Telomere length predicts cardiovascular disease

To the editor,

The prospect of leucocyte telomere length (LTL) as a biomarker for coronary artery disease is an exciting one. Haycock et al should be applauded on their comprehensive review of the evidence linking LTL and coronary artery disease in the general population (1). The plethora of different study designs and the heterogeneity of the topic make it a very challenging area to make solid and independent conclusions on its potential role. The multiple observational studies in this field have been examined and the differences accounted for in the analysis. Drawing all these independent studies on LTL length being independently associated with cardiovascular disease. However all the studies examine LTL at one time point, and potentially this is a marker that by the nature of the changes of LTL with age would be more sensitive being measured in a longitudinal study.

Masi et al recently published longitudinal observational data from the 1946 British Birth Cohort demonstrating the rate of LTL shortening was related to subclinical measures of atherosclerosis (2). The relationship was independent of traditional cardiovascular disease risk factors (2). The longitudinal perspective that this study offers supports the conclusions that Haycock et al make. LTL appears to be very strong marker over time of a patient’s individual cardiovascular disease risk.

LTL potentially offers a new angle to managing cardiovascular disease risk. LTL potentially offers an opportunity to identify patients whom are genetically susceptible to cardiovascular disease and may allow monitoring of risk modification strategies. Saliques et al demonstrated in a large cohort that following an acute myocardial infarction that is statins were taken LTL was longer(3). A variety of different statins were used in this study and this group were older. However, it suggests LTL is impacted by statin therapy. Notably this study did not correlate statin use, LTL and cardiovascular disease outcomes.

Longitudinally LTL offers a good potential target for surveying an individuals and populations inherent cardiovascular disease risk. Moreover it may offer potential markers of success of certain risk modification strategies.

References

1. Haycock PC, Heydon EE, Kaptoge S, Butterworth AS, Thompson A, Willeit P. Leucocyte telomere length and risk of cardiovascular disease: systematic review and meta-analysis. Bmj. 2014;349:g4227.
2. Masi S, D'Aiuto F, Martin-Ruiz C, Kahn T, Wong A, Ghosh AK, et al. Rate of telomere shortening and cardiovascular damage: a longitudinal study in the 1946 British Birth Cohort. European heart journal. 2014.
3. Saliques S, Teyssier JR, Vergely C, Lorgis L, Lorin J, Farnier M, et al. Circulating leukocyte telomere length and oxidative stress: a new target for statin therapy. Atherosclerosis. 2011;219(2):753-60.