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Dabravolski S, Orekhov NA, Melnichenko A, Sukhorukov VN, Popov MA, Orekhov A. Cholesteryl Ester Transfer Protein (CETP) Variations in Relation to Lipid Profiles and Cardiovascular Diseases: An Update. Curr Pharm Des 2024; 30:742-756. [PMID: 38425105 DOI: 10.2174/0113816128284695240219093612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 03/02/2024]
Abstract
Lipid metabolism plays an essential role in the pathogenesis of cardiovascular and metabolic diseases. Cholesteryl ester transfer protein (CETP) is a crucial glycoprotein involved in lipid metabolism by transferring cholesteryl esters (CE) and triglycerides (TG) between plasma lipoproteins. CETP activity results in reduced HDL-C and increased VLDL- and LDL-C concentrations, thus increasing the risk of cardiovascular and metabolic diseases. In this review, we discuss the structure of CETP and its mechanism of action. Furthermore, we focus on recent experiments on animal CETP-expressing models, deciphering the regulation and functions of CETP in various genetic backgrounds and interaction with different external factors. Finally, we discuss recent publications revealing the association of CETP single nucleotide polymorphisms (SNPs) with the risk of cardiovascular and metabolic diseases, lifestyle factors, diet and therapeutic interventions. While CETP SNPs can be used as effective diagnostic markers, diet, lifestyle, gender and ethnic specificity should also be considered for effective treatment.
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Affiliation(s)
- Siarhei Dabravolski
- Department of Biotechnology Engineering, ORT Braude College, Braude Academic College of Engineering, Karmiel, Israel
| | - Nikolay A Orekhov
- Laboratory of Angiopatology, Research Institute of General Pathology and Pathophysiology, The Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Alexandra Melnichenko
- Laboratory of Angiopatology, Research Institute of General Pathology and Pathophysiology, The Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Vasily N Sukhorukov
- Laboratory of Angiopatology, Research Institute of General Pathology and Pathophysiology, The Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Mikhail A Popov
- Laboratory of Angiopatology, Research Institute of General Pathology and Pathophysiology, The Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Alexander Orekhov
- Laboratory of Angiopatology, Research Institute of General Pathology and Pathophysiology, The Russian Academy of Medical Sciences, Moscow, Russian Federation
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2
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Poliakova T, Wellington CL. Roles of peripheral lipoproteins and cholesteryl ester transfer protein in the vascular contributions to cognitive impairment and dementia. Mol Neurodegener 2023; 18:86. [PMID: 37974180 PMCID: PMC10652636 DOI: 10.1186/s13024-023-00671-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
This narrative review focuses on the role of cholesteryl ester transfer protein (CETP) and peripheral lipoproteins in the vascular contributions to cognitive impairment and dementia (VCID). Humans have a peripheral lipoprotein profile where low-density lipoproteins (LDL) represent the dominant lipoprotein fraction and high-density lipoproteins (HDL) represent a minor lipoprotein fraction. Elevated LDL-cholesterol (LDL-C) levels are well-established to cause cardiovascular disease and several LDL-C-lowering therapies are clinically available to manage this vascular risk factor. The efficacy of LDL-C-lowering therapies to reduce risk of all-cause dementia and AD is now important to address as recent studies demonstrate a role for LDL in Alzheimer's Disease (AD) as well as in all-cause dementia. The LDL:HDL ratio in humans is set mainly by CETP activity, which exchanges cholesteryl esters for triglycerides across lipoprotein fractions to raise LDL and lower HDL as CETP activity increases. Genetic and pharmacological studies support the hypothesis that CETP inhibition reduces cardiovascular risk by lowering LDL, which, by extension, may also lower VCID. Unlike humans, wild-type mice do not express catalytically active CETP and have HDL as their major lipoprotein fraction. As HDL has potent beneficial effects on endothelial cells, the naturally high HDL levels in mice protect them from vascular disorders, likely including VCID. Genetic restoration of CETP expression in mice to generate a more human-like lipid profile may increase the relevance of murine models for VCID studies. The therapeutic potential of existing and emerging LDL-lowering therapies for VCID will be discussed. Figure Legend. Cholesteryl Ester Transfer Protein in Alzheimer's Disease. CETP is mainly produced by the liver, and exchanges cholesteryl esters for triglycerides across lipoprotein fractions to raise circulating LDL and lower HDL as CETP activity increases. Low CETP activity is associated with better cardiovascular health, due to decreased LDL and increased HDL, which may also improve brain health. Although most peripheral lipoproteins cannot enter the brain parenchyma due to the BBB, it is increasingly appreciated that direct access to the vascular endothelium may enable peripheral lipoproteins to have indirect effects on brain health. Thus, lipoproteins may affect the cerebrovasculature from both sides of the BBB. Recent studies show an association between elevated plasma LDL, a well-known cardiovascular risk factor, and a higher risk of AD, and considerable evidence suggests that high HDL levels are associated with reduced CAA and lower neuroinflammation. Considering the potential detrimental role of LDL in AD and the importance of HDL's beneficial effects on endothelial cells, high CETP activity may lead to compromised BBB integrity, increased CAA deposits and greater neuroinflammation. Abbreviations: CETP - cholesteryl transfer ester protein; LDL - low-density lipoproteins; HDL - high-density lipoproteins; BBB - blood-brain barrier; CAA - cerebral amyloid angiopathy, SMC - smooth muscle cells, PVM - perivascular macrophages, RBC - red blood cells.
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Affiliation(s)
- Tetiana Poliakova
- Department of Pathology and Laboratory Medicine, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Cheryl L Wellington
- Department of Pathology and Laboratory Medicine, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
- International Collaboration On Repair Discoveries, Vancouver, BC, Canada.
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.
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Yu C, Bakshi A, Watts GF, Renton AE, Fulton‐Howard B, Goate AM, Natarajan P, Chasman DI, Robman L, Woods RL, Guymer R, Wolfe R, Thao LTP, McNeil JJ, Tonkin AM, Nicholls SJ, Lacaze P. Genome-Wide Association Study of Cardiovascular Resilience Identifies Protective Variation in the CETP Gene. J Am Heart Assoc 2023; 12:e031459. [PMID: 37929782 PMCID: PMC10727421 DOI: 10.1161/jaha.123.031459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
Background The risk of atherosclerotic cardiovascular disease (ASCVD) increases sharply with age. Some older individuals, however, remain unaffected despite high predicted risk. These individuals may carry cardioprotective genetic variants that contribute to resilience. Our aim was to assess whether asymptomatic older individuals without prevalent ASCVD carry cardioprotective genetic variants that contribute to ASCVD resilience. Methods and Results We performed a genome-wide association study using a 10-year predicted ASCVD risk score as a quantitative trait, calculated only in asymptomatic older individuals aged ≥70 years without prevalent ASCVD. Our discovery genome-wide association study of N=12 031 ASCVD event-free individuals from the ASPREE (Aspirin in Reducing Events in the Elderly) trial identified 2 independent variants, rs9939224 (P<5×10-8) and rs56156922 (P<10-6), in the CETP (cholesteryl ester transfer protein) gene. The CETP gene is a regulator of plasma high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and lipoprotein(a) levels, and it is a therapeutic drug target. The associations were replicated in the UK Biobank (subpopulation of N=13 888 individuals aged ≥69 years without prevalent ASCVD). Carriers of the identified CETP variants (versus noncarriers) had higher plasma high-density lipoprotein cholesterol levels, lower plasma low-density lipoprotein cholesterol levels, and reduced risk of incident ASCVD events during follow-up. Expression quantitative trait loci analysis predicted the identified CETP variants reduce CETP gene expression across various tissues. Previously reported associations between genetic CETP inhibition and increased risk of age-related macular degeneration were not observed among the 3917 ASPREE trial participants with retinal imaging and genetic data available. Conclusions Common genetic variants in the CETP gene region are associated with cardiovascular resilience during aging. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583.
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Affiliation(s)
- Chenglong Yu
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Andrew Bakshi
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Gerald F. Watts
- School of MedicineUniversity of Western AustraliaPerthWAAustralia
- Lipid Disorders Clinic, Cardiometabolic Service, Department of CardiologyRoyal Perth HospitalPerthWAAustralia
| | - Alan E. Renton
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Brian Fulton‐Howard
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Alison M. Goate
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Pradeep Natarajan
- Cardiovascular Research Center and Center for Genomic MedicineMassachusetts General HospitalBostonMA
- Program in Population and Medical Genetics and the Cardiovascular Disease InitiativeBroad Institute of Harvard and MITCambridgeMA
- Department of MedicineHarvard Medical SchoolBostonMA
| | - Daniel I. Chasman
- Preventive Medicine Division, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Liubov Robman
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
- Centre for Eye Research AustraliaThe University of Melbourne, Royal Victorian Eye and Ear HospitalMelbourneVICAustralia
| | - Robyn L. Woods
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Robyn Guymer
- Centre for Eye Research AustraliaThe University of Melbourne, Royal Victorian Eye and Ear HospitalMelbourneVICAustralia
| | - Rory Wolfe
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Le Thi Phuong Thao
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - John J. McNeil
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Andrew M. Tonkin
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Stephen J. Nicholls
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
- Monash Cardiovascular Research Centre, Victorian Heart InstituteMonash UniversityClaytonVICAustralia
| | - Paul Lacaze
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
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Naber A, Demus D, Slieker R, Nicolardi S, Beulens JWJ, Elders PJM, Lieverse AG, Sijbrands EJG, 't Hart LM, Wuhrer M, van Hoek M. Apolipoprotein-CIII O-Glycosylation, a Link between GALNT2 and Plasma Lipids. Int J Mol Sci 2023; 24:14844. [PMID: 37834292 PMCID: PMC10573541 DOI: 10.3390/ijms241914844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
Apolipoprotein-CIII (apo-CIII) is involved in triglyceride-rich lipoprotein metabolism and linked to beta-cell damage, insulin resistance, and cardiovascular disease. Apo-CIII exists in four main proteoforms: non-glycosylated (apo-CIII0a), and glycosylated apo-CIII with zero, one, or two sialic acids (apo-CIII0c, apo-CIII1 and apo-CIII2). Our objective is to determine how apo-CIII glycosylation affects lipid traits and type 2 diabetes prevalence, and to investigate the genetic basis of these relations with a genome-wide association study (GWAS) on apo-CIII glycosylation. We conducted GWAS on the four apo-CIII proteoforms in the DiaGene study in people with and without type 2 diabetes (n = 2318). We investigated the relations of the identified genetic loci and apo-CIII glycosylation with lipids and type 2 diabetes. The associations of the genetic variants with lipids were replicated in the Diabetes Care System (n = 5409). Rs4846913-A, in the GALNT2-gene, was associated with decreased apo-CIII0a. This variant was associated with increased high-density lipoprotein cholesterol and decreased triglycerides, while high apo-CIII0a was associated with raised high-density lipoprotein-cholesterol and triglycerides. Rs67086575-G, located in the IFT172-gene, was associated with decreased apo-CIII2 and with hypertriglyceridemia. In line, apo-CIII2 was associated with low triglycerides. On a genome-wide scale, we confirmed that the GALNT2-gene plays a major role i O-glycosylation of apolipoprotein-CIII, with subsequent associations with lipid parameters. We newly identified the IFT172/NRBP1 region, in the literature previously associated with hypertriglyceridemia, as involved in apolipoprotein-CIII sialylation and hypertriglyceridemia. These results link genomics, glycosylation, and lipid metabolism, and represent a key step towards unravelling the importance of O-glycosylation in health and disease.
