%0 Journal Article %J J Am Coll Cardiol %D 2017 %T ANGPTL3 Deficiency and Protection Against Coronary Artery Disease. %A Stitziel, Nathan O %A Khera, Amit V %A Wang, Xiao %A Bierhals, Andrew J %A Vourakis, A Christina %A Sperry, Alexandra E %A Natarajan, Pradeep %A Klarin, Derek %A Emdin, Connor A %A Zekavat, Seyedeh M %A Nomura, Akihiro %A Erdmann, Jeanette %A Schunkert, Heribert %A Samani, Nilesh J %A Kraus, William E %A Shah, Svati H %A Yu, Bing %A Boerwinkle, Eric %A Rader, Daniel J %A Gupta, Namrata %A Frossard, Philippe M %A Rasheed, Asif %A Danesh, John %A Lander, Eric S %A Gabriel, Stacey %A Saleheen, Danish %A Musunuru, Kiran %A Kathiresan, Sekar %K Adult %K Angiopoietin-Like Protein 3 %K Angiopoietin-like Proteins %K Angiopoietins %K Animals %K Atherosclerosis %K Case-Control Studies %K Coronary Artery Disease %K Female %K Humans %K Lipids %K Male %K Mice, Inbred C57BL %K Mice, Knockout %K Middle Aged %K Mutation, Missense %K Myocardial Infarction %K Risk Factors %X

BACKGROUND: Familial combined hypolipidemia, a Mendelian condition characterized by substantial reductions in all 3 major lipid fractions, is caused by mutations that inactivate the gene angiopoietin-like 3 (ANGPTL3). Whether ANGPTL3 deficiency reduces risk of coronary artery disease (CAD) is unknown.

OBJECTIVES: The study goal was to leverage 3 distinct lines of evidence-a family that included individuals with complete (compound heterozygote) ANGPTL3 deficiency, a population based-study of humans with partial (heterozygote) ANGPTL3 deficiency, and biomarker levels in patients with myocardial infarction (MI)-to test whether ANGPTL3 deficiency is associated with lower risk for CAD.

METHODS: We assessed coronary atherosclerotic burden in 3 individuals with complete ANGPTL3 deficiency and 3 wild-type first-degree relatives using computed tomography angiography. In the population, ANGPTL3 loss-of-function (LOF) mutations were ascertained in up to 21,980 people with CAD and 158,200 control subjects. LOF mutations were defined as nonsense, frameshift, and splice-site variants, along with missense variants resulting in <25% of wild-type ANGPTL3 activity in a mouse model. In a biomarker study, circulating ANGPTL3 concentration was measured in 1,493 people who presented with MI and 3,232 control subjects.

RESULTS: The 3 individuals with complete ANGPTL3 deficiency showed no evidence of coronary atherosclerotic plaque. ANGPTL3 gene sequencing demonstrated that approximately 1 in 309 people was a heterozygous carrier for an LOF mutation. Compared with those without mutation, heterozygous carriers of ANGPTL3 LOF mutations demonstrated a 17% reduction in circulating triglycerides and a 12% reduction in low-density lipoprotein cholesterol. Carrier status was associated with a 34% reduction in odds of CAD (odds ratio: 0.66; 95% confidence interval: 0.44 to 0.98; p = 0.04). Individuals in the lowest tertile of circulating ANGPTL3 concentrations, compared with the highest, had reduced odds of MI (adjusted odds ratio: 0.65; 95% confidence interval: 0.55 to 0.77; p < 0.001).

CONCLUSIONS: ANGPTL3 deficiency is associated with protection from CAD.

%B J Am Coll Cardiol %V 69 %P 2054-2063 %8 2017 Apr 25 %G eng %N 16 %1 https://www.ncbi.nlm.nih.gov/pubmed/28385496?dopt=Abstract %R 10.1016/j.jacc.2017.02.030