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The relationship between circulating lipids and breast cancer risk: A Mendelian randomization study.
PLoS Med. 2020 09; 17(9):e1003302.PM

Abstract

BACKGROUND

A number of epidemiological and genetic studies have attempted to determine whether levels of circulating lipids are associated with risks of various cancers, including breast cancer (BC). However, it remains unclear whether a causal relationship exists between lipids and BC. If alteration of lipid levels also reduced risk of BC, this could present a target for disease prevention. This study aimed to assess a potential causal relationship between genetic variants associated with plasma lipid traits (high-density lipoprotein, HDL; low-density lipoprotein, LDL; triglycerides, TGs) with risk for BC using Mendelian randomization (MR).

METHODS AND FINDINGS

Data from genome-wide association studies in up to 215,551 participants from the Million Veteran Program (MVP) were used to construct genetic instruments for plasma lipid traits. The effect of these instruments on BC risk was evaluated using genetic data from the BCAC (Breast Cancer Association Consortium) based on 122,977 BC cases and 105,974 controls. Using MR, we observed that a 1-standard-deviation genetically determined increase in HDL levels is associated with an increased risk for all BCs (HDL: OR [odds ratio] = 1.08, 95% confidence interval [CI] = 1.04-1.13, P < 0.001). Multivariable MR analysis, which adjusted for the effects of LDL, TGs, body mass index (BMI), and age at menarche, corroborated this observation for HDL (OR = 1.06, 95% CI = 1.03-1.10, P = 4.9 × 10-4) and also found a relationship between LDL and BC risk (OR = 1.03, 95% CI = 1.01-1.07, P = 0.02). We did not observe a difference in these relationships when stratified by breast tumor estrogen receptor (ER) status. We repeated this analysis using genetic variants independent of the leading association at core HDL pathway genes and found that these variants were also associated with risk for BCs (OR = 1.11, 95% CI = 1.06-1.16, P = 1.5 × 10-6), including locus-specific associations at ABCA1 (ATP Binding Cassette Subfamily A Member 1), APOE-APOC1-APOC4-APOC2 (Apolipoproteins E, C1, C4, and C2), and CETP (Cholesteryl Ester Transfer Protein). In addition, we found evidence that genetic variation at the ABO locus is associated with both lipid levels and BC. Through multiple statistical approaches, we minimized and tested for the confounding effects of pleiotropy and population stratification on our analysis; however, the possible existence of residual pleiotropy and stratification remains a limitation of this study.

CONCLUSIONS

We observed that genetically elevated plasma HDL and LDL levels appear to be associated with increased BC risk. Future studies are required to understand the mechanism underlying this putative causal relationship, with the goal of developing potential therapeutic strategies aimed at altering the cholesterol-mediated effect on BC risk.

Authors+Show Affiliations

Cell and Molecular Biology Graduate Group, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.Genomics and Computational Biology Graduate Group, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America.Boston VA Healthcare System, Boston, Massachusetts, United States of America. Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America. Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America.Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America. Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.No affiliation info availableCorporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.VA Palo Alto Health Care System, Palo Alto, California, United States of America. Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America.VA Palo Alto Health Care System, Palo Alto, California, United States of America. Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America.Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America. Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

