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Genetic Association of Lipids and Lipid Drug Targets With Abdominal Aortic Aneurysm: A Meta-analysis.
JAMA Cardiol. 2018 01 01; 3(1):26-33.JC

Abstract

Importance

Risk factors for abdominal aortic aneurysm (AAA) are largely unknown, which has hampered the development of nonsurgical treatments to alter the natural history of disease.

Objective

To investigate the association between lipid-associated single-nucleotide polymorphisms (SNPs) and AAA risk.

Design, Setting, and Participants

Genetic risk scores, composed of lipid trait-associated SNPs, were constructed and tested for their association with AAA using conventional (inverse-variance weighted) mendelian randomization (MR) and data from international AAA genome-wide association studies. Sensitivity analyses to account for potential genetic pleiotropy included MR-Egger and weighted median MR, and multivariable MR method was used to test the independent association of lipids with AAA risk. The association between AAA and SNPs in loci that can act as proxies for drug targets was also assessed. Data collection took place between January 9, 2015, and January 4, 2016. Data analysis was conducted between January 4, 2015, and December 31, 2016.

Exposures

Genetic elevation of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG).

Main Outcomes and Measures

The association between genetic risk scores of lipid-associated SNPs and AAA risk, as well as the association between SNPs in lipid drug targets (HMGCR, CETP, and PCSK9) and AAA risk.

Results

Up to 4914 cases and 48 002 controls were included in our analysis. A 1-SD genetic elevation of LDL-C was associated with increased AAA risk (odds ratio [OR], 1.66; 95% CI, 1.41-1.96; P = 1.1 × 10-9). For HDL-C, a 1-SD increase was associated with reduced AAA risk (OR, 0.67; 95% CI, 0.55-0.82; P = 8.3 × 10-5), whereas a 1-SD increase in triglycerides was associated with increased AAA risk (OR, 1.69; 95% CI, 1.38-2.07; P = 5.2 × 10-7). In multivariable MR analysis and both MR-Egger and weighted median MR methods, the association of each lipid fraction with AAA risk remained largely unchanged. The LDL-C-reducing allele of rs12916 in HMGCR was associated with AAA risk (OR, 0.93; 95% CI, 0.89-0.98; P = .009). The HDL-C-raising allele of rs3764261 in CETP was associated with lower AAA risk (OR, 0.89; 95% CI, 0.85-0.94; P = 3.7 × 10-7). Finally, the LDL-C-lowering allele of rs11206510 in PCSK9 was weakly associated with a lower AAA risk (OR, 0.94; 95% CI, 0.88-1.00; P = .04), but a second independent LDL-C-lowering variant in PCSK9 (rs2479409) was not associated with AAA risk (OR, 0.97; 95% CI, 0.92-1.02; P = .28).

Conclusions and Relevance

The MR analyses in this study lend support to the hypothesis that lipids play an important role in the etiology of AAA. Analyses of individual genetic variants used as proxies for drug targets support LDL-C lowering as a potential effective treatment strategy for preventing and managing AAA.

Authors+Show Affiliations

Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge, England. Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, England.Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England. Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England. National Institute for Health Research, Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, England.Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, England. Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, England.Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. Department of Medical Genetics, Centre for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, England.Department of Surgery, University of Otago, Dunedin, New Zealand.Department of Medical Genetics, Centre for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands.Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. Department of Medical Genetics, Centre for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.Vascular Surgery Research Group, Imperial College Charing Cross Hospital, London, England.National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, England.Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.Institute of Cardiovascular Science, University College London, London, England. Department of Medicine, Imperial College London, Hammersmith Hospital, London, England.Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.Department of Surgery, University of Otago, Dunedin, New Zealand.Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania.Department of Vascular and Endovascular Surgery, Geisinger Health System, Danville, Pennsylvania.Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania. Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania. Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, England.National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, England.National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, England.Department of Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, England.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

