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Article History

Received: 8 January 2026

Accepted: 11 May 2026

First Online: 17 July 2026

Ethics

Acknowledgements: We thank M. Valde (Norwegian School of Sport Sciences, Oslo, Norway) for excellent technical assistance and organising blood sampling. The authors acknowledge the Scientific Computing Department of the IT Division at the Charité, Universitätsmedizin Berlin ( ) for providing computational resources that contributed to the research results reported in this paper. We also thank the study participants for their time and effort.

Data availability: This work uses data provided by patients and collected by the NHS as part of their care and support. Individual-level data from UK Biobank are publicly available to bona fide researchers upon application ( ).

Code availability: The code used to generate the results and figures in this study is available at .

Funding: This work was supported by the Norwegian School of Sport Sciences, the German Centre for Cardiovascular Research (DZHK), the German Ministry of Education and Research (BMBF), the Friede Springer Cardiovascular Prevention Center at Charité – Universitätsmedizin Berlin, Germany, and Prot4CVD (81X2100281) DZHK. The Genes & Health study is/has recently been core-funded by Wellcome (WT102627 and WT210561), the UK Medical Research Council (M009017, MR/X009777/1 and MR/X009920/1), the Higher Education Funding Council for England Catalyst, Barts Charity (845/1796), Health Data Research UK (for the London substantive site), and has received research delivery support from the NHS National Institute for Health Research Clinical Research Network (North Thames). We acknowledge the support from the National Institute for Health and Care Research Barts Biomedical Research Centre (NIHR203330), which is a delivery partnership of Barts Health NHS Trust, Queen Mary University of London, St George’s University Hospitals NHS Foundation Trust and St George’s University of London. The Genes & Health study is/has recently been funded by Alnylam Pharmaceuticals and Genomics plc, and a Life Sciences Industry Consortium of AstraZeneca plc, Bristol-Myers Squibb Co., GlaxoSmithKline Research and Development Ltd, Maze Therapeutics Inc, Merck Sharp & Dohme LLC, Novo Nordisk A/S, Pfizer Inc and Takeda Development Center Americas Inc.

Authors’ relationships and activities: The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

Contribution statement: BU, MP and CL contributed to the conception and design of the study. DAvH, JJ and CL contributed to the acquisition of data. BU, AW, KJK, PBJ, AJK, MK, MZ, CB, SY, CM, JS and MP contributed to the analysis of data. BU, AW, KJK, PBJ, AJK, YB, MR, SO, SB, JCZ, JJ, MP and CL contributed to interpretation of the data. BU, MP and CL drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version for publication. CL and MP are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.