AUTHOR=Zheng Jilin , Chen Ken , Huang Tao , Shao Chunli , Li Ping , Wang Jingjia , Wang Wenyao , Zhang Kuo , Meng Xiangbin , Gao Jun , Wang Xuliang , Liu Yupeng , Song Jingjing , Dong Eran , Tang Yi-Da 

TITLE=Genetically Determined Lifestyle and Cardiometabolic Risk Factors Mediate the Association of Genetically Predicted Age at Menarche With Genetic Predisposition to Myocardial Infarction: A Two-Step, Two-Sample Mendelian Randomization Study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.821068

DOI=10.3389/fcvm.2022.821068

ISSN=2297-055X

ABSTRACT=Background
Observational studies have shown an association between early age at menarche (AAM) and myocardial infarction (MI) by recorded cases. In this mendelian randomization (MR) study we used large amounts of summary data from genome-wide association studies (GWAS) to further estimate the association of genetically predicted AAM with genetically predicated risk of MI and investigate to what extent this association is mediated by genetically-determined lifestyles, cardiometabolic factors, and estrogen exposure. 
Methods
A two-step, two-sample MR study was performed with mediation analysis. Genetic variants identified by GWAS meta-analysis of Reproductive Genetics Consortium (n=182,416) were selected for genetically predicted AAM. Genetic variants identified by the Coronary ARtery DIsease Genome-wide Replication and Meta-analysis plus The Coronary Artery Disease Genetics Consortium (n=184,305) were selected for genetically predicted risk of MI. Genetic variants from other international GWAS summary data were selected for genetically-determined mediators. 
Results
The current MR study showed that an increase in genetically predicted AAM was associated with a lower risk of genetically predicted MI (odds ratio 0.91, 95% confidence interval 0.84-0.98). Inverse variance weighted (IVW) MR analysis also showed that a decrease in genetically predicted AAM was associated with higher genetically predicted alcohol intake frequency, current smoking behavior, higher waist-to-hip ratio, higher levels of systolic blood pressure (SBP), fasting blood glucose, hemoglobin A1c (HbA1c) and triglycerides (TG). Furthermore, an increase in genetically predicted AAM was associated with genetically predicted longer sleep duration, higher levels of high-density lipoproteins and older age that started hormone replacement therapy. The most essential mediators identified were genetically predicted current smoking behavior and levels of HbA1c, SBP, and TG, which were estimated to genetically mediate 13.9%, 12.2%, 10.5% and 9.2%, respectively, with a combined mediation proportion of 37.5% in the association of genetically predicted AAM with genetically predicted increasing risk of MI in a MR framework.
Conclusion
Our MR analysis showed that an increase in genetically predicted AAM was associated with lower genetically predicted risk of MI, which was substantially mediated by genetically- determined current smoking behavior and levels of HbA1c, SBP, and TG. Intervening on the above mediators may reduce risk of MI.