- Rocheleau, Ghislain;
- Clarke, Shoa;
- Auguste, Gaëlle;
- Hasbani, Natalie;
- Morrison, Alanna;
- Heath, Adam;
- Bielak, Lawrence;
- Iyer, Kruthika;
- Young, Erica;
- Stitziel, Nathan;
- Jun, Goo;
- Laurie, Cecelia;
- Broome, Jai;
- Khan, Alyna;
- Arnett, Donna;
- Becker, Lewis;
- Bis, Joshua;
- Boerwinkle, Eric;
- Bowden, Donald;
- Carson, April;
- Ellinor, Patrick;
- Fornage, Myriam;
- Franceschini, Nora;
- Freedman, Barry;
- Heard-Costa, Nancy;
- Hou, Lifang;
- Chen, Yii-Der;
- Kenny, Eimear;
- Kooperberg, Charles;
- Kral, Brian;
- Loos, Ruth;
- Lutz, Sharon;
- Manson, JoAnn;
- Martin, Lisa;
- Mitchell, Braxton;
- Nassir, Rami;
- Palmer, Nicholette;
- Post, Wendy;
- Preuss, Michael;
- Psaty, Bruce;
- Raffield, Laura;
- Regan, Elizabeth;
- Rich, Stephen;
- Smith, Jennifer;
- Taylor, Kent;
- Yanek, Lisa;
- Young, Kendra;
- Hilliard, Austin;
- Tcheandjieu, Catherine;
- Peyser, Patricia;
- Vasan, Ramachandran;
- Rotter, Jerome;
- Miller, Clint;
- Assimes, Themistocles;
- de Vries, Paul;
- Do, Ron
Whole genome sequences (WGS) enable discovery of rare variants which may contribute to missing heritability of coronary artery disease (CAD). To measure their contribution, we apply the GREML-LDMS-I approach to WGS of 4949 cases and 17,494 controls of European ancestry from the NHLBI TOPMed program. We estimate CAD heritability at 34.3% assuming a prevalence of 8.2%. Ultra-rare (minor allele frequency ≤ 0.1%) variants with low linkage disequilibrium (LD) score contribute ~50% of the heritability. We also investigate CAD heritability enrichment using a diverse set of functional annotations: i) constraint; ii) predicted protein-altering impact; iii) cis-regulatory elements from a cell-specific chromatin atlas of the human coronary; and iv) annotation principal components representing a wide range of functional processes. We observe marked enrichment of CAD heritability for most functional annotations. These results reveal the predominant role of ultra-rare variants in low LD on the heritability of CAD. Moreover, they highlight several functional processes including cell type-specific regulatory mechanisms as key drivers of CAD genetic risk.