V122I Transthyretin Variant in Elderly Black Americans

To the Editor: In their long-term analysis of black American carriers of the V122I allele in the transthyretin gene (TTR), Quarta et al. (Jan. 1 issue)¹ confirm reported carrier frequencies² but find a low prevalence of echocardiographic features of cardiomyopathy and no significant effect on mortality in spite of an increased incidence of heart failure. However, amyloid cardiomyopathy associated with the TTR V122I variant disproportionately afflicts elderly men,³ and only 11 men were included in the final analysis. The mortality trend in carriers older than 80 years of age and the disparate male dropout rate suggest that in . . .