Rare monogenic forms of common diseases have provided key fundamental insights about common disease. However, genetic, environmental, and stochastic elements influence risk for disease. Familial hypercholesterolemia (FH), an autosomal dominant disorder afflicting 1 in 250 linked to severe increases in LDL cholesterol and premature coronary heart disease (CHD) risk, is an ideal model to characterize modifiers of disease. Despite the presence of a strong genetic driver of hypercholesterolemia from FH mutations, we recently observed that half do not have the expected severe hypercholesterolemia. In this proposal, we outline several methods to discover and dissect the genetic and non-genetic factors influencing CHD risk conferred by FH mutations in humans and determine whether knowledge of these factors can improve risk discrimination among those with FH mutations. Our approach harnesses several multi-dimensional datasets: whole genome sequences, metabolomics, and cross-sectional and longitudinal cardiovascular phenotypes.
In Aim 1, we will aggregate and curate 75,000 deep (30X) whole genome sequences and cardiovascular phenotypes.
In Aim 2, we will discover genetic and non-genetic modifiers of LDL cholesterol and CHD risk in FH and evaluate their metabolomic consequences.
In Aim 3, we will develop a method incorporating genetics and longitudinal non- genetic exposures for CHD risk stratification among ~4,000 with FH mutations in the Million Veteran Program. In addition to the proposed Aims, this five-year proposal outlines a comprehensive strategy for the principal investigator's (PI's) scientific and professional development in academic cardiovascular medicine. The research strategy builds upon the PI's prior research experience and clinical training. In addition to an undergraduate degree in Molecular Biology and master's degree in Biomedical Informatics, he completed post- graduate medical training in Internal Medicine and Cardiovascular Medicine. He recently developed a new preventive/genetic cardiology clinic focusing on the evaluation and management of those with or a family history of premature CHD, including those with FH, at Massachusetts General Hospital (MGH). This proposal now focuses on expanding his scientific skills in human genetics and genomics into new domains: integrative genomics, statistical genetics, clinical informatics, and risk modeling. The career development goals will be at achieved through a multi-faceted approach involving mentorship, collaboration, didactic coursework, conferences, and scientific investigation. This work will take place in a unique training environment comprised of MGH and the Broad Institute. Successful completion of this career development award will result in improved fundamental understanding of the determinants of CHD, result in the PI's transition to an independent physician-scientist, and provide a solid foundation from which he will apply for R01-level funding.

Public Health Relevance

/ PUBLIC HEALTH RELEVANCE Cardiovascular disease, largely due to coronary heart disease (CHD), remains the leading cause of death in the United States and now worldwide despite current advances. Familial hypercholesterolemia is a relative common genetic disorder characterized by severe hypercholesterolemia and premature CHD but many carrying these mutations do not develop these consequences. This proposal seeks to define and characterize the factors modifying CHD risk among those with FH mutations; success has the potential to broadly identify new mechanisms of CHD and novel strategies for prevention.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Clinical Investigator Award (CIA) (K08)
Project #
Application #
Study Section
NHLBI Mentored Clinical and Basic Science Review Committee (MCBS)
Program Officer
Lidman, Karin Fredriksson
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Massachusetts General Hospital
United States
Zip Code
Natarajan, Pradeep (2018) Polygenic Risk Scoring for Coronary Heart Disease: The First Risk Factor. J Am Coll Cardiol 72:1894-1897
Natarajan, Pradeep; Peloso, Gina M; Zekavat, Seyedeh Maryam et al. (2018) Deep-coverage whole genome sequences and blood lipids among 16,324 individuals. Nat Commun 9:3391
Alver, Maris; Palover, Marili; Saar, Aet et al. (2018) Recall by genotype and cascade screening for familial hypercholesterolemia in a population-based biobank from Estonia. Genet Med :
Peloso, Gina M; Natarajan, Pradeep (2018) Insights from population-based analyses of plasma lipids across the allele frequency spectrum. Curr Opin Genet Dev 50:1-6
Zekavat, Seyedeh M; Ruotsalainen, Sanni; Handsaker, Robert E et al. (2018) Publisher Correction: Deep coverage whole genome sequences and plasma lipoprotein(a) in individuals of European and African ancestries. Nat Commun 9:3493
Emdin, Connor A; Khera, Amit V; Chaffin, Mark et al. (2018) Analysis of predicted loss-of-function variants in UK Biobank identifies variants protective for disease. Nat Commun 9:1613
Zekavat, Seyedeh M; Ruotsalainen, Sanni; Handsaker, Robert E et al. (2018) Deep coverage whole genome sequences and plasma lipoprotein(a) in individuals of European and African ancestries. Nat Commun 9:2606
Natarajan, Pradeep; Jaiswal, Siddhartha; Kathiresan, Sekar (2018) Clonal Hematopoiesis: Somatic Mutations in Blood Cells and Atherosclerosis. Circ Genom Precis Med 11:e001926
Gusarova, Viktoria; O'Dushlaine, Colm; Teslovich, Tanya M et al. (2018) Genetic inactivation of ANGPTL4 improves glucose homeostasis and is associated with reduced risk of diabetes. Nat Commun 9:2252
Khera, Amit V; Chaffin, Mark; Aragam, Krishna G et al. (2018) Genome-wide polygenic scores for common diseases identify individuals with risk equivalent to monogenic mutations. Nat Genet 50:1219-1224

Showing the most recent 10 out of 11 publications