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Affiliation(s)
- Annemieke Naber
- Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Daniel Demus
- Center for Proteomics and Metabolomics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Roderick Slieker
- Department of Cell and Chemical Biology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Simone Nicolardi
- Center for Proteomics and Metabolomics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Aloysius G Lieverse
- Department of Internal Medicine, Maxima Medical Center, P.O. Box 90052, 5600 PD Eindhoven, The Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Leen M 't Hart
- Department of Cell and Chemical Biology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Biomedical Data Science, Section Molecular Epidemiology, Leiden University Medical Center, Postal Zone S5-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Alvarenga L, Cardozo LFMF, Ribeiro-Alves M, Damasceno NRT, Berretta AA, Lima JA, Khosla P, Fouque D, Mafra D. Effects of turmeric extract supplementation on the lipid and lipoprotein subfraction profile in hemodialysis patients: A randomised, double-blind, crossover and controlled trial. Phytother Res 2023; 37:3424-3437. [PMID: 37042623 DOI: 10.1002/ptr.7814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 04/13/2023]
Abstract
Dyslipidemia is common in patients with chronic kidney disease. Curcumin, a bioactive polyphenol from Curcuma longa, can improve lipid profile. This study aims to analyze the effects of Curcuma Longa extract supplementation on lipid profile and lipoprotein subfractions in hemodialysis (HD) patients. This is a longitudinal, double-blind, washout-period randomized clinical trial. The patients were randomized into two groups: the curcumin group (n = 10) (orange and carrot juice with 2.5 g of Curcuma Longa extract) and the control group (n = 11) (juice without curcumin) 3x/w during HD sessions for 3 months. After the washout period, patients continued the supplementation as a crossover for the same period. The lipid profile was measured using enzymatic assays. The high-density lipoprotein and low-density lipoprotein subfractions analyses were performed using LipoprintTM. In the curcumin group, the triglyceride values tended to decrease with a different triglyceride variation between the pre and post-intervention for the control and curcumin groups of 38.5 (19.8) mg/dL (p = 0.06). There was no statistical difference in the others parameters. In conclusion, Curcuma longa extract may be a good nutritional strategy to reduce triglyceride plasma levels in hemodialysis patients, but it seems ineffective for the other parameter.
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Affiliation(s)
- L Alvarenga
- Graduate Program in Biological Sciences-Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - L F M F Cardozo
- Graduate Program in Cardiovascular Sciences, Fluminense Federal University (UFF), Niterói, Brazil
| | - M Ribeiro-Alves
- HIV/AIDS Clinical Research Center, National Institute of Infectology (INI/Fiocruz), Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - N R T Damasceno
- Department of Nutrition, Faculty of Public Health, University of São Paulo (FSP-USP), São Paulo, Brazil
| | - A A Berretta
- Research, Development, and Innovation Department, Apis Flora Indl. Coml. Ltda., Ribeirão Preto, São Paulo, Brazil
| | - J A Lima
- Research, Development, and Innovation Department, Apis Flora Indl. Coml. Ltda., Ribeirão Preto, São Paulo, Brazil
| | - P Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, Michigan, USA
| | - D Fouque
- Department of Nephrology, Centre Hopitalier Lyon Sud, INSERM 1060, CENS, Université de Lyon, Lyon, France
| | - D Mafra
- Graduate Program in Biological Sciences-Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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6
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Moors J, Krishnan M, Sumpter N, Takei R, Bixley M, Cadzow M, Major TJ, Phipps-Green A, Topless R, Merriman M, Rutledge M, Morgan B, Carlson JC, Zhang JZ, Russell EM, Sun G, Cheng H, Weeks DE, Naseri T, Reupena MS, Viali S, Tuitele J, Hawley NL, Deka R, McGarvey ST, de Zoysa J, Murphy R, Dalbeth N, Stamp L, Taumoepeau M, King F, Wilcox P, Rapana N, McCormick S, Minster RL, Merriman TR, Leask M. A Polynesian -specific missense CETP variant alters the lipid profile. HGG ADVANCES 2023; 4:100204. [PMID: 37250494 PMCID: PMC10209881 DOI: 10.1016/j.xhgg.2023.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Identifying population-specific genetic variants associated with disease and disease-predisposing traits is important to provide insights into the genetic determinants of health and disease between populations, as well as furthering genomic justice. Various common pan-population polymorphisms at CETP associate with serum lipid profiles and cardiovascular disease. Here, sequencing of CETP identified a missense variant rs1597000001 (p.Pro177Leu) specific to Māori and Pacific people that associates with higher HDL-C and lower LDL-C levels. Each copy of the minor allele associated with higher HDL-C by 0.236 mmol/L and lower LDL-C by 0.133 mmol/L. The rs1597000001 effect on HDL-C is comparable with CETP Mendelian loss-of-function mutations that result in CETP deficiency, consistent with our data, which shows that rs1597000001 lowers CETP activity by 27.9%. This study highlights the potential of population-specific genetic analyses for improving equity in genomics and health outcomes for population groups underrepresented in genomic studies.
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Affiliation(s)
- Jaye Moors
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Mohanraj Krishnan
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nick Sumpter
- Division of Clinical Rheumatology and Immunology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Riku Takei
- Division of Clinical Rheumatology and Immunology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matt Bixley
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Murray Cadzow
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Tanya J. Major
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | | | - Ruth Topless
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Marilyn Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Malcolm Rutledge
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Ben Morgan
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Jenna C. Carlson
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jerry Z. Zhang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily M. Russell
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Guangyun Sun
- Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Hong Cheng
- Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Daniel E. Weeks
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Take Naseri
- Ministry of Health, Apia, Samoa
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | | | | | - John Tuitele
- Department of Public Health, Lyndon B. Johnson Tropical Medical Center, Faga’alu, American Samoa, USA
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Ranjan Deka
- Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stephen T. McGarvey
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Janak de Zoysa
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Lisa Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Mele Taumoepeau
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Frances King
- Ngāti Porou Hauora, Te Puia Springs, New Zealand
| | - Phillip Wilcox
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Nuku Rapana
- Pukapukan Community Centre, Māngere, Auckland, New Zealand
| | - Sally McCormick
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Ryan L. Minster
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tony R. Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- Division of Clinical Rheumatology and Immunology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Megan Leask
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- Division of Clinical Rheumatology and Immunology, University of Alabama at Birmingham, Birmingham, AL, USA
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7
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Nicholls SJ, Ray KK, Nelson AJ, Kastelein JJP. Can we revive CETP-inhibitors for the prevention of cardiovascular disease? Curr Opin Lipidol 2022; 33:319-325. [PMID: 36345867 DOI: 10.1097/mol.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW To review recent developments in the field of cholesteryl ester transfer protein (CETP) inhibition from clinical trials and genomic analyses which have the potential to impact future clinical programs. RECENT FINDINGS CETP plays an important role in remodelling of lipoproteins. A large body of evidence suggests that the presence of low CETP activity should have favourable effects on lipid profiles and cardiovascular risk. However, a number of clinical development programs of pharmacological CETP inhibitors have been disappointing with reports of toxicity and clinical futility. These findings have led many to consider abandoning CETP inhibition as a potential strategy for cardiovascular prevention. However, recent observations from genomic analyses and post hoc observations of prior clinical trials have given greater insights into the potential relationship between CETP inhibition and cardiovascular risk. This has highlighted the importance of lowering levels of atherogenic lipoproteins. SUMMARY These findings provide a pathway for ongoing clinical development of CETP inhibitors, where the potential to play an important role in the prevention of cardiovascular disease may still be possible. The lessons learned and pathway forward for new CETP inhibitors will be reviewed.
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Affiliation(s)
| | | | - Adam J Nelson
- Victorian Heart Institute, Monash University, Melbourne, Australia
| | - John J P Kastelein
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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8
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Dangas K, Navar AM, Kastelein JJP. The effect of CETP inhibitors on new-onset diabetes: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:622-632. [PMID: 35441656 PMCID: PMC9729761 DOI: 10.1093/ehjcvp/pvac025] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/16/2022] [Accepted: 04/24/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite the increasing prevalence of type 2 diabetes mellitus (T2DM), limited pharmacologic options are available for prevention. Cholesteryl ester transfer protein inhibitors (CETPis) have been studied primarily as a therapy to reduce cardiovascular disease, but have also been shown to reduce new-onset diabetes. As new trial data have become available, this meta-analysis examines the effect of CETP inhibitors on new-onset diabetes and related glycaemic measures. METHODS AND RESULTS We searched MEDLINE, EMBASE, and Cochrane databases (all articles until 4 March, 2021) for randomised controlled trials (RCT) ≥1-year duration, with at least 500 participants, comparing CETPi to placebo, and that reported data on new-onset diabetes or related glycaemic measures [haemoglobin A1C (HbA1C), fasting plasma glucose, insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)]. A fixed effects meta-analysis model was applied to all eligible studies to quantify the effect of CETPi therapy on new-onset diabetes. Four RCTs (n = 75 102) were eligible for quantitative analysis of the effect of CETPi on new-onset diabetes. CETPis were found to significantly decrease the risk of new-onset diabetes by 16% (RR: 0.84; 95% CI: 0.78, 0.91; P < 0.001), with low between-trial heterogeneity (I2 = 4.1%). Glycaemic measures were also significantly improved or trended towards improvement in those with and without diabetes across most trials. CONCLUSION Although RCTs have shown mixed results regarding the impact of CETPi on cardiovascular disease, they have shown a consistent reduction in the risk of new-onset diabetes with CETPi therapy. Future trials of CETPis and potentially other HDL-raising agents should therefore specify new-onset diabetes and reversal of existing T2DM as secondary endpoints.
