Phenome-Wide Association ofAPOEAlleles in theAll of UsResearch Program

Abstract

ABSTRACTBackgroundGenetic variation inAPOEis associated with altered lipid metabolism, as well as cardiovascular and neurodegenerative disease risk. However, prior studies are largely limited to European ancestry populations and differential risk by sex and ancestry has not been widely evaluated. We utilized a phenome-wide association study (PheWAS) approach to exploreAPOE- associated phenotypes in theAll of UsResearch Program.MethodsWe determinedAPOEalleles for 181,880All of Usparticipants with whole genome sequencing and electronic health record (EHR) data, representing seven gnomAD ancestry groups. We tested association ofAPOEvariants, ordered based on Alzheimer’s disease risk hierarchy (ε2/ε2<ε2/ε3<ε3/ε3<ε2/ε4<ε3/ε4<ε4/ε4), with 2,318 EHR-derived phenotypes. Bonferroni-adjusted analyses were performed overall, by ancestry, by sex, and with adjustment for social determinants of health (SDOH).FindingsIn the overall cohort, PheWAS identified 17 significant associations, including an increased odds of hyperlipidemia (OR 1.15 [1.14–1.16] perAPOEgenotype group;P=1.8×10-129), dementia, and Alzheimer’s disease (OR 1.55 [1.40–1.70];P=5×10-19), and a reduced odds of fatty liver disease (OR 0.93 [0.90–0.95];P=1.6×10-9) and chronic liver disease. ORs were similar after SDOH adjustment and by sex, except for an increased number of cardiovascular associations in males, and decreased odds of noninflammatory disorders of vulva and perineum in females (OR 0.89 [0.84–0.94];P=1.1×10-5). Significant heterogeneity was observed for hyperlipidemia and mild cognitive impairment across ancestry. Unique associations by ancestry included transient retinal arterial occlusion in the European ancestry group, and first-degree atrioventricular block in the American Admixed/Latino ancestry group.InterpretationWe replicate extensive phenotypic associations withAPOEalleles in a large, diverse cohort, despite limitations in accuracy for EHR-derived phenotypes. We provide a comprehensive catalog ofAPOE-associated phenotypes and present evidence of unique phenotypic associations by sex and ancestry, as well as heterogeneity in effect size across ancestry.FundingFunding is listed in the acknowledgements.