been reported in age-related macular degeneration (AMD) patients .
The CFH gene has been found to contribute around 50% percent of the risk of AMD . AMD and atherosclerotic cardiovascular disease appear to share common pathogenic mechanisms: both are characterized by lipid deposition (drusen and plaques) and thickening of connective tissue (Bruch's membrane and arterial intima) . One possible pathogenic mechanism is that the normal role of CFH is to prevent uncontrolled complement activation and inflammation . Hence, mutations in CFH may increase inflammation and its pathological consequences. However, there is evidence that the mechanisms of atherogenesis may vary according to the size of arteries, which means that whilst CFH genetic variants may contribute to the atherogenesis in the tiny vessels in the eye, they may not have the same effect in the coronary arteries .
A recent study in Netherlands showed that the Y402H polymorphism was associated with increased risk of myocardial infarction. The HH homozygotes had a hazard ratio of 1.77 (95% confidence interval 1.23 to 2.55) . They first excluded the non-MI CHD patients (13% of the study population). In their case-control study, using samples from the Physicians' Health Study, Zee et al did not find any association between the CFH Y402H gene polymorphism and incident myocardial infarction, ischaemic stroke, or venous thromboembolism . Using samples from the Atherogene and ECTIM studies, Nicaud and colleagues were also unable to find any association between common polymorphisms in the CFH and coronary artery disease . Likewise, in their study of 1170 patients with angiographically confirmed coronary artery disease and 560 controls, Goverdhan and co-workers did not detect any association between the CFH Y402H gene variant and presence or severity of CAD . Such non-replication of findings is a common finding in the field of the genetics of complex disease .
One possible explanation for the lack of association in some of these reported studies is that CFH may be involved more in the formation of unstable plaques rather than the more stable atherosclerotic lesions. A significant characteristic of unstable lesions is the presence of numerous macrophages with matrix metalloproteinases, which can digest the fibrous cap part of the plaque. In the paper by Sivaprasad and colleagues, 3-fold increases of matrix metalloproteinase-9 were found in the AMD patients . This function may be mediated in part by C-Reactive Protein, which has been reported to be associated with unstable atherosclerotic lesions . Another supporting study showed that the activation of CFH is greater in the superficial rather than the deeper layer of the atherosclerotic plaque .
Whilst we have shown differences in the prevalence of conventional risk factors between the probands and siblings, family-based statistical analyses are, unfortunately, not suited to investigating gene-environment interactions since, unlike the subjects in a case-control study, families cannot be neatly divided into those with and those without the environmental risk factor of interest (such as smoking status or diabetes).
Although free from the problems of hidden population stratification, there is a relative lack of power with family based association studies. The number of families recruited was 580; however, the number of informative families ranged from 181 to 323 (Table 3). Of course, we cannot exclude the possibility that other polymorphisms in the CFH gene, which are not in linkage disequilibrium with any of these 6 SNPs, may play a role. However, we found no association between 6 common SNPs or 5 haplotypes of the CFH gene and early-onset CHD in this Irish family-based population.
In this family-based study, we found no evidence of an association between variants of the CFH gene and early-onset coronary heart disease.
We thank Paul McGlinchey and Mark Spence for their valuable contribution to collection of families for this study.
The research was supported by the Research and the Development Office, Northern Ireland, a Royal Victoria Hospital Research Fellowship, the Northern Ireland Chest, Heart and Stroke Association, and the Heart Trust Fund (Royal Victoria Hospital). The funding bodies were not involved in study design, the collection, analysis or interpretation of data, nor in the writing of the manuscript for publication.