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Affiliation(s)
| | - Ann-Marie Navar
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - John J P Kastelein
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam 1081, Netherlands
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9
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Nelson AJ, Sniderman AD, Ditmarsch M, Dicklin MR, Nicholls SJ, Davidson MH, Kastelein JJP. Cholesteryl Ester Transfer Protein Inhibition Reduces Major Adverse Cardiovascular Events by Lowering Apolipoprotein B Levels. Int J Mol Sci 2022; 23:ijms23169417. [PMID: 36012684 PMCID: PMC9409323 DOI: 10.3390/ijms23169417] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Cholesteryl ester transfer protein (CETP) facilitates the exchange of cholesteryl esters and triglycerides (TG) between high-density lipoprotein (HDL) particles and TG-rich, apolipoprotein (apo) B-containing particles. Initially, these compounds were developed to raise plasma HDL cholesterol (HDL-C) levels, a mechanism that was previously thought to lower the risk of atherosclerotic cardiovascular disease (ASCVD). More recently, the focus changed and the use of pharmacologic CETP inhibitors to reduce low-density lipoprotein cholesterol (LDL-C), non-HDL-C and apoB concentrations became supported by several lines of evidence from animal models, observational investigations, randomized controlled trials and Mendelian randomization studies. Furthermore, a cardiovascular outcome trial of anacetrapib demonstrated that CETP inhibition significantly reduced the risk of major coronary events in patients with ASCVD in a manner directly proportional to the substantial reduction in LDL-C and apoB. These data have dramatically shifted the attention on CETP away from raising HDL-C instead to lowering apoB-containing lipoproteins, which is relevant since the newest CETP inhibitor, obicetrapib, reduces LDL-C by up to 51% and apoB by up to 30% when taken in combination with a high-intensity statin. An ongoing cardiovascular outcome trial of obicetrapib in patients with ASCVD is expected to provide further evidence of the ability of CETP inhibitors to reduce major adverse cardiovascular events by lowering apoB. The purpose of the present review is to provide an up-to-date understanding of CETP inhibition and its relationship to ASCVD risk reduction.
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Affiliation(s)
- Adam J. Nelson
- Victorian Heart Institute, Monash University, Clayton, VIC 3800, Australia
| | - Allan D. Sniderman
- Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, Department of Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | | | | | | | | | - John J. P. Kastelein
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
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10
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Sun C, Förster F, Gutsmann B, Moulla Y, Stroh C, Dietrich A, Schön MR, Gärtner D, Lohmann T, Dressler M, Stumvoll M, Blüher M, Kovacs P, Breitfeld J, Guiu-Jurado E. Metabolic Effects of the Waist-To-Hip Ratio Associated Locus GRB14/COBLL1 Are Related to GRB14 Expression in Adipose Tissue. Int J Mol Sci 2022; 23:ijms23158558. [PMID: 35955692 PMCID: PMC9369072 DOI: 10.3390/ijms23158558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023] Open
Abstract
GRB14/COBLL1 locus has been shown to be associated with body fat distribution (FD), but neither the causal gene nor its role in metabolic diseases has been elucidated. We hypothesize that GRB14/COBLL1 may act as the causal genes for FD-related SNPs (rs10195252 and rs6738627), and that they may be regulated by SNP to effect obesity-related metabolic traits. We genotyped rs10195252 and rs6738627 in 2860 subjects with metabolic phenotypes. In a subgroup of 560 subjects, we analyzed GRB14/COBLL1 gene expression in paired visceral and subcutaneous adipose tissue (AT) samples. Mediation analyses were used to determine the causal relationship between SNPs, AT GRB14/COBLL1 mRNA expression, and obesity-related traits. In vitro gene knockdown of Grb14/Cobll1 was used to test their role in adipogenesis. Both gene expressions in AT are correlated with waist circumference. Visceral GRB14 mRNA expression is associated with FPG and HbA1c. Both SNPs are associated with triglycerides, FPG, and leptin levels. Rs10195252 is associated with HbA1c and seems to be mediated by visceral AT GRB14 mRNA expression. Our data support the role of the GRB14/COBLL1 gene expression in body FD and its locus in metabolic sequelae: in particular, lipid metabolism and glucose homeostasis, which is likely mediated by AT GRB14 transcript levels.
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Affiliation(s)
- Chang Sun
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (C.S.); (F.F.); (B.G.); (M.S.); (M.B.); (P.K.); (J.B.)
| | - Franz Förster
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (C.S.); (F.F.); (B.G.); (M.S.); (M.B.); (P.K.); (J.B.)
| | - Beate Gutsmann
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (C.S.); (F.F.); (B.G.); (M.S.); (M.B.); (P.K.); (J.B.)
| | - Yusef Moulla
- Clinic for Visceral, Transplantation and Thorax and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany; (Y.M.); (A.D.)
| | - Christine Stroh
- Departement of Obesity and Metabolic Surgery, SRH Wald-Klinikum Gera Str.d. Friedens 122, 07548 Gera, Germany;
| | - Arne Dietrich
- Clinic for Visceral, Transplantation and Thorax and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany; (Y.M.); (A.D.)
| | - Michael R. Schön
- Städtisches Klinikum Karlsruhe, Clinic of Visceral Surgery, 76133 Karlsruhe, Germany; (M.R.S.); (D.G.)
| | - Daniel Gärtner
- Städtisches Klinikum Karlsruhe, Clinic of Visceral Surgery, 76133 Karlsruhe, Germany; (M.R.S.); (D.G.)
| | - Tobias Lohmann
- Municipal Clinic Dresden-Neustadt, 01129 Dresden, Germany; (T.L.); (M.D.)
| | - Miriam Dressler
- Municipal Clinic Dresden-Neustadt, 01129 Dresden, Germany; (T.L.); (M.D.)
| | - Michael Stumvoll
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (C.S.); (F.F.); (B.G.); (M.S.); (M.B.); (P.K.); (J.B.)
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, 04103 Leipzig, Germany
| | - Matthias Blüher
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (C.S.); (F.F.); (B.G.); (M.S.); (M.B.); (P.K.); (J.B.)
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, 04103 Leipzig, Germany
| | - Peter Kovacs
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (C.S.); (F.F.); (B.G.); (M.S.); (M.B.); (P.K.); (J.B.)
| | - Jana Breitfeld
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (C.S.); (F.F.); (B.G.); (M.S.); (M.B.); (P.K.); (J.B.)
| | - Esther Guiu-Jurado
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, 04103 Leipzig, Germany; (C.S.); (F.F.); (B.G.); (M.S.); (M.B.); (P.K.); (J.B.)
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, 04103 Leipzig, Germany
- Deutsches Zentrum für Diabetesforschung e.V., 85764 Neuherberg, Germany
- Correspondence:
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11
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Zheng YT, Xiao TM, Wu CX, Cheng JY, Li LY. Correlation of Adiponectin Gene Polymorphisms rs266729 and rs3774261 With Risk of Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:798417. [PMID: 35399941 PMCID: PMC8983824 DOI: 10.3389/fendo.2022.798417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/22/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Increasing evidence has suggested an association of adiponectin gene polymorphisms rs1501299, rs2241766, rs266729 and rs3774261 with risk of nonalcoholic fatty liver disease (NAFLD). This correlation has been extensively meta-analyzed for the first two polymorphisms, but not the second two. METHODS The PubMed, EMBASE, Google Scholar, and China National Knowledge Infrastructure databases were searched for relevant literature. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS A total of 10 case-control studies on rs266729 (2,619 cases and 1,962 controls) and 3 case-control studies on rs3774261 (562 cases and 793 controls) were included. Meta-analysis showed that rs266729 was associated with significantly higher NAFLD risk based on the following five models: allelic, OR 1.72, 95% CI 1.34-2.21, P < 0.001; recessive, OR 2.35, 95% CI 1.86-2.95, P < 0.001; dominant, OR 1.84, 95% CI 1.34-2.53, P < 0.001; homozygous, OR 2.69, 95% CI 1.84-3.92, P < 0.001; and heterozygous, OR 1.72, 95% CI 1.28-2.32, P < 0.001. This association between rs266729 and NAFLD risk remained significant for all five models among studies with Asian, Chinese and Caucasian samples. The rs2241766 polymorphism was associated with significantly higher NAFLD risk according to the recessive model (OR 1.87, 95% CI 1.15-3.04, P = 0.01). CONCLUSION Polymorphisms rs266729 and rs3774261 in the adiponectin gene may be risk factors for NAFLD. These findings may pave the way for novel therapeutic strategies, but they should be verified in large, well-designed studies.
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12
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Nurmohamed NS, Ditmarsch M, Kastelein JJP. CETP-inhibitors: from HDL-C to LDL-C lowering agents? Cardiovasc Res 2021; 118:2919-2931. [PMID: 34849601 PMCID: PMC9648826 DOI: 10.1093/cvr/cvab350] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022] Open
Abstract
Cholesteryl ester transfer protein (CETP) is a liver-synthesized glycoprotein whose main functions are facilitating transfer of both cholesteryl esters from high-density lipoprotein (HDL) particles to apolipoprotein B (apoB)-containing particles as well as transfer of triglycerides from apoB-containing particles to HDL particles. Novel crystallographic data have shown that CETP exchanges lipids in the circulation by a dual molecular mechanism. Recently, it has been suggested that the atherosclerotic cardiovascular disease (ASCVD) benefit from CETP inhibition is the consequence of the achieved low-density lipoprotein cholesterol (LDL-C) and apoB reduction, rather than through the HDL cholesterol (HDL-C) increase. The use of CETP inhibitors is supported by genetic evidence from Mendelian randomization studies, showing that LDL-C lowering by CETP gene variants achieves equal ASCVD risk reduction as LDL-C lowering through gene proxies for statins, ezetimibe, and proprotein convertase subtilisin–kexin Type 9 inhibitors. Although first-generation CETP inhibitors (torcetrapib, dalcetrapib) were mainly raising HDL-C or had off-target effects, next generation CETP inhibitors (anacetrapib, evacetrapib) were also effective in reducing LDL-C and apoB and have been proven safe. Anacetrapib was the first CETP inhibitor to be proven effective in reducing ASCVD risk. In addition, CETP inhibitors have been shown to lower the risk of new-onset diabetes, improve glucose tolerance, and insulin sensitivity. The newest-generation CETP inhibitor obicetrapib, specifically designed to lower LDL-C and apoB, has achieved significant reductions of LDL-C up to 45%. Obicetrapib, about to enter phase III development, could become the first CETP inhibitor as add-on therapy for patients not reaching their guideline LDL-C targets.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - John J P Kastelein
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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13
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Black DM, Miller M, Heinonen TM, Zhang G. Advancing Beyond Failed High-density Lipoprotein Clinical Trials to Pharmacogenetic Studies of ADCY9 and Cholesterol Ester Transfer Protein Inhibition. J Cardiovasc Pharmacol 2021; 78:496-500. [PMID: 34173811 DOI: 10.1097/fjc.0000000000001093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/05/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Atherosclerosis has been effectively avoided with many therapies that lower low-density lipoprotein cholesterol. However, significant cardiovascular burden remains. The effect of raising high-density lipoprotein (HDL) has been confounded by other factors (such as lowering triglycerides or LDL) and unsuccessful when attempting to solely increase HDL. Reviewing the available data, the failures of previous strategies may reflect the complexity of HDL in human metabolism and the heterogeneity of human genetics. dal-GenE (NCT02525939) represents the first large cardiovascular outcomes study to use a selective genomic test to identify the target population most likely to receive therapeutic benefit and uses a cholesterol ester transfer protein inhibitor, dalcetrapib. Both the cholesterol ester transfer protein target and the ADCY9 polymorphism identified by the diagnostic test are based on inheritance and an evolving understanding of inborn risk. Selective treatment of subpopulations may be the key to the conundrum of HDL as an actionable risk factor.