32915777

Citation

Johnson, Kelsey E., et al. "The Relationship Between Circulating Lipids and Breast Cancer Risk: a Mendelian Randomization Study." PLoS Medicine, vol. 17, no. 9, 2020, pp. e1003302.
Johnson KE, Siewert KM, Klarin D, et al. The relationship between circulating lipids and breast cancer risk: A Mendelian randomization study. PLoS Med. 2020;17(9):e1003302.
Johnson, K. E., Siewert, K. M., Klarin, D., Damrauer, S. M., Chang, K. M., Tsao, P. S., Assimes, T. L., Maxwell, K. N., & Voight, B. F. (2020). The relationship between circulating lipids and breast cancer risk: A Mendelian randomization study. PLoS Medicine, 17(9), e1003302. https://doi.org/10.1371/journal.pmed.1003302
Johnson KE, et al. The Relationship Between Circulating Lipids and Breast Cancer Risk: a Mendelian Randomization Study. PLoS Med. 2020;17(9):e1003302. PubMed PMID: 32915777.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The relationship between circulating lipids and breast cancer risk: A Mendelian randomization study. AU - Johnson,Kelsey E, AU - Siewert,Katherine M, AU - Klarin,Derek, AU - Damrauer,Scott M, AU - ,, AU - Chang,Kyong-Mi, AU - Tsao,Philip S, AU - Assimes,Themistocles L, AU - Maxwell,Kara N, AU - Voight,Benjamin F, Y1 - 2020/09/11/ PY - 2019/10/18/received PY - 2020/08/10/accepted PY - 2020/9/11/entrez PY - 2020/9/12/pubmed PY - 2020/10/21/medline SP - e1003302 EP - e1003302 JF - PLoS medicine JO - PLoS Med VL - 17 IS - 9 N2 - BACKGROUND: A number of epidemiological and genetic studies have attempted to determine whether levels of circulating lipids are associated with risks of various cancers, including breast cancer (BC). However, it remains unclear whether a causal relationship exists between lipids and BC. If alteration of lipid levels also reduced risk of BC, this could present a target for disease prevention. This study aimed to assess a potential causal relationship between genetic variants associated with plasma lipid traits (high-density lipoprotein, HDL; low-density lipoprotein, LDL; triglycerides, TGs) with risk for BC using Mendelian randomization (MR). METHODS AND FINDINGS: Data from genome-wide association studies in up to 215,551 participants from the Million Veteran Program (MVP) were used to construct genetic instruments for plasma lipid traits. The effect of these instruments on BC risk was evaluated using genetic data from the BCAC (Breast Cancer Association Consortium) based on 122,977 BC cases and 105,974 controls. Using MR, we observed that a 1-standard-deviation genetically determined increase in HDL levels is associated with an increased risk for all BCs (HDL: OR [odds ratio] = 1.08, 95% confidence interval [CI] = 1.04-1.13, P < 0.001). Multivariable MR analysis, which adjusted for the effects of LDL, TGs, body mass index (BMI), and age at menarche, corroborated this observation for HDL (OR = 1.06, 95% CI = 1.03-1.10, P = 4.9 × 10-4) and also found a relationship between LDL and BC risk (OR = 1.03, 95% CI = 1.01-1.07, P = 0.02). We did not observe a difference in these relationships when stratified by breast tumor estrogen receptor (ER) status. We repeated this analysis using genetic variants independent of the leading association at core HDL pathway genes and found that these variants were also associated with risk for BCs (OR = 1.11, 95% CI = 1.06-1.16, P = 1.5 × 10-6), including locus-specific associations at ABCA1 (ATP Binding Cassette Subfamily A Member 1), APOE-APOC1-APOC4-APOC2 (Apolipoproteins E, C1, C4, and C2), and CETP (Cholesteryl Ester Transfer Protein). In addition, we found evidence that genetic variation at the ABO locus is associated with both lipid levels and BC. Through multiple statistical approaches, we minimized and tested for the confounding effects of pleiotropy and population stratification on our analysis; however, the possible existence of residual pleiotropy and stratification remains a limitation of this study. CONCLUSIONS: We observed that genetically elevated plasma HDL and LDL levels appear to be associated with increased BC risk. Future studies are required to understand the mechanism underlying this putative causal relationship, with the goal of developing potential therapeutic strategies aimed at altering the cholesterol-mediated effect on BC risk. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/32915777/The_relationship_between_circulating_lipids_and_breast_cancer_risk:_A_Mendelian_randomization_study_ L2 - https://dx.plos.org/10.1371/journal.pmed.1003302 DB - PRIME DP - Unbound Medicine ER -