- Oksjoki R, Kovanen PT, Pentikainen MO: Role of complement activation in atherosclerosis. Curr Opin Lipidol. 2003, 14: 477-482. 10.1097/00041433-200310000-00008.View ArticlePubMedGoogle Scholar
- Oksjoki R, Jarva H, Kovanen PT, Laine P, Meri S, Pentikäinen MO: Association between Complement Factor H and Proteoglycans in Early Human Coronary Atherosclerotic Lesions. Arterioscler Thromb Vasc Biol. 2003, 23: 630-636. 10.1161/01.ATV.0000057808.91263.A4.View ArticlePubMedGoogle Scholar
- Klein RJ, Zeiss C, Chew EY, Tsai JY, Sackler RS, Haynes C, Henning AK, SanGiovanni JP, Mane SM, Mayne ST, Bracken MB, Ferris FL, Ott J, Barnstable C, Hoh J: Complement Factor H Polymorphism in Age-Related Macular Degeneration. Science. 2005, 308 (5720): 385-9. 10.1126/science.1109557.View ArticlePubMedPubMed CentralGoogle Scholar
- Haines JL, Hauser MA, Schmidt S, Scott WK, Olson LM, Gallins P, Spencer KL, Kwan SY, Noureddine M, Gilbert JR, Schnetz-Boutaud N, Agarwal A, Postel EA, Pericak-Vance MA: Complement Factor H Variant Increases the Risk of Age-Related Macular Degeneration. Science. 2005, 308: 419-421. 10.1126/science.1110359.View ArticlePubMedGoogle Scholar
- Edwards AO, Ritter R, Abel KJ, Manning A, Panhuysen C, Farrer LA: Complement factor H polymorphism and age-related macular degeneration. Science. 2005, 308 (5720): 421-424. 10.1126/science.1110189.View ArticlePubMedGoogle Scholar
- Hageman GS, Anderson DH, Johnson LV, Hancox LS, Taiber AJ, Hardisty LI, Hageman JL, Stockman HA, Borchardt JD, Gehrs KM, Smith RJ, Silvestri G, Russell SR, Klaver CC, Barbazetto I, Chang S, Yannuzzi LA, Barile GR, Merriam JC, Smith RT, Olsh AK, Bergeron J, Zernant J, Merriam JE, Gold B, Dean M, Allikmets R: A common haplotype in the complement regulatory gene factor H (HF1/CFH) predisposes individuals to age-related macular degeneration. Proc Natl Acad Sci. 2005, 102: 7227-7732. 10.1073/pnas.0501536102.View ArticlePubMedPubMed CentralGoogle Scholar
- Hughes AE, Orr N, Esfandiary H, Diaz-Torres M, Goodship T, Chakravarthy U: A common CFH haplotype, with deletion of CFHR1 and CFHR3, is associated with lower risk of age-related macular degeneration. Nature Genetics. 2006, 38: 1173-1177. 10.1038/ng1890.View ArticlePubMedGoogle Scholar
- Giannakis E, Jokiranta TS, Male DA, Ranganathan S, Ormsby RJ, Fischetti VA, Mold C, Gordon DL: A common site within factor H SCR 7 responsible for binding heparin, C-reactive protein and streptococcal M protein. Eur J Immunol. 2003, 33: 962-969. 10.1002/eji.200323541.View ArticlePubMedGoogle Scholar
- Rodríguez de Córdoba S, Esparza-Gordillo J, Goicoechea de Jorge E, Lopez-Trascasa M, Sánchez-Corral P: The human complement factor H: functional roles, genetic variations and disease associations. Mol Immunol. 2004, 41: 355-367. 10.1016/j.molimm.2004.02.005.View ArticlePubMedGoogle Scholar
- Kardys I, Klaver CC, Despriet DD, Bergen AA, Uitterlinden AG, Hofman A, Oostra BA, Van Duijn CM, de Jong PT, Witteman JC: A common polymorphism in the complement factor H gene is associated with increased risk of myocardial infarction: the Rotterdam Study. J Am Coll Cardiol. 2006, 47: 1568-1575. 10.1016/j.jacc.2005.11.076.View ArticlePubMedGoogle Scholar