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Affiliation(s)
| | - Michael Miller
- Department of Cardiology, University of Maryland, College Park, MD; and
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14
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Le Lay JE, Du Q, Mehta MB, Bhagroo N, Hummer BT, Falloon J, Carlson G, Rosenbaum AI, Jin C, Kimko H, Tsai LF, Novick S, Cook B, Han D, Han CY, Vaisar T, Chait A, Karathanasis SK, Rhodes CJ, Hirshberg B, Damschroder MM, Hsia J, Grimsby JS. Blocking endothelial lipase with monoclonal antibody MEDI5884 durably increases high density lipoprotein in nonhuman primates and in a phase 1 trial. Sci Transl Med 2021; 13:13/590/eabb0602. [PMID: 33883272 DOI: 10.1126/scitranslmed.abb0602] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/23/2021] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease (CVD) is the leading global cause of death, and treatments that further reduce CV risk remain an unmet medical need. Epidemiological studies have consistently identified low high-density lipoprotein cholesterol (HDL-C) as an independent risk factor for CVD, making HDL elevation a potential clinical target for improved CVD resolution. Endothelial lipase (EL) is a circulating enzyme that regulates HDL turnover by hydrolyzing HDL phospholipids and driving HDL particle clearance. Using MEDI5884, a first-in-class, EL-neutralizing, monoclonal antibody, we tested the hypothesis that pharmacological inhibition of EL would increase HDL-C by enhancing HDL stability. In nonhuman primates, MEDI5884 treatment resulted in lasting, dose-dependent elevations in HDL-C and circulating phospholipids, confirming the mechanism of EL action. We then showed that a favorable lipoprotein profile of elevated HDL-C and reduced low-density lipoprotein cholesterol (LDL-C) could be achieved by combining MEDI5884 with a PCSK9 inhibitor. Last, when tested in healthy human volunteers, MEDI5884 not only raised HDL-C but also increased HDL particle numbers and average HDL size while enhancing HDL functionality, reinforcing EL neutralization as a viable clinical approach aimed at reducing CV risk.
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Affiliation(s)
- John E Le Lay
- Bioscience Metabolism, Research and Early Development, Cardiovascular, Renal, and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Qun Du
- Biologic Therapeutics, Antibody Discovery and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Minal B Mehta
- Bioscience Metabolism, Research and Early Development, Cardiovascular, Renal, and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Nicholas Bhagroo
- Bioscience Metabolism, Research and Early Development, Cardiovascular, Renal, and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - B Timothy Hummer
- CVRM Safety, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Judith Falloon
- Clinical Development, Research and Early Development, CVRM, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Glenn Carlson
- Clinical CV, Late Stage Development, CVRM, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Anton I Rosenbaum
- Integrated Bioanalysis, Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, South San Francisco, CA 94080, USA
| | - ChaoYu Jin
- Clinical Immunology and Bioanalysis, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, South San Francisco, CA 94080, USA
| | - Holly Kimko
- Clinical Pharmacology and DMPK, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Lan-Feng Tsai
- CVRM Biometrics, Data Sciences and AI, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Steven Novick
- Data Sciences and Quantitative Biology, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Bill Cook
- Clinical Development, Research and Early Development, CVRM, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD 20878, USA
| | - David Han
- Parexel International, Glendale, CA 91206, USA
| | - Chang Yeop Han
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA 98915, USA
| | - Tomas Vaisar
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA 98915, USA
| | - Alan Chait
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA 98915, USA
| | - Sotirios K Karathanasis
- Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Christopher J Rhodes
- Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Boaz Hirshberg
- Clinical Development, Research and Early Development, CVRM, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Melissa M Damschroder
- Biologic Therapeutics, Antibody Discovery and Protein Engineering, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Judith Hsia
- Clinical Development, Research and Early Development, CVRM, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Joseph S Grimsby
- Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD 20878, USA.
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15
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Nurmohamed NS, Navar AM, Kastelein JJP. New and Emerging Therapies for Reduction of LDL-Cholesterol and Apolipoprotein B: JACC Focus Seminar 1/4. J Am Coll Cardiol 2021; 77:1564-1575. [PMID: 33766264 DOI: 10.1016/j.jacc.2020.11.079] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 01/04/2023]
Abstract
Adding to the foundation of statins, ezetimibe and proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i), novel, emerging low-density lipoprotein cholesterol (LDL-C)-lowering therapies are under development for the prevention of cardiovascular disease. Inclisiran, a small interfering RNA molecule that inhibits PCSK9, only needs to be dosed twice a year and has the potential to help overcome current barriers to persistence and adherence to lipid-lowering therapies. Bempedoic acid, which lowers LDL-C upstream from statins, provides a novel alternative for patients with statin intolerance. Angiopoetin-like 3 protein (ANGPTL3) inhibitors have been shown to provide potent LDL-C lowering in patients with homozygous familial hypercholesterolemia without major adverse effects as seen with lomitapide and mipomersen, and may reduce the need for apheresis. Finally, CETP inhibitors may yet be effective with the development of obicetrapib. These novel agents provide the clinician the tools to effectively lower LDL-C across the entire range of LDL-C-induced elevation of cardiovascular risk, from primary prevention and secondary prevention to null-null homozygous familial hypercholesterolemia patients.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. https://twitter.com/NickNurmohamed
| | - Ann Marie Navar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA. https://twitter.com/AnnMarieNavar
| | - John J P Kastelein
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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16
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Madsen CM, Varbo A, Nordestgaard BG. Novel Insights From Human Studies on the Role of High-Density Lipoprotein in Mortality and Noncardiovascular Disease. Arterioscler Thromb Vasc Biol 2020; 41:128-140. [PMID: 33232200 DOI: 10.1161/atvbaha.120.314050] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The vast majority of research about HDL (high-density lipoprotein) has for decades revolved around the possible role of HDL in atherosclerosis and its therapeutic potential within cardiovascular disease prevention; however, failures with therapies aimed at increasing HDL cholesterol has left questions as to what the role and function of HDL in human health and disease is. Recent observational studies have further shown that extreme high HDL cholesterol is associated with high mortality leading to speculations that HDL could in some instances be harmful. In addition, evidence from observational, and to a lesser extent genetic studies has emerged indicating that HDL might be associated with the development of other major noncardiovascular diseases, such as infectious disease, autoimmune disease, cancer, type 2 diabetes, kidney disease, and lung disease. In this review, we discuss (1) the association between extreme high HDL cholesterol and mortality and (2) the emerging human evidence linking HDL to several major diseases outside the realm of cardiovascular disease.
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Affiliation(s)
- Christian M Madsen
- Department of Clinical Biochemistry (C.M.M., A.V., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,The Copenhagen General Population Study (C.M.M., A.V., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (C.M.M., A.V., B.G.N.)
| | - Anette Varbo
- Department of Clinical Biochemistry (C.M.M., A.V., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,The Copenhagen General Population Study (C.M.M., A.V., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (C.M.M., A.V., B.G.N.)
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry (C.M.M., A.V., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,The Copenhagen General Population Study (C.M.M., A.V., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (C.M.M., A.V., B.G.N.).,The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, Denmark (B.G.N.)
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17
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Agongo G, Amenga-Etego L, Nonterah EA, Debpuur C, Choudhury A, Bentley AR, Oduro AR, Rotimi CN, Crowther NJ, Ramsay M, H Africa. Candidate Gene Analysis Reveals Strong Association of CETP Variants With High Density Lipoprotein Cholesterol and PCSK9 Variants With Low Density Lipoprotein Cholesterol in Ghanaian Adults: An AWI-Gen Sub-Study. Front Genet 2020; 11:456661. [PMID: 33193594 PMCID: PMC7661969 DOI: 10.3389/fgene.2020.456661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/30/2020] [Indexed: 02/06/2023] Open
Abstract
Variations in lipid levels are attributed partly to genetic factors. Genome-wide association studies (GWASs) mainly performed in European, African American and Asian cohorts have identified variants associated with LDL-C, HDL-C, total cholesterol (TC) and triglycerides (TG), but few studies have been performed in sub-Saharan Africans. This study evaluated the effect of single nucleotide variants (SNVs) in eight candidate loci (ABCA1, LCAT, LPL, PON1, CETP, PCSK9, MVK, and MMAB) on lipid levels among 1855 Ghanaian adults. All lipid levels were measured directly using an automated analyser. DNA was extracted and genotyped using the H3Africa SNV array. Linear regression models were used to test the association between SNVs and log-transformed lipid levels, adjusting for sex, age and waist circumference. In addition Bonferroni correction was performed to account for multiple testing. Several variants of CETP, LCAT, PCSK9, and PON1 (MAF > 0.05) were associated with HDL-C, LDL-C and TC levels at p < 0.05. The lead variants for association with HDL-C were rs17231520 in CETP (β = 0.139, p < 0.0001) and rs1109166 in LCAT (β = −0.044, p = 0.028). Lower LDL-C levels were associated with an intronic variant in PCSK9 (rs11806638 [β = −0.055, p = 0.027]) and increased TC was associated with a variant in PON1 (rs854558 [β = 0.040, p = 0.020]). In silico functional analyses indicated that these variants likely influence gene function through their effect on gene transcription. We replicated a strong association between CETP variants and HDL-C and between PCSK9 variant and LDL-C in West Africans, with two potentially functional variants and identified three novel variants in linkage disequilibrium in PON1 which were associated with increasing TC levels in Ghanaians.
