Telomere length in patients with adult congenital heart disease
T Tournoy, B Daelman, L Demulier, A Van De Bruaene, W Budts, P Moons, J De BackerAbstract
Background/introduction
Thanks to improved survival of individuals with congenital heart disease (CHD), the population is growing and aging. However, these patients should not be considered cured, and both cardiac- and noncardiac age-related comorbidities tend to occur more frequently and at a younger age than in the general population. This observation raises the hypothesis of accelerated biological aging. Telomere length (TL) is recognized as a hallmark of aging, as it shortens with advancing age and cumulative biological stress.
Purpose
To compare TL between adults with CHD and matched healthy controls, and to assess the association between CHD disease severity and short TL.
Methods
In this cross-sectional multicenter study, TL was measured in 528 adults with CHD (mean age 40±15 years, 239 females) and 528 age- and sex-matched healthy controls. In our cohort, 149 had simple, 269 moderate and 110 complex CHD. Leukocyte relative TL was measured by qPCR and expressed as the telomere-to-single copy gene (T/S) ratio. Short TL was defined as values below the 10th percentile of age- and sex-adjusted TL residuals derived from healthy controls. Associations between disease severity and short TL were evaluated using logistic regression and reported as odds ratios (ORs).
Results
Adults with CHD had shorter relative TL compared to healthy controls (0.95±0.20 vs 0.99±0.19 respectively, p<0.001), shown in figure 1. TL was inversely correlated with age in both patients and controls (Pearson R=-0.38 and R=-0.49 respectively, both p<0.001). The odds of short TL were higher in patients with moderate CHD (OR 2.3 (95% CI 1.5-3.5), p<0.001) and complex CHD (OR 1.9 (95% CI 1.1-3.4), p=0.024) compared to healthy peers, but not in patients with simple CHD (OR 1.5 (95% CI 0.9-2.6), p=0.130), as illustrated in figure 2. Overall, disease severity was significantly associated with short TL (p<0.001).
Conclusion(s)
Adults with CHD exhibit shorter relative TL compared with matched healthy controls, supporting the hypothesis of accelerated biological aging in this population. As TL was measured in leukocytes, these findings could reflect a broader systemic impact of CHD beyond the cardiovascular system. The higher prevalence of short TL with greater disease complexity suggests that CHD severity may contribute to the aging trajectory. Together, these findings highlight TL as a promising biomarker in CHD to identify individuals at risk for accelerated aging which could contribute to risk stratification and personalized follow-up in this aging population.Figure 1Figure 2