29188294

Citation

Harrison, Seamus C., et al. "Genetic Association of Lipids and Lipid Drug Targets With Abdominal Aortic Aneurysm: a Meta-analysis." JAMA Cardiology, vol. 3, no. 1, 2018, pp. 26-33.
Harrison SC, Holmes MV, Burgess S, et al. Genetic Association of Lipids and Lipid Drug Targets With Abdominal Aortic Aneurysm: A Meta-analysis. JAMA Cardiol. 2018;3(1):26-33.
Harrison, S. C., Holmes, M. V., Burgess, S., Asselbergs, F. W., Jones, G. T., Baas, A. F., van 't Hof, F. N., de Bakker, P. I. W., Blankensteijn, J. D., Powell, J. T., Saratzis, A., de Borst, G. J., Swerdlow, D. I., van der Graaf, Y., van Rij, A. M., Carey, D. J., Elmore, J. R., Tromp, G., Kuivaniemi, H., ... Humphries, S. E. (2018). Genetic Association of Lipids and Lipid Drug Targets With Abdominal Aortic Aneurysm: A Meta-analysis. JAMA Cardiology, 3(1), 26-33. https://doi.org/10.1001/jamacardio.2017.4293
Harrison SC, et al. Genetic Association of Lipids and Lipid Drug Targets With Abdominal Aortic Aneurysm: a Meta-analysis. JAMA Cardiol. 2018 01 1;3(1):26-33. PubMed PMID: 29188294.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Genetic Association of Lipids and Lipid Drug Targets With Abdominal Aortic Aneurysm: A Meta-analysis. AU - Harrison,Seamus C, AU - Holmes,Michael V, AU - Burgess,Stephen, AU - Asselbergs,Folkert W, AU - Jones,Gregory T, AU - Baas,Annette F, AU - van 't Hof,F N, AU - de Bakker,Paul I W, AU - Blankensteijn,Jan D, AU - Powell,Janet T, AU - Saratzis,Athanasios, AU - de Borst,Gert J, AU - Swerdlow,Daniel I, AU - van der Graaf,Yolanda, AU - van Rij,Andre M, AU - Carey,David J, AU - Elmore,James R, AU - Tromp,Gerard, AU - Kuivaniemi,Helena, AU - Sayers,Robert D, AU - Samani,Nilesh J, AU - Bown,Matthew J, AU - Humphries,Steve E, PY - 2017/12/1/pubmed PY - 2019/9/10/medline PY - 2017/12/1/entrez SP - 26 EP - 33 JF - JAMA cardiology JO - JAMA Cardiol VL - 3 IS - 1 N2 - Importance: Risk factors for abdominal aortic aneurysm (AAA) are largely unknown, which has hampered the development of nonsurgical treatments to alter the natural history of disease. Objective: To investigate the association between lipid-associated single-nucleotide polymorphisms (SNPs) and AAA risk. Design, Setting, and Participants: Genetic risk scores, composed of lipid trait-associated SNPs, were constructed and tested for their association with AAA using conventional (inverse-variance weighted) mendelian randomization (MR) and data from international AAA genome-wide association studies. Sensitivity analyses to account for potential genetic pleiotropy included MR-Egger and weighted median MR, and multivariable MR method was used to test the independent association of lipids with AAA risk. The association between AAA and SNPs in loci that can act as proxies for drug targets was also assessed. Data collection took place between January 9, 2015, and January 4, 2016. Data analysis was conducted between January 4, 2015, and December 31, 2016. Exposures: Genetic elevation of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Main Outcomes and Measures: The association between genetic risk scores of lipid-associated SNPs and AAA risk, as well as the association between SNPs in lipid drug targets (HMGCR, CETP, and PCSK9) and AAA risk. Results: Up to 4914 cases and 48 002 controls were included in our analysis. A 1-SD genetic elevation of LDL-C was associated with increased AAA risk (odds ratio [OR], 1.66; 95% CI, 1.41-1.96; P = 1.1 × 10-9). For HDL-C, a 1-SD increase was associated with reduced AAA risk (OR, 0.67; 95% CI, 0.55-0.82; P = 8.3 × 10-5), whereas a 1-SD increase in triglycerides was associated with increased AAA risk (OR, 1.69; 95% CI, 1.38-2.07; P = 5.2 × 10-7). In multivariable MR analysis and both MR-Egger and weighted median MR methods, the association of each lipid fraction with AAA risk remained largely unchanged. The LDL-C-reducing allele of rs12916 in HMGCR was associated with AAA risk (OR, 0.93; 95% CI, 0.89-0.98; P = .009). The HDL-C-raising allele of rs3764261 in CETP was associated with lower AAA risk (OR, 0.89; 95% CI, 0.85-0.94; P = 3.7 × 10-7). Finally, the LDL-C-lowering allele of rs11206510 in PCSK9 was weakly associated with a lower AAA risk (OR, 0.94; 95% CI, 0.88-1.00; P = .04), but a second independent LDL-C-lowering variant in PCSK9 (rs2479409) was not associated with AAA risk (OR, 0.97; 95% CI, 0.92-1.02; P = .28). Conclusions and Relevance: The MR analyses in this study lend support to the hypothesis that lipids play an important role in the etiology of AAA. Analyses of individual genetic variants used as proxies for drug targets support LDL-C lowering as a potential effective treatment strategy for preventing and managing AAA. SN - 2380-6591 UR - https://www.unboundmedicine.com/medline/citation/29188294/Genetic_Association_of_Lipids_and_Lipid_Drug_Targets_With_Abdominal_Aortic_Aneurysm:_A_Meta_analysis_ L2 - https://jamanetwork.com/journals/jamacardiology/fullarticle/10.1001/jamacardio.2017.4293 DB - PRIME DP - Unbound Medicine ER -