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Affiliation(s)
- Godfred Agongo
- Navrongo Health Research Centre, Navrongo, Ghana.,Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucas Amenga-Etego
- Navrongo Health Research Centre, Navrongo, Ghana.,West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
| | - Engelbert A Nonterah
- Navrongo Health Research Centre, Navrongo, Ghana.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Ananyo Choudhury
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | | | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - H Africa
- Navrongo Health Research Centre, Navrongo, Ghana.,Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,West African Centre for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States.,Department of Chemical Pathology, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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18
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In-depth Mendelian randomization analysis of causal factors for coronary artery disease. Sci Rep 2020; 10:9208. [PMID: 32514076 PMCID: PMC7280530 DOI: 10.1038/s41598-020-66027-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 05/11/2020] [Indexed: 12/26/2022] Open
Abstract
Selecting a set of valid genetic variants is critical for Mendelian randomization (MR) to correctly infer risk factors causing a disease. We here developed a method for selecting genetic variants as valid instrumental variables for inferring risk factors causing coronary artery disease (CAD). Using this method, we selected two sets of single-nucleotide-polymorphism (SNP) genetic variants (SNP338 and SNP363) associated with each of the three potential risk factors for CAD including low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c) and triglycerides (TG) from two independent GWAS datasets. We performed in-depth multivariate MR (MVMR) analyses and the results from both datasets consistently showed that LDL-c was strongly associated with increased risk for CAD (β = 0.396,OR = 1.486 per 1 SD (equivalent to 38 mg/dL), 95CI = (1.38, 1.59) in SNP338; and β = 0.424, OR = 1.528 per 1 SD, 95%CI = (1.42, 1.65) in SNP363); HDL-c was strongly associated with reduced risk for CAD (β = −0.315, OR = 0.729 per 1 SD (equivalent to 16 mg/dL), 95CI = (0.68, 0.78) in SNP338; and β = −0.319, OR = 0.726 per 1 SD, 95%CI = (0.66, 0.80), in SNP363). In case of TG, when using the full datasets, an increased risk for CAD (β = 0.184, OR = 1.2 per 1 SD (equivalent to 89 mg/dL), 95%CI = (1.12, 1.28) in SNPP338; and β = 0.207, OR = 1.222 per 1 SD, 95%CI = (1.10, 1.36) in SNP363) was observed, while using partial datasets that contain shared and unique SNPs showed that TG is not a risk factor for CAD. From these results, it can be inferred that TG itself is not a causal risk factor for CAD, but it’s shown as a risk factor due to pleiotropic effects associated with LDL-c and HDL-c SNPs. Large-scale simulation experiments without pleiotropic effects also corroborated these results.
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19
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Menon V, Kumar A, Patel DR, St John J, Riesmeyer J, Weerakkody G, Ruotolo G, Wolski KE, McErlean E, Cremer PC, Nicholls SJ, Lincoff AM, Nissen SE. Effect of CETP inhibition with evacetrapib in patients with diabetes mellitus enrolled in the ACCELERATE trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e000943. [PMID: 32179516 PMCID: PMC7073792 DOI: 10.1136/bmjdrc-2019-000943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND High-density lipoprotein (HDL) levels are inversely associated with cardiovascular risk. Cholesteryl ester transfer protein inhibition with evacetrapib results in a marked increase in HDL and reduction in low-density lipoprotein (LDL) levels. We evaluated the impact of treatment with evacetrapib versus placebo in the subset of 8236 patients with diabetes mellitus (DM) enrolled in the Assessment of Clinical Effects of Cholesteryl Ester Transfer Protein Inhibition with Evacetrapib in Patients at a High Risk for Vascular Outcomes trial. METHODS AND RESULTS Time to first occurrence of any component of the primary composite endpoint of cardiovascular death, myocardial infarction, stroke, revascularization, and hospitalization for unstable angina was compared among patients with DM randomized to treatment with evacetrapib (n=4127) or placebo (n=4109) over a median of 26 months of follow-up. The mean baseline LDL at initiation was 80 mg/dL with a mean baseline HDL of 44 mg/dL. In patients with DM, evacetrapib resulted in a 131% mean increase in HDL levels and a 32% mean decrease in LDL at 3 months that was sustained during the course of the trial. At 6 months, hemoglobin A1c (HbA1c) levels were lower with evacetrapib than placebo (7.08% vs 7.15%, p=0.023). Composite event rates were higher in patients with DM than without DM (Kaplan-Meier estimates: 15.2% vs 10.6%, HR 1.46, 95% CI 1.30 to 1.64, p<0.001). In the DM group, event rates for the composite endpoint (14.5% evacetrapib vs 16% placebo, HR 0.95, 95% CI 0.85 to 1.07, p=0.38) and individual components of the composite were similar for both evacetrapib and placebo groups. No significant treatment interaction between treatment assignment and diabetes status was noted. CONCLUSION Despite a favorable increase in HDL, and decreases in LDL and HbA1c levels in patients with DM, we observed no benefits of treatment with evacetrapib on prespecified clinical outcomes in this high-risk population.
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Affiliation(s)
- Venu Menon
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anirudh Kumar
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Divyang R Patel
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Julie St John
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | - Kathy E Wolski
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ellen McErlean
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Paul C Cremer
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
| | - A Michael Lincoff
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Steven E Nissen
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Cholesteryl Ester Transfer Protein Inhibition for Preventing Cardiovascular Events: JACC Review Topic of the Week. J Am Coll Cardiol 2019; 73:477-487. [PMID: 30704580 PMCID: PMC6354546 DOI: 10.1016/j.jacc.2018.10.072] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/19/2018] [Accepted: 10/29/2018] [Indexed: 01/01/2023]
Abstract
Cholesteryl ester transfer protein (CETP) facilitates exchange of triglycerides and cholesteryl ester between high-density lipoprotein (HDL) and apolipoprotein B100–containing lipoproteins. Evidence from genetic studies that variants in the CETP gene were associated with higher blood HDL cholesterol, lower low-density lipoprotein cholesterol, and lower risk of coronary heart disease suggested that pharmacological inhibition of CETP may be beneficial. To date, 4 CETP inhibitors have entered phase 3 cardiovascular outcome trials. Torcetrapib was withdrawn due to unanticipated off-target effects that increased risk of death, and major trials of dalcetrapib and evacetrapib were terminated early for futility. In the 30,000-patient REVEAL (Randomized Evaluation of the Effects of Anacetrapib through Lipid Modification) trial, anacetrapib doubled HDL cholesterol, reduced non-HDL cholesterol by 17 mg/dl (0.44 mmol/l), and reduced major vascular events by 9% over 4 years, but anaceptrapib was found to accumulate in adipose tissue, and regulatory approval is not being sought. Therefore, despite considerable initial promise, CETP inhibition provides insufficient cardiovascular benefit for routine use.
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21
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Cholesteryl Ester Transfer Protein Genetic Variants Associated with Risk for Type 2 Diabetes and Diabetic Kidney Disease in Taiwanese Population. Genes (Basel) 2019; 10:genes10100782. [PMID: 31597401 PMCID: PMC6826370 DOI: 10.3390/genes10100782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/24/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022] Open
Abstract
Cholesteryl ester transfer protein (CETP) plays an important role in lipid metabolism. Low levels of high-density lipoprotein cholesterol (HDL-C) increase the risk of type 2 diabetes (T2D). This study investigated CETP gene variants to assess the risk of T2D and specific complications of diabetic kidney disease (DKD) and diabetic retinopathy. Towards this, a total of 3023 Taiwanese individuals (1383 without T2D, 1640 with T2D) were enrolled in this study. T2D mice (+Leprdb/+Leprdb, db/db) were used to determine CETP expression in tissues. The A-alleles of rs3764261, rs4783961, and rs1800775 variants were found to be independently associated with 2.86, 1.71, and 0.91 mg/dL increase in HDL-C per allele, respectively. In addition, the A-allele of rs4783961 was significantly associated with a reduced T2D risk (odds ratio (OR), 0.82; 95% confidence interval (CI), 0.71–0.96)), and the A-allele of rs1800775 was significantly related to a lowered DKD risk (OR, 0.78; 95% CI, 0.64–0.96). CETP expression was significantly decreased in the T2D mice kidney compared to that in the control mice (T2D mice, 0.16 ± 0.01 vs. control mice, 0.21 ± 0.02; p = 0.02). These collective findings indicate that CETP variants in the promoter region may affect HDL-C levels. Taiwanese individuals possessing an allele associated with higher HDL-C levels had a lower risk of T2D and DKD.
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Do Cholesteryl Ester Transfer Protein Inhibitors Have a Role in the Treatment of Cardiovascular Disease? Am J Cardiovasc Drugs 2019; 19:229-235. [PMID: 30610681 DOI: 10.1007/s40256-018-00323-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cholesteryl ester transfer protein (CETP) plays an important role in lipid metabolism and has presented an attractive target for drug development, primarily resting on the hope that CETP inhibition would reduce cardiovascular events through its ability to increase levels of high-density lipoprotein cholesterol (HDL-C). However, clinical development of CETP inhibitors has proven disappointing, with a spectrum of results spanning from evidence of harm, to futility, to only modest benefit in large-scale cardiovascular outcomes trials. A number of additional insights from genomic studies have suggested potential benefits from these agents in specific clinical settings. We review the current state of CETP inhibitors as an approach to targeting cardiovascular risk.
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The Relationship Between Premature Myocardial Infarction with TC/HDL-C Ratio Subgroups in a Multiple Risk Factor Model. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 3:e24. [PMID: 31410401 PMCID: PMC6683591 DOI: 10.22114/ajem.v0i0.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION So far, there is no evidence available to demonstrate the relationship between five subgroups of total cholesterol/high density lipoprotein cholesterol (TC/HDL-C) ratio with premature myocardial infarction (MI). OBJECTIVE We conducted a case control study to probe more features of the relation between TC/HDL-C ratio and the five subgroups of the ratio with myocardial infarction under 55 years and above it. METHOD A hospital based case control study with incident cases was designed. Cases and controls were comprised of 523 under 55-year and 699 above 55-year documented newly diagnosed MI cases, respectively. Standardized clinical and para clinical method were used to ascertain disease and risk factors. Independent sample t-test, Pearson chi square test, Odds ratios and Mantel-Haenszel test and logistic regression analysis conducted to evaluate relationships. RESULTS This study enrolled 1222 MI cases. Patients with very low risk category of TC/HDL-C ratio estimated OR=0.18 with 95% confidence interval (CI) (0.04-0.72) for developing MI under 55 years. Patients who had low risk category of TC/HDL-C ratio having OR=0.26 95% CI (0.07-0.89). Low risk and very low risk categories of the TC/HDL-C ratio compare to high risk subgroup of the ratio demonstrate decreased risk of developing MI under 55 years p<0.05. CONCLUSION Our study results can be translated as an aggressive treatment for lowering TC/HDL-C ratio in both general population and victims of coronary events. Mitigation of the level of TC/HDL-C ratio from low risk to very low risk category will attenuate the risk of MI under55 years about 8% which is the immediate clinical implication of our findings.
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Sidaraite A, Liutkeviciene R, Glebauskiene B, Vilkeviciute A, Kriauciuniene L. Associations of cholesteryl ester transfer protein (CETP) gene variants with pituitary adenoma. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:189-195. [PMID: 31012439 DOI: 10.5507/bp.2019.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/04/2019] [Indexed: 01/06/2023] Open
Abstract
AIM The aim was to evaluate the association of CETP (rs5882 and rs708272) single nucleotide polymorphisms with the presence, invasiveness, hormonal activity and recurrence of pituitary adenoma (PA). METHODS The study group included 142 patients with PA and the control group, 753 healthy subjects. The genotyping of CETP (rs5882 and rs708272) was performed using a real-time PCR method. RESULTS After statistical analysis we found that CETP rs708272 genotype G/A under the over-dominant model was associated with the decreased odds of PA (OR=0.637; 95%CI: 0.443-0.917; P=0.015), active PA (OR=0.538; 95%CI: 0.335-0.865; P =0.01) and non-recurrent PA (OR=0.602; 95% CI: 0.402 - 0.902; P =0.014). When compared to controls, the rs708272 genotype G/A was less frequent in the active PA subgroup (37.5% vs 52.7%, P =0.009) and the non-recurrent PA subgroup (40.2% vs 52.7%, P=0.013), while the rs5882 genotype A/A was less frequent in the non-recurrent PA subgroup (37.5% vs 46.2%, P=0.015). CONCLUSION Our study showed that CETP rs708272 genotype G/A may be associated with a decreased risk of PA.
