Journal Article

Common conditions associated with hereditary haemochromatosis genetic variants: cohort study in UK Biobank

Kuchel, George A, Melzer, David, Jones, Garan, Pilling, Luke C, Kuo, Chai-Ling, Jones, Lindsay, Tamosauskaite, Jone, Wood, Andrew R, Ferrucci, Luigi

2019

Overview

AbstractObjectiveTo compare prevalent and incident morbidity and mortality between those with the HFE p.C282Y genetic variant (responsible for most hereditary haemochromatosis type 1) and those with no p.C282Y mutations, in a large UK community sample of European descent.DesignCohort study.Setting22 centres across England, Scotland, and Wales in UK Biobank (2006-10).Participants451 243 volunteers of European descent aged 40 to 70 years, with a mean follow-up of seven years (maximum 9.4 years) through hospital inpatient diagnoses and death certification.Main outcome measureOdds ratios and Cox hazard ratios of disease rates between participants with and without the haemochromatosis mutations, adjusted for age, genotyping array type, and genetic principal components. The sexes were analysed separately as morbidity due to iron excess occurs later in women.ResultsOf 2890 participants homozygous for p.C282Y (0.6%, or 1 in 156), haemochromatosis was diagnosed in 21.7% (95% confidence interval 19.5% to 24.1%, 281/1294) of men and 9.8% (8.4% to 11.2%, 156/1596) of women by end of follow-up. p.C282Y homozygous men aged 40 to 70 had a higher prevalence of diagnosed haemochromatosis (odds ratio 411.1, 95% confidence interval 299.0 to 565.3, P<0.001), liver disease (4.30, 2.97 to 6.18, P<0.001), rheumatoid arthritis (2.23, 1.51 to 3.31, P<0.001), osteoarthritis (2.01, 1.71 to 2.36, P<0.001), and diabetes mellitus (1.53, 1.16 to 1.98, P=0.002), versus no p.C282Y mutations (n=175 539). During the seven year follow-up, 15.7% of homozygous men developed at least one incident associated condition versus 5.0% (P<0.001) with no p.C282Y mutations (women 10.1% v 3.4%, P<0.001). Haemochromatosis diagnoses were more common in p.C282Y/p.H63D heterozygotes, but excess morbidity was modest.ConclusionsIn a large community sample, HFE p.C282Y homozygosity was associated with substantial prevalent and incident clinically diagnosed morbidity in both men and women. As p.C282Y associated iron overload is preventable and treatable if intervention starts early, these findings justify re-examination of options for expanded early case ascertainment and screening.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group Ltd
• Subject: Adult / Aged / Arthritis / Arthritis, Rheumatoid - epidemiology / Cardiac arrhythmia / Cardiovascular disease / Cholesterol / Cohort analysis / Comorbidity / Confidence intervals / Coronary vessels / Diabetes / Diabetes mellitus / Diabetes Mellitus - epidemiology / Female / Follow-Up Studies / Genetic analysis / Genetic diversity / Genotype & phenotype / Genotyping / Hemochromatosis - epidemiology / Hemochromatosis - genetics / Hemochromatosis Protein - genetics / Heterozygote / Heterozygotes / Hispanic people / Homozygote / Humans / Incidence / Infertility / Iron / Liver cancer / Liver diseases / Liver Diseases - epidemiology / Male / Middle Aged / Morbidity / Mutation / Osteoarthritis / Osteoarthritis - epidemiology / Osteoporosis / Pneumonia / Population / Prevalence / Rheumatoid arthritis / Survival analysis / United Kingdom