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J Am Coll Cardiol. 2015 Apr 21;65(15):1552-61. doi: 10.1016/j.jacc.2015.02.020. Epub 2015 Mar 11.

Effect of naturally random allocation to lower low-density lipoprotein cholesterol on the risk of coronary heart disease mediated by polymorphisms in NPC1L1, HMGCR, or both: a 2 × 2 factorial Mendelian randomization study.

Author information

1
Division of Translational Research and Clinical Epidemiology, Wayne State University School of Medicine, Detroit, Michigan; Division of Cardiovascular Medicine, Wayne State University School of Medicine, Detroit, Michigan; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan. Electronic address: bference@med.wayne.edu.
2
Division of Translational Research and Clinical Epidemiology, Wayne State University School of Medicine, Detroit, Michigan.
3
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.
4
Division of Translational Research and Clinical Epidemiology, Wayne State University School of Medicine, Detroit, Michigan; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.
5
Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

Abstract

BACKGROUND:

Considerable uncertainty exists as to whether lowering low-density lipoprotein cholesterol (LDL-C) by inhibiting the Niemann-Pick C1-Like 1 (NPC1L1) receptor with ezetimibe, either alone or in combination with a 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) inhibitor (statin), will reduce the risk of coronary heart disease (CHD).

OBJECTIVES:

This study evaluated the effect of naturally random allocation to lower LDL-C mediated by polymorphisms in the NPC1L1 gene (target of ezetimibe), the HMGCR gene (target of statins), or both (target of combination therapy) on the risk of CHD.

METHODS:

We constructed NPC1L1 and HMGCR genetic LDL-C scores to naturally randomize participants into 4 groups: reference, lower LDL-C mediated by NPC1L1 polymorphisms, lower LDL-C mediated by HMGCR polymorphisms, or lower LDL-C mediated by polymorphisms in both NPC1L1 and HMGCR. We compared the risk of CHD (fatal or nonfatal myocardial infarction) among each group using a 2 × 2 factorial mendelian randomization study design.

RESULTS:

A total of 108,376 persons (10,464 CHD events) from 14 studies were included. There were no significant differences in baseline characteristics among the 4 groups, thus confirming that allocation was random. Compared to the reference group, the NPC1L1 group had 2.4 mg/dl lower LDL-C and 4.8% lower risk of CHD (odds ratio [OR]: 0.952, 95% confidence interval [CI]: 0.920 to 0.985); whereas the HMGCR group had 2.9 mg/dl lower LDL-C and a similar 5.3% lower risk of CHD (OR: 0.947, 95% CI: 0.909 to 0.986). The group with lower LDL-C mediated by both NPC1L1 and HMGCR polymorphisms had 5.8 mg/dl additively lower LDL-C and a 10.8% log-linearly additive lower risk of CHD (OR: 0.892, 95% CI: 0.854 to 0.932).

CONCLUSIONS:

The effect of lower LDL-C on the risk of CHD mediated by polymorphisms in NPC1L1, HMGCR, or both is approximately the same per unit lower LDL-C and log-linearly proportional to the absolute exposure to lower LDL-C.

KEYWORDS:

PCSK9; ezetimibe; genetic association; statins

PMID:
25770315
PMCID:
PMC6101243
DOI:
10.1016/j.jacc.2015.02.020
[Indexed for MEDLINE]
Free PMC Article

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