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Affiliation(s)
- Agne Sidaraite
- Lithuanian University of Health Sciences, Medical Academy, Eiveniu 2, Kaunas, Lithuania
| | - Rasa Liutkeviciene
- Neuroscience Institute, Lithuanian University of Health Sciences, Medical Academy, Eiveniu 2, Kaunas, Lithuania.,Department of Ophthalmology, Lithuanian University of Health Sciences, Medical Academy, Eiveniu 2, Kaunas, Lithuania
| | - Brigita Glebauskiene
- Department of Ophthalmology, Lithuanian University of Health Sciences, Medical Academy, Eiveniu 2, Kaunas, Lithuania
| | - Alvita Vilkeviciute
- Neuroscience Institute, Lithuanian University of Health Sciences, Medical Academy, Eiveniu 2, Kaunas, Lithuania
| | - Loresa Kriauciuniene
- Neuroscience Institute, Lithuanian University of Health Sciences, Medical Academy, Eiveniu 2, Kaunas, Lithuania.,Department of Ophthalmology, Lithuanian University of Health Sciences, Medical Academy, Eiveniu 2, Kaunas, Lithuania
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Hebbar P, Abubaker JA, Abu-Farha M, Tuomilehto J, Al-Mulla F, Thanaraj TA. A Perception on Genome-Wide Genetic Analysis of Metabolic Traits in Arab Populations. Front Endocrinol (Lausanne) 2019; 10:8. [PMID: 30761081 PMCID: PMC6362414 DOI: 10.3389/fendo.2019.00008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/09/2019] [Indexed: 12/16/2022] Open
Abstract
Despite dedicated nation-wide efforts to raise awareness against the harmful effects of fast-food consumption and sedentary lifestyle, the Arab population continues to struggle with an increased risk for metabolic disorders. Unlike the European population, the Arab population lacks well-established genetic risk determinants for metabolic disorders, and the transferability of established risk loci to this population has not been satisfactorily demonstrated. The most recent findings have identified over 240 genetic risk loci (with ~400 independent association signals) for type 2 diabetes, but thus far only 25 risk loci (ADAMTS9, ALX4, BCL11A, CDKAL1, CDKN2A/B, COL8A1, DUSP9, FTO, GCK, GNPDA2, HMG20A, HNF1A, HNF1B, HNF4A, IGF2BP2, JAZF1, KCNJ11, KCNQ1, MC4R, PPARγ, SLC30A8, TCF7L2, TFAP2B, TP53INP1, and WFS1) have been replicated in Arab populations. To our knowledge, large-scale population- or family-based association studies are non-existent in this region. Recently, we conducted genome-wide association studies on Arab individuals from Kuwait to delineate the genetic determinants for quantitative traits associated with anthropometry, lipid profile, insulin resistance, and blood pressure levels. Although these studies led to the identification of novel recessive variants, they failed to reproduce the established loci. However, they provided insights into the genetic architecture of the population, the applicability of genetic models based on recessive mode of inheritance, the presence of genetic signatures of inbreeding due to the practice of consanguinity, and the pleiotropic effects of rare disorders on complex metabolic disorders. This perspective presents analysis strategies and study designs for identifying genetic risk variants associated with diabetes and related traits in Arab populations.
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Affiliation(s)
- Prashantha Hebbar
- Genetics and Bioinformatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- Doctoral Program in Population Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jehad Ahmed Abubaker
- Genetics and Bioinformatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mohamed Abu-Farha
- Genetics and Bioinformatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jaakko Tuomilehto
- Genetics and Bioinformatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Fahd Al-Mulla
- Genetics and Bioinformatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- *Correspondence: Fahd Al-Mulla
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Pikó P, Fiatal S, Kósa Z, Sándor J, Ádány R. Generalizability and applicability of results obtained from populations of European descent regarding the effect direction and size of HDL-C level-associated genetic variants to the Hungarian general and Roma populations. Gene 2018; 686:187-193. [PMID: 30468910 DOI: 10.1016/j.gene.2018.11.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/28/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Large-scale association studies that mainly involve European populations identified many genetic loci related to high-density lipoprotein cholesterol (HDL-C) levels, one of the most important indicators of the risk for cardiovascular diseases. The question with intense speculation of whether the effect estimates obtained from European populations for different HDL-C level-related SNPs are applicable to the Roma ethnicity, the largest minority group in Europe with a South Asian origin, was addressed in the present study. DESIGN The associations between 21 SNPs (in the genes LIPC(G), CETP, GALNT2, HMGCP, ABCA1, KCTD10 and WWOX) and HDL-C levels were examined separately in adults of the Hungarian general (N = 1542) and Roma (N = 646) populations by linear regression. Individual effects (direction and size) of single SNPs on HDL-C levels were computed and compared between the study groups and with data published in the literature. RESULTS Significant associations between SNPs and HDL-C levels were more frequently found in general subjects than in Roma subjects (11 SNPs in general vs. 4 SNPs in Roma). The CETP gene variants rs1532624, rs708272 and rs7499892 consistently showed significant associations with HDL-C levels across the study groups (p ˂ 0.05), indicating a possible causal variant(s) in this region. Although nominally significant differences in effect size were found for three SNPs (rs693 in gene APOB, rs9989419 in gene CETP, and rs2548861 in gene WWOX) by comparing the general and Roma populations, most of these SNPs did not have a significant effect on HDL-C levels. The β coefficients for SNPs in the Roma population were found to be identical both in direction and magnitude to the effect obtained previously in large-scale studies on European populations. CONCLUSIONS The effect of the vast majority of the SNPs on HDL-C levels could be replicated in the Hungarian general and Roma populations, which indicates that the effect size measurements obtained from the literature can be used for risk estimation for both populations.
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Affiliation(s)
- Péter Pikó
- MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Faculty of Public Health, University of Debrecen, Debrecen 4028, Hungary; Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4028, Hungary
| | - Szilvia Fiatal
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4028, Hungary; WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4028, Hungary
| | - Zsigmond Kósa
- Department of Health Visitor Methodology and Public Health, Faculty of Health, University of Debrecen, Nyíregyháza 4400, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4028, Hungary; WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4028, Hungary
| | - Róza Ádány
- MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Faculty of Public Health, University of Debrecen, Debrecen 4028, Hungary; Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4028, Hungary; WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen 4028, Hungary.
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27
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Barter PJ, Cochran BJ, Rye KA. CETP inhibition, statins and diabetes. Atherosclerosis 2018; 278:143-146. [PMID: 30278356 DOI: 10.1016/j.atherosclerosis.2018.09.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/07/2018] [Accepted: 09/25/2018] [Indexed: 01/15/2023]
Abstract
Type 2 diabetes is a causal risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). While treatment with a statin reduces the risk of having an ASCVD event in all people, including those with type-2 diabetes, statin treatment also increases the likelihood of new onset diabetes when given to those with risk factors for developing diabetes. Treatment with the cholesteryl ester transfer protein (CETP) inhibitor, anacetrapib, reduces the risk of having a coronary event over and above that achieved with a statin. However, unlike statins, anacetrapib decreases the risk of developing diabetes. If the reduced risk of new-onset diabetes is confirmed in another CETP inhibitor outcome trial, there will be a case for considering the use of the combination of a statin plus a CETP inhibitor in high ASCVD-risk people who are also at increased risk of developing diabetes.
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Affiliation(s)
- Philip J Barter
- Lipid Research Group, School of Medical Sciences, The University of New South Wales, Australia.
| | - Blake J Cochran
- Lipid Research Group, School of Medical Sciences, The University of New South Wales, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, The University of New South Wales, Australia
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Abstract
Mendelian randomization studies demonstrate that apolipoprotein B-containing lipoproteins have both causal and cumulative effects on the risk of atherosclerotic cardiovascular disease. The clinical benefit of lipid-lowering therapies depends on both the absolute reduction in circulating apolipoprotein B-containing lipoproteins and the total duration of exposure to these particles. Because atherosclerosis seems to be caused by the retention of apolipoprotein B-containing lipoproteins rather than by the cholesterol content carried by those lipoproteins, high-density lipoprotein-mediated efflux of cholesterol from the arterial wall may not reduce the risk of atherosclerotic cardiovascular disease.
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Affiliation(s)
- Brian A Ference
- Institute for Advanced Studies, University of Bristol, 3rd Floor, Senate House, Bristol BS8 1UH, UK.
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29
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Zhang H, de Aguiar Vallim TQ, Martel C. Translational and Therapeutic Approaches to the Understanding and Treatment of Dyslipidemia. Arterioscler Thromb Vasc Biol 2018; 36:e56-61. [PMID: 27335468 DOI: 10.1161/atvbaha.116.307808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Hanrui Zhang
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (H.Z.); Division of Cardiology, School of Medicine, University of California Los Angeles (T.Q. de A. V.); and Department of Medicine, Montreal Heart Institute Research Center, Université de Montréal, Montreal, Quebec, Canada (C.M.).
| | - Thomas Q de Aguiar Vallim
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (H.Z.); Division of Cardiology, School of Medicine, University of California Los Angeles (T.Q. de A. V.); and Department of Medicine, Montreal Heart Institute Research Center, Université de Montréal, Montreal, Quebec, Canada (C.M.).
| | - Catherine Martel
- From the Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (H.Z.); Division of Cardiology, School of Medicine, University of California Los Angeles (T.Q. de A. V.); and Department of Medicine, Montreal Heart Institute Research Center, Université de Montréal, Montreal, Quebec, Canada (C.M.).
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30
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Ference BA. Using Genetic Variants in the Targets of Lipid Lowering Therapies to Inform Drug Discovery and Development: Current and Future Treatment Options. Clin Pharmacol Ther 2018; 105:568-581. [PMID: 29953581 DOI: 10.1002/cpt.1163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/14/2018] [Indexed: 11/06/2022]
Abstract
Mendelian randomization studies and "human knock-out" studies of rare loss-of-function coding variants suggest that plasma levels of low-density lipoprotein-cholesterol LDL-C, triglycerides (TGs), and lipoprotein(a) (Lp(a)) are causally associated with the risk of cardiovascular disease, and, therefore, therapies directed against these targets should reduce the risk of cardiovascular events. However, several therapies directed against these targets have failed to reduce the risk of cardiovascular events in large-scale randomized trials, thus suggesting that causality is not sufficient evidence to establish genetic target validation. Instead, the critical question that needs to be answered to improve drug discovery and development is how much a causal biomarker needs to be changed to produce a clinically meaningful benefit in a short-term trial. This review describes how to use naturally randomized genetic evidence to accurately anticipate the results of randomized trials evaluating current and future lipid lowering therapies, inform the design of randomized trials, and transform the drug discovery and development process.
