Abstract
The activity of lipoprotein lipase (LPL) is the rate-determining step in clearing triglyceride-rich lipoproteins from the circulation. Mutations that damage the LPL gene (LPL) lead to lifelong deficiency in enzymatic activity and can provide insight into the relationship of LPL to human disease. To determine whether rare and/or common variants in LPL are associated with early-onset coronary artery disease (CAD). In a cross-sectional study, LPL was sequenced in 10 CAD case-control cohorts of the multinational Myocardial Infarction Genetics Consortium and a nested CAD case-control cohort of the Geisinger Health System DiscovEHR cohort between 2010 and 2015. Common variants were genotyped in up to 305 699 individuals of the Global Lipids Genetics Consortium and up to 120 600 individuals of the CARDIoGRAM Exome Consortium between 2012 and 2014. Study-specific estimates were pooled via meta-analysis. Rare damaging mutations in LPL included loss-of-function variants and missense variants annotated as pathogenic in a human genetics database or predicted to be damaging by computer prediction algorithms trained to identify mutations that impair protein function. Common variants in the LPL gene region included those independently associated with circulating triglyceride levels. Circulating lipid levels and CAD. Among 46 891 individuals with LPL gene sequencing data available, the mean (SD) age was 50 (12.6) years and 51% were female. A total of 188 participants (0.40%; 95% CI, 0.35%-0.46%) carried a damaging mutation in LPL, including 105 of 32 646 control participants (0.32%) and 83 of 14 245 participants with early-onset CAD (0.58%). Compared with 46 703 noncarriers, the 188 heterozygous carriers of an LPL damaging mutation displayed higher plasma triglyceride levels (19.6 mg/dL; 95% CI, 4.6-34.6 mg/dL) and higher odds of CAD (odds ratio = 1.84; 95% CI, 1.35-2.51; P < .001). An analysis of 6 common LPL variants resulted in an odds ratio for CAD of 1.51 (95% CI, 1.39-1.64; P = 1.1 × 10-22) per 1-SD increase in triglycerides. The presence of rare damaging mutations in LPL was significantly associated with higher triglyceride levels and presence of coronary artery disease. However, further research is needed to assess whether there are causal mechanisms by which heterozygous lipoprotein lipase deficiency could lead to coronary artery disease.
Highlights
IMPORTANCE The activity of lipoprotein lipase (LPL) is the rate-determining step in clearing triglyceride-rich lipoproteins from the circulation
An analysis of 6 common LPL variants resulted in an odds ratio for coronary artery disease (CAD) of 1.51 per 1-SD increase in triglycerides
The presence of rare damaging mutations in LPL was significantly associated with higher triglyceride levels and presence of coronary artery disease
Summary
Study Populations Gene sequencing of LPL was performed in participants of 10 previously described CAD case-control cohorts (eTable 1 in the Supplement). Studies included the Atherosclerosis, Thrombosis, and Vascular Biology Italian Study; the Exome Sequencing Project Early-Onset Myocardial Infarction study; a nested case-control of the Jackson Heart Study; the South German Myocardial Infarction study; the Ottawa Heart Study; the Precocious Coronary Artery Disease study; the Pakistan Risk of Myocardial Infarction Study; the Registre Gironí del COR (Gerona Heart Registry) study; the Leicester Myocardial Infarction study; and the North German Myocardial Infarction study.. Written informed consent was obtained from all participants of contributing studies, each of which received ethical approval from respective institutional review boards. Approval for this analysis was obtained from the institutional review board of Partners HealthCare
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