Genetic determinants of lipids and cardiovascular disease outcomes: a wide-angled mendelian randomization investigation.
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Published version
Author(s)
Type
Journal Article
Abstract
Background - Evidence from randomized trials has shown that therapies that lower low-density lipoprotein (LDL)-cholesterol and triglycerides reduce coronary artery disease (CAD) risk. However, there is still uncertainty regarding their effects on other cardiovascular outcomes. We therefore performed a systematic investigation of causal relationships between circulating lipids and cardiovascular outcomes using a Mendelian randomization approach. Methods - In the primary analysis, we performed two-sample multivariable Mendelian randomization using data from participants of European ancestry. We also conducted univariable analyses using inverse-variance weighted and robust methods, and gene-specific analyses using variants that can be considered as proxies for specific lipid-lowering medications. We obtained associations with lipid fractions from the Global Lipids Genetics Consortium, a meta-analysis of 188,577 participants, and genetic associations with cardiovascular outcomes from 367,703 participants in UK Biobank. Results - For LDL-cholesterol, in addition to the expected positive associations with CAD risk (odds ratio per 1 standard deviation increase [OR], 1.45; 95% confidence interval [95%CI] 1.35-1.57) and other atheromatous outcomes (ischemic cerebrovascular disease and peripheral vascular disease), we found independent associations of genetically-predicted LDL-cholesterol with abdominal aortic aneurysm (OR 1.75; 95%CI 1.40-2.17) and aortic valve stenosis (OR 1.46; 95%CI 1.25-1.70). Genetically-predicted triglyceride levels were positively associated with CAD (OR 1.25; 95%CI 1.12-1.40), aortic valve stenosis (OR 1.29; 95%CI 1.04-1.61), and hypertension (OR 1.17; 95%CI 1.07-1.27), but inversely associated with venous thromboembolism (OR 0.79; 95%CI 0.67-0.93) and haemorrhagic stroke (OR 0.78; 95%CI 0.62-0.98). We also found positive associations of genetically-predicted LDL-cholesterol and triglycerides with heart failure that appeared to be mediated by CAD. Conclusions - Lowering LDL-cholesterol is likely to prevent abdominal aortic aneurysm and aortic stenosis, in addition to CAD and other atheromatous cardiovascular outcomes. Lowering triglycerides is likely to prevent CAD and aortic valve stenosis, but may increase thromboembolic risk.
Date Issued
2019-11-22
Date Acceptance
2019-11-15
Citation
Circulation: Genomic and Precision Medicine, 2019, 12 (12), pp.543-551
ISSN
2574-8300
Publisher
American Heart Association
Start Page
543
End Page
551
Journal / Book Title
Circulation: Genomic and Precision Medicine
Volume
12
Issue
12
Copyright Statement
© 2018 The Authors. Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
Sponsor
United Kingdom Research and Innovation
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31756303
Grant Number
MR/S004068/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Genetics & Heredity
Cardiovascular System & Cardiology
aortic valve stenosis
epidemiology
lipids
Mendelian randomization
venous thromboembolism
ASSOCIATION TASK-FORCE
AMERICAN-COLLEGE
VASCULAR-DISEASE
AORTIC-STENOSIS
ARTERY-DISEASE
STATIN THERAPY
DOUBLE-BLIND
RISK
MANAGEMENT
VOLANESORSEN
Mendelian randomization
aortic valve stenosis
epidemiology
lipids
venous thromboembolism
INVENT consortium
Publication Status
Published online
Coverage Spatial
United States
Date Publish Online
2019-11-22