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Affiliation(s)
- Brian A Ference
- Centre for Naturally Randomized Trials, Strangeways Research Laboratory, University of Cambridge, Cambridge, UK
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Kajani S, Curley S, McGillicuddy FC. Unravelling HDL-Looking beyond the Cholesterol Surface to the Quality Within. Int J Mol Sci 2018; 19:ijms19071971. [PMID: 29986413 PMCID: PMC6073561 DOI: 10.3390/ijms19071971] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 12/11/2022] Open
Abstract
High-density lipoprotein (HDL) particles have experienced a turbulent decade of falling from grace with widespread demotion from the most-sought-after therapeutic target to reverse cardiovascular disease (CVD), to mere biomarker status. HDL is slowly emerging from these dark times due to the HDL flux hypothesis wherein measures of HDL cholesterol efflux capacity (CEC) are better predictors of reduced CVD risk than static HDL-cholesterol (HDL-C) levels. HDL particles are emulsions of metabolites, lipids, protein, and microRNA (miR) built on the backbone of Apolipoprotein A1 (ApoA1) that are growing in their complexity due to the higher sensitivity of the respective “omic” technologies. Our understanding of particle composition has increased dramatically within this era and has exposed how our understanding of these particles to date has been oversimplified. Elucidation of the HDL proteome coupled with the identification of specific miRs on HDL have highlighted the “hormonal” characteristics of HDL in that it carries and delivers messages systemically. HDL can dock to most peripheral cells via its receptors, including SR-B1, ABCA1, and ABCG1, which may be a critical step for facilitating HDL-to-cell communication. The composition of HDL particles is, in turn, altered in numerous disease states including diabetes, auto-immune disease, and CVD. The consequence of changes in composition, however, on subsequent biological activities of HDL is currently poorly understood and this is an important avenue for the field to explore in the future. Improving HDL particle quality as opposed to HDL quantity may, in turn, prove a more beneficial investment to reduce CVD risk.
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Affiliation(s)
- Sarina Kajani
- Cardiometabolic Research Group, Diabetes Complications Research Centre, UCD Conway Institute, University College Dublin, Belfield, 4 Dublin, Ireland.
| | - Sean Curley
- Cardiometabolic Research Group, Diabetes Complications Research Centre, UCD Conway Institute, University College Dublin, Belfield, 4 Dublin, Ireland.
| | - Fiona C McGillicuddy
- Cardiometabolic Research Group, Diabetes Complications Research Centre, UCD Conway Institute, University College Dublin, Belfield, 4 Dublin, Ireland.
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Povsic TJ, Scott R, Mahaffey KW, Blaustein R, Edelberg JM, Lefkowitz MP, Solomon SD, Fox JC, Healy KE, Khakoo AY, Losordo DW, Malik FI, Monia BP, Montgomery RL, Riesmeyer J, Schwartz GG, Zelenkofske SL, Wu JC, Wasserman SM, Roe MT. Navigating the Future of Cardiovascular Drug Development-Leveraging Novel Approaches to Drive Innovation and Drug Discovery: Summary of Findings from the Novel Cardiovascular Therapeutics Conference. Cardiovasc Drugs Ther 2018; 31:445-458. [PMID: 28735360 DOI: 10.1007/s10557-017-6739-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The need for novel approaches to cardiovascular drug development served as the impetus to convene an open meeting of experts from the pharmaceutical industry and academia to assess the challenges and develop solutions for drug discovery in cardiovascular disease. METHODS The Novel Cardiovascular Therapeutics Summit first reviewed recent examples of ongoing or recently completed programs translating basic science observations to targeted drug development, highlighting successes (protein convertase sutilisin/kexin type 9 [PCSK9] and neprilysin inhibition) and targets still under evaluation (cholesteryl ester transfer protein [CETP] inhibition), with the hope of gleaning key lessons to successful drug development in the current era. Participants then reviewed the use of innovative approaches being explored to facilitate rapid and more cost-efficient evaluations of drug candidates in a short timeframe. RESULTS We summarize observations gleaned from this summit and offer insight into future cardiovascular drug development. CONCLUSIONS The rapid development in genetic and high-throughput drug evaluation technologies, coupled with new approaches to rapidly evaluate potential cardiovascular therapies with in vitro techniques, offer opportunities to identify new drug targets for cardiovascular disease, study new therapies with better efficiency and higher throughput in the preclinical setting, and more rapidly bring the most promising therapies to human testing. However, there must be a critical interface between industry and academia to guide the future of cardiovascular drug development. The shared interest among academic institutions and pharmaceutical companies in developing promising therapies to address unmet clinical needs for patients with cardiovascular disease underlies and guides innovation and discovery platforms that are significantly altering the landscape of cardiovascular drug development.
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Affiliation(s)
- Thomas J Povsic
- Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt Street, Duke Medicine, Durham, NC, 27705, USA.
| | - Rob Scott
- AbbVie Pharmaceuticals, Chicago, IL, USA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research (SCCR), Stanford University School of Medicine, Stanford, CA, USA
| | - Robert Blaustein
- Merck Research Laboratories, Merck & Co., Inc, Kenilworth, NJ, USA
| | | | | | | | | | - Kevin E Healy
- University of California, Berkeley, Berkeley, CA, USA
| | | | | | | | | | | | | | | | | | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Matthew T Roe
- Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt Street, Duke Medicine, Durham, NC, 27705, USA
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Padmapriyadarsini C, Ramesh K, Sekar L, Ramachandran G, Reddy D, Narendran G, Sekar S, Chandrasekar C, Anbarasu D, Wanke C, Swaminathan S. Factors affecting high-density lipoprotein cholesterol in HIV-infected patients on nevirapine-based antiretroviral therapy. Indian J Med Res 2018; 145:641-650. [PMID: 28948955 PMCID: PMC5644299 DOI: 10.4103/ijmr.ijmr_1611_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background & objectives: Cardiovascular disease (CVD) risk with low high-density lipoprotein cholesterol (HDL-C) and high triglycerides is common in the general population in India. As nevirapine (NVP)-based antiretroviral therapy (ART) tends to increase HDL-C, gene polymorphisms associated with HDL-C metabolism in HIV-infected adults on stable NVP-based ART were studied. Methods: A cross-sectional study was conducted between January 2013 and July 2014 among adults receiving NVP-based ART for 12-15 months. Blood lipids were estimated and gene polymorphisms in apolipoprotein C3 (APOC3), cholesteryl ester transfer protein (CETP) and lipoprotein lipase (LPL) genes were analyzed by real-time polymerase chain reaction. Framingham's 10-yr CVD risk score was estimated. Logistic regression was done to show factors related to low HDL-C levels. Results: Of the 300 patients included (mean age: 38.6±8.7 yr; mean CD4 count 449±210 cell/μl), total cholesterol (TC) >200 mg/dl was observed in 116 (39%) patients. Thirty nine per cent males and 47 per cent females had HDL-C levels below normal while 32 per cent males and 37 per cent females had TC/HDL ratio of 4.5 and 4.0, respectively. Body mass index [adjusted odds ratio (aOR)=1.70, 95% confidence interval (CI) 1.01-2.84, P=0.04] and viral load (aOR=3.39, 95% CI: 1.52-7.52, P=0.003) were negatively associated with serum HDL-C levels. The 10-yr risk score of developing CVD was 11-20 per cent in 3 per cent patients. Allelic variants of APOC3 showed a trend towards low HDL-C. Interpretation & conclusions: High-risk lipid profiles for atherosclerosis and cardiovascular disease were common among HIV-infected individuals, even after 12 months of NVP-based ART. Targeted interventions to address these factors should be recommended in the national ART programmes.
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Affiliation(s)
- C Padmapriyadarsini
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - K Ramesh
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - L Sekar
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Geetha Ramachandran
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Devaraj Reddy
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - G Narendran
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - S Sekar
- ART Centre, Rajiv Gandhi Government General Hospital, Chennai, India
| | - C Chandrasekar
- Nodal ART Medical Officer, Government Hospital of Thoracic Medicine, Chennai, India
| | - D Anbarasu
- ART Centre, Government Vellore Medical College & Hospital, Vellore, India
| | - Christine Wanke
- Department of Medicine, Tufts University School of Medicine, Boston, USA
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Shrestha S, Wu BJ, Guiney L, Barter PJ, Rye KA. Cholesteryl ester transfer protein and its inhibitors. J Lipid Res 2018; 59:772-783. [PMID: 29487091 PMCID: PMC5928430 DOI: 10.1194/jlr.r082735] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/10/2018] [Indexed: 12/22/2022] Open
Abstract
Most of the cholesterol in plasma is in an esterified form that is generated in potentially cardioprotective HDLs. Cholesteryl ester transfer protein (CETP) mediates bidirectional transfers of cholesteryl esters (CEs) and triglycerides (TGs) between plasma lipoproteins. Because CE originates in HDLs and TG enters the plasma as a component of VLDLs, activity of CETP results in a net mass transfer of CE from HDLs to VLDLs and LDLs, and of TG from VLDLs to LDLs and HDLs. As inhibition of CETP activity increases the concentration of HDL-cholesterol and decreases the concentration of VLDL- and LDL-cholesterol, it has the potential to reduce atherosclerotic CVD. This has led to the development of anti-CETP neutralizing monoclonal antibodies, vaccines, and antisense oligonucleotides. Small molecule inhibitors of CETP have also been developed and four of them have been studied in large scale cardiovascular clinical outcome trials. This review describes the structure of CETP and its mechanism of action. Details of its regulation and nonlipid transporting functions are discussed, and the results of the large scale clinical outcome trials of small molecule CETP inhibitors are summarized.
