|Title||Association of Rare Protein-Truncating DNA Variants in APOB or PCSK9 With Low-density Lipoprotein Cholesterol Level and Risk of Coronary Heart Disease.|
|Publication Type||Journal Article|
|Year of Publication||2023|
|Authors||Dron, JS, Patel, AP, Zhang, Y, Jurgens, SJ, Maamari, DJ, Wang, M, Boerwinkle, E, Morrison, AC, de Vries, PS, Fornage, M, Hou, L, Lloyd-Jones, DM, Psaty, BM, Tracy, RP, Bis, JC, Vasan, RS, Levy, D, Heard-Costa, N, Rich, SS, Guo, X, Taylor, KD, Gibbs, RA, Rotter, JI, Willer, CJ, Oelsner, EC, Moran, AE, Peloso, GM, Natarajan, P, Khera, AV|
|Date Published||2023 Feb 01|
IMPORTANCE: Protein-truncating variants (PTVs) in apolipoprotein B (APOB) and proprotein convertase subtilisin/kexin type 9 (PCSK9) are associated with significantly lower low-density lipoprotein (LDL) cholesterol concentrations. The association of these PTVs with coronary heart disease (CHD) warrants further characterization in large, multiracial prospective cohort studies.
OBJECTIVE: To evaluate the association of PTVs in APOB and PCSK9 with LDL cholesterol concentrations and CHD risk.
DESIGN, SETTING, AND PARTICIPANTS: This studied included participants from 5 National Heart, Lung, and Blood Institute (NHLBI) studies and the UK Biobank. NHLBI study participants aged 5 to 84 years were recruited between 1971 and 2002 across the US and underwent whole-genome sequencing. UK Biobank participants aged 40 to 69 years were recruited between 2006 and 2010 in the UK and underwent whole-exome sequencing. Data were analyzed from June 2021 to October 2022.
EXPOSURES: PTVs in APOB and PCSK9.
MAIN OUTCOMES AND MEASURES: Estimated untreated LDL cholesterol levels and CHD.
RESULTS: Among 19 073 NHLBI participants (10 598 [55.6%] female; mean [SD] age, 52  years), 139 (0.7%) carried an APOB or PCSK9 PTV, which was associated with 49 mg/dL (95% CI, 43-56) lower estimated untreated LDL cholesterol level. Over a median (IQR) follow-up of 21.5 (13.9-29.4) years, incident CHD was observed in 12 of 139 carriers (8.6%) vs 3029 of 18 934 noncarriers (16.0%), corresponding to an adjusted hazard ratio of 0.51 (95% CI, 0.28-0.89; P = .02). Among 190 464 UK Biobank participants (104 831 [55.0%] female; mean [SD] age, 57  years), 662 (0.4%) carried a PTV, which was associated with 45 mg/dL (95% CI, 42-47) lower estimated untreated LDL cholesterol level. Estimated CHD risk by age 75 years was 3.7% (95% CI, 2.0-5.3) in carriers vs 7.0% (95% CI, 6.9-7.2) in noncarriers, corresponding to an adjusted hazard ratio of 0.51 (95% CI, 0.32-0.81; P = .004).
CONCLUSIONS AND RELEVANCE: Among 209 537 individuals in this study, 0.4% carried an APOB or PCSK9 PTV that was associated with less exposure to LDL cholesterol and a 49% lower risk of CHD.
|Alternate Journal||JAMA Cardiol|