Mitochondrial heteroplasmic variant has been increasingly recognized as a potential contributor to common complex diseases, yet its relationship with cardiometabolic disorders (CMDs) remains poorly understood. Leveraging deep whole-genome sequencing data from 16,882 participants across six multi-ancestry TOPMed cohorts, we systematically evaluated the associations between rare heteroplasmic variants and eight CMD traits, including body mass index (BMI), obesity, blood pressure, hypertension, blood glucose, diabetes, low-density lipoprotein (LDL), and hyperlipidemia. Using a previously developed statistical framework, we identified heteroplasmic variants according to three coding definitions and performed gene-based burden, SKAT, SKAT-O and ACAT-O tests within sixteen mitochondrial DNA (mtDNA) genes. We identified twelve significant gene-trait associations after Bonferroni correction, with consistent effect directions across coding definitions. The strongest association was observed between hyperlipidemia and heteroplasmic variants in CO1 gene (OR=0.28, 95% CI=(0.17, 0.46), p=3.4E-7) among EA (European Americans). Additional associations were detected for BMI, adjusted SBP (systolic blood pressure), BG (blood glucose), diabetes, and adjusted LDL. These findings highlight the contribution of heteroplasmic variation within mtDNA to cardiometabolic phenotypes and provide new insight into mitochondrial involvement in CMD pathophysiology.
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