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Affiliation(s)
- Sudichhya Shrestha
- School of Medical Sciences, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Ben J Wu
- School of Medical Sciences, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Liam Guiney
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Philip J Barter
- School of Medical Sciences, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Kerry-Anne Rye
- School of Medical Sciences, University of New South Wales Sydney, Sydney, New South Wales, Australia
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35
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Barter PJ, Rye KA. Cholesteryl Ester Transfer Protein Inhibitors as Agents to Reduce Coronary Heart Disease Risk. Cardiol Clin 2018; 36:299-310. [DOI: 10.1016/j.ccl.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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36
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Lin S, Dai R, Lin R. A meta-analytic evaluation of cholesteryl ester transfer protein (CETP) C-629A polymorphism in association with coronary heart disease risk and lipid changes. Oncotarget 2018; 8:2153-2163. [PMID: 27791990 PMCID: PMC5356788 DOI: 10.18632/oncotarget.12898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/19/2016] [Indexed: 01/06/2023] Open
Abstract
Lipid metabolism plays an essential role in the pathogenesis of atherosclerosis, a major cause for coronary heart disease (CHD). Cholesteryl ester transfer protein (CETP) is an important glycoprotein involved in lipid metabolism by transferring cholesteryl esters to apolipoprotein B-containing lipoproteins in exchange for triglycerides. The objective of this meta-analysis was to evaluate the association of CETP C-629A polymorphism with CHD risk and lipid changes. Four public databases were searched, and data from 17 qualified articles were extracted in duplicate and analyzed by STATA software. Overall association of C-629A with CHD risk was nonsignificant in 5441 patients and 7967 controls. Subgroup analyses by ethnicity revealed significance only in Caucasians, with the odds of CHD being 1.18, 1.43 and 1.41 under allelic, genotypic and dominant models, respectively (P < 0.001). Similarly, the -629C allele increased the corresponding risk of myocardial infarction by 1.23-, 1.28- and 1.29-fold (P < 0.02). The association of C-629A with CHD was significantly strengthened in prospective and large studies. Moreover, carriers of the -629C allele had significant higher levels of circulating CETP (weighted mean difference [WMD]: 0.45 μg/mL; 95% confidence interval [CI]: 0.25 to 0.65; P < 0.001), but lower levels of high-density lipoprotein cholesterol (HDL-C) (WMD: -3.65 mg/dL; 95% CI: -5.59 to -1.70; P < 0.001) relative to the -629AA homozygotes. The probability of publication bias was low. Our meta-analytic findings collectively demonstrate that the -629C allele was significantly associated with an increased risk of CHD in Caucasians, and this association may be mediated by its phenotypic regulation on circulating CETP and HDL-C.
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Affiliation(s)
- Shouwei Lin
- Department of Cardiology, Fujian Medical University Affiliated First Quanzhou Hospital, Fujian Province, P.R. China
| | - Ruozhu Dai
- Department of Cardiology, Fujian Medical University Affiliated First Quanzhou Hospital, Fujian Province, P.R. China
| | - Rong Lin
- Department of Cardiology, Fujian Medical University Affiliated First Quanzhou Hospital, Fujian Province, P.R. China
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Genetic variations of cholesteryl ester transfer protein and diet interactions in relation to lipid profiles and coronary heart disease: a systematic review. Nutr Metab (Lond) 2017; 14:77. [PMID: 29234452 PMCID: PMC5721696 DOI: 10.1186/s12986-017-0231-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/28/2017] [Indexed: 12/24/2022] Open
Abstract
Data on diet–genotype interactions in the prevention or treatment of dyslipidemia have increased remarkably. This systematic review aimed to assess nutrigenetic studies regarding the modulating effect of diet on cholesteryl ester transfer protein (CETP) polymorphisms in relation to metabolic traits. Data were collected through studies published between 2000 and SEP. 2016 using five electronic databases. The quality of eligible studies was assessed using a 12-item quality checklist, derived from the STrengthening the REporting of Genetic Association Studies (STREGA) statement. CETP variants that had associations with lipid profiles in previous studies were extracted for drawing of the linkage disequilibrium (LD) plot. Among CETP variants, the rs9989419 best represented this genome wide association signal across all populations, based on LD r2 estimates from 1000 genomes references. In the 23 found eligible studies (clinical trials and observational), the TaqIB and I405V polymorphisms were the two most intensively studied. Two studies reported the effect of interaction between rs3764261 and diet on lipid levels. Regarding the rs708272 (Taq1B), individuals with the B1 risk allele showed better responses to dietary interventions than those with B2B2 genotype, whereas with I405V, inconsistent results have been reported. Modest alcohol consumption was associated with decreased risk of coronary heart disease among B2 carriers of rs708272. It is concluded that variations in the CETP gene may modulate the effects of dietary components on metabolic traits. These results have been controversial, indicating complex polygenic factors in metabolic response to diet and lack of uniformity in the study conditions and designs.
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38
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Messas N, Dubé MP, Tardif JC. Pharmacogenetics of Lipid-Lowering Agents: an Update Review on Genotype-Dependent Effects of HDL-Targetingand Statin Therapies. Curr Atheroscler Rep 2017; 19:43. [PMID: 28944433 DOI: 10.1007/s11883-017-0679-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW High-density lipoproteins (HDL) are involved in reverse cholesterol transport. Results from randomized trials of HDL-targeting therapies, including cholesteryl ester transfer protein (CETP) inhibitors, have shown a lack of benefit in unsegmented populations. These observations could be explained by inter-individual variability of clinical responses to such agents depending on the patients' genotypes. In parallel, although lowering of LDL cholesterol (LDL-c) with statin therapy reduces the risk of vascular events in a wide range of individuals, inter-individual variability exists with regard to LDL-c-lowering response as well as efficacy in reducing major cardiovascular events. RECENT FINDINGS Pharmacogenomic analyses were performed in the dal-OUTCOMES and dal-PLAQUE-2 studies. Beneficial and concordant results were observed in patients with the favorable genotype when treated with the CETP inhibitor dalcetrapib. Similarly, previous studies revealed genetic variants associated with differential LDL-c response to statin therapy. In this review, we discuss the pharmacogenetic determinants of HDL-targeting and statin therapy responses in light of the latest available published data, and their potential therapeutic applications.
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Affiliation(s)
- Nathan Messas
- Department of Medicine, Montreal Heart Institute, 5000 Belanger St, Montreal, Quebec, H1T 1C8, Canada.,Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Strasbourg, France
| | - Marie-Pierre Dubé
- Department of Medicine, Montreal Heart Institute, 5000 Belanger St, Montreal, Quebec, H1T 1C8, Canada.,Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Claude Tardif
- Department of Medicine, Montreal Heart Institute, 5000 Belanger St, Montreal, Quebec, H1T 1C8, Canada. .,Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.
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39
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Nomura A, Won HH, Khera AV, Takeuchi F, Ito K, McCarthy S, Emdin CA, Klarin D, Natarajan P, Zekavat SM, Gupta N, Peloso GM, Borecki IB, Teslovich TM, Asselta R, Duga S, Merlini PA, Correa A, Kessler T, Wilson JG, Bown MJ, Hall AS, Braund PS, Carey DJ, Murray MF, Kirchner HL, Leader JB, Lavage DR, Manus JN, Hartze DN, Samani NJ, Schunkert H, Marrugat J, Elosua R, McPherson R, Farrall M, Watkins H, Juang JMJ, Hsiung CA, Lin SY, Wang JS, Tada H, Kawashiri MA, Inazu A, Yamagishi M, Katsuya T, Nakashima E, Nakatochi M, Yamamoto K, Yokota M, Momozawa Y, Rotter JI, Lander ES, Rader DJ, Danesh J, Ardissino D, Gabriel S, Willer CJ, Abecasis GR, Saleheen D, Kubo M, Kato N, Ida Chen YD, Dewey FE, Kathiresan S. Protein-Truncating Variants at the Cholesteryl Ester Transfer Protein Gene and Risk for Coronary Heart Disease. Circ Res 2017; 121:81-88. [PMID: 28506971 PMCID: PMC5523940 DOI: 10.1161/circresaha.117.311145] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 04/28/2017] [Accepted: 05/12/2017] [Indexed: 12/30/2022]
Abstract
RATIONALE Therapies that inhibit CETP (cholesteryl ester transfer protein) have failed to demonstrate a reduction in risk for coronary heart disease (CHD). Human DNA sequence variants that truncate the CETP gene may provide insight into the efficacy of CETP inhibition. OBJECTIVE To test whether protein-truncating variants (PTVs) at the CETP gene were associated with plasma lipid levels and CHD. METHODS AND RESULTS We sequenced the exons of the CETP gene in 58 469 participants from 12 case-control studies (18 817 CHD cases, 39 652 CHD-free controls). We defined PTV as those that lead to a premature stop, disrupt canonical splice sites, or lead to insertions/deletions that shift frame. We also genotyped 1 Japanese-specific PTV in 27561 participants from 3 case-control studies (14 286 CHD cases, 13 275 CHD-free controls). We tested association of CETP PTV carrier status with both plasma lipids and CHD. Among 58 469 participants with CETP gene-sequencing data available, average age was 51.5 years and 43% were women; 1 in 975 participants carried a PTV at the CETP gene. Compared with noncarriers, carriers of PTV at CETP had higher high-density lipoprotein cholesterol (effect size, 22.6 mg/dL; 95% confidence interval, 18-27; P<1.0×10-4), lower low-density lipoprotein cholesterol (-12.2 mg/dL; 95% confidence interval, -23 to -0.98; P=0.033), and lower triglycerides (-6.3%; 95% confidence interval, -12 to -0.22; P=0.043). CETP PTV carrier status was associated with reduced risk for CHD (summary odds ratio, 0.70; 95% confidence interval, 0.54-0.90; P=5.1×10-3). CONCLUSIONS Compared with noncarriers, carriers of PTV at CETP displayed higher high-density lipoprotein cholesterol, lower low-density lipoprotein cholesterol, lower triglycerides, and lower risk for CHD.
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40
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Paththinige CS, Sirisena ND, Dissanayake V. Genetic determinants of inherited susceptibility to hypercholesterolemia - a comprehensive literature review. Lipids Health Dis 2017; 16:103. [PMID: 28577571 PMCID: PMC5457620 DOI: 10.1186/s12944-017-0488-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/17/2017] [Indexed: 02/08/2023] Open
Abstract
Hypercholesterolemia is a strong determinant of mortality and morbidity associated with cardiovascular diseases and a major contributor to the global disease burden. Mutations in four genes (LDLR, APOB, PCSK9 and LDLRAP1) account for the majority of cases with familial hypercholesterolemia. However, a substantial proportion of adults with hypercholesterolemia do not have a mutation in any of these four genes. This indicates the probability of having other genes with a causative or contributory role in the pathogenesis of hypercholesterolemia and suggests a polygenic inheritance of this condition. Here in, we review the recent evidence of association of the genetic variants with hypercholesterolemia and the three lipid traits; total cholesterol (TC), HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C), their biological pathways and the associated pathogenetic mechanisms. Nearly 80 genes involved in lipid metabolism (encoding structural components of lipoproteins, lipoprotein receptors and related proteins, enzymes, lipid transporters, lipid transfer proteins, and activators or inhibitors of protein function and gene transcription) with single nucleotide variants (SNVs) that are recognized to be associated with hypercholesterolemia and serum lipid traits in genome-wide association studies and candidate gene studies were identified. In addition, genome-wide association studies in different populations have identified SNVs associated with TC, HDL-C and LDL-C in nearly 120 genes within or in the vicinity of the genes that are not known to be involved in lipid metabolism. Over 90% of the SNVs in both these groups are located outside the coding regions of the genes. These findings indicates that there might be a considerable number of unrecognized processes and mechanisms of lipid homeostasis, which when disrupted, would lead to hypercholesterolemia. Knowledge of these molecular pathways will enable the discovery of novel treatment and