- Zee RYL, Diehl KA, Ridker PM: Complement factor H Y402H gene polymorphism, C-reactive protein, and risk of incident myocardial infarction, ischaemic stroke, and venous thromboembolism: a nested case-control study. Atherosclerosis. 2006, 187: 332-335. 10.1016/j.atherosclerosis.2005.09.009.View ArticlePubMedGoogle Scholar
- Nicaud V, Francomme C, Ruidavets JB, Luc G, Arveiler D, Kee F, Evans A, Morrison C, Blankenberg S, Cambien F, Tiret L: Lack of association between complement factor H polymorphisms and coronary artery disease or myocardial infarction. J Mol Med. 2007, 85: 771-775. 10.1007/s00109-007-0185-2.View ArticlePubMedGoogle Scholar
- Goverdhan SV, Lotery AJ, Cree AJ, Ye S: Complement factor H Y402H gene polymorphism in coronary artery disease and atherosclerosis. Atherosclerosis. 2006, 188: 213-214. 10.1016/j.atherosclerosis.2006.04.013.View ArticlePubMedGoogle Scholar
- Spence MS, McGlinchey PG, Patterson CC, Belton C, Murphy G, McMaster D, Fogarty DG, Evans AE, McKeown PP: Family-based investigation of the C677T polymorphism of the methylenetetrahydrofolate reductase gene in ischaemic heart disease. Atherosclerosis. 2002, 165: 293-299. 10.1016/S0021-9150(02)00239-3.View ArticlePubMedGoogle Scholar
- Rose GA, Blackburn H, Gillum RF, Prineas RJ: World Health Organization: Cardiovascular Survey Methods. 1982, Geneva: World Health Organization, 2Google Scholar
- Blackburn H, Keys A, Simonson E, Rautaharju P, Punsar S: The Electrocardiogram in Population Studies. A classification system. Circulation. 1960, 21: 1160-1175.View ArticlePubMedGoogle Scholar
- Spielman RS, Ewens WJ: A sibship test for linkage in the presence of association: the sib transmission/disequilibrium test. Am J Hum Genet. 1998, 62: 450-458. 10.1086/301714.View ArticlePubMedPubMed CentralGoogle Scholar
- Spielman lab: TDT & S-TDT. [http://genomics.med.upenn.edu/spielman/TDT.htm]
- Topol EJ, Smith J, Plow EF, Wang QK: Genetic susceptibility to myocardial infarction and coronary artery disease. Hum Mol Genet. 2006, 15 (Spec No 2): R117-R123. 10.1093/hmg/ddl183.View ArticlePubMedGoogle Scholar
- Friedman E: The role of the atherosclerotic process in the pathogenesis of age-related macular degeneration. Am J Ophthalmol. 2000, 130: 658-663. 10.1016/S0002-9394(00)00643-7.View ArticlePubMedGoogle Scholar
- Napoli C, Witztum JL, de Nigris F, Palumbo G, D'Armiento FP, Palinski W: Intracranial Arteries of Human Fetuses Are More Resistant to Hypercholesterolemia-Induced Fatty Streak Formation Than Extracranial Arteries. Circulation. 1999, 99: 2003-2010.View ArticlePubMedGoogle Scholar
- Morgan TM, Krumholz HM, Lifton RP, Spertus JA: Nonvalidation of reported genetic risk factors for acute coronary syndrome in a large-scale replication study. JAMA. 2007, 297: 1551-1561. 10.1001/jama.297.14.1551.View ArticlePubMedGoogle Scholar
- Sivaprasad S, Bailey TA, Chong VN: Bruch's membrane and the vascular intima: is there a common basis for age-related changes and disease?. Clin Experiment Ophthalmol. 2005, 33: 518-523. 10.1111/j.1442-9071.2005.01074.x.View ArticlePubMedGoogle Scholar
- Moukarbel GV, Arnaout MS, Alam SE: C-reactive protein is a marker for a complex culprit lesion anatomy in unstable angina. Clin Cardiol. 2001, 24: 506-510.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://0-www.biomedcentral.com.brum.beds.ac.uk/1471-2350/8/62/prepub
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.