L oss of the Y chromosome (LOY) in blood cells was already described in the 1960s and affects ≈15% of the male population of older age.1 Only recently, LOY was associated with a higher risk of (nonhematological) cancer and overall mortality. 2,3 This relationship was speculated to be because of smoking and a disrupted tumor immunosurveillance.
See Editorial by Dumanski et al See Clinical PerspectiveThe Y chromosome exhibited an immuneregulatory function by acting as a global transexpression quantitative trait locus in mice. 8 The Y chromosome directly mediated changes in the transcriptome of CD4 + T cells and macrophages, contributing to altered gene expression and alternative splicing. A role in global immune response was also found in the monocyte and macrophage transcriptome results of males with haplotype I that exhibited a 50% greater risk of myocardial infarction. 9 Comparison of gene expression data between haplotype I and other haplotypes revealed pathways that are related to inflammation and immunity, revealing downregulation of adaptive immunity and upregulation of inflammatory response in haplotype I carriers.Background-Recent studies found an immune regulatory role for Y chromosome and a relationship between loss of Y chromosome (LOY) in blood cells and a higher risk of cancer and mortality. Given involvement of immune cells in atherosclerosis, we hypothesized that LOY is associated with the severity of atherosclerotic plaque characteristics and outcome in men undergoing carotid endarterectomy. Methods and Results-LOY was quantified in blood and plaque from raw intensity genotyping data in men within the Athero-Express biobank study. Plaques were dissected, and the culprit lesions used for histology and the measurement of inflammatory proteins. We tested LOY for association with (inflammatory) atherosclerotic plaque phenotypes and cytokines and assessed the association of LOY with secondary events during 3-year follow-up. Of 366 patients with carotid endarterectomy, 61 exhibited some degree of LOY in blood. LOY was also present in atherosclerotic plaque lesions (n=8/242, 3%). LOY in blood was negatively associated with age (β=−0.03/10 y; r 2 =0.07; P=1.6×10 -7 ) but not with cardiovascular disease severity at baseline. LOY in blood was associated with a larger atheroma size (odds ratio, 2.15; 95% confidence interval, 1.06-4.76; P=0.04); however, this association was not significant after correction for multiple testing. LOY was independently associated with secondary major cardiovascular events (hazard ratio=2.28; 95% confidence interval, 1.11-4.67; P=0.02) in blood when corrected for confounders. Conclusions-In this hypothesis-generating study, LOY in blood is independently associated with secondary major cardiovascular events in a severely atherosclerotic population. Our data could indicate that LOY affects secondary outcome via other mechanisms than inflammation in the atherosclerotic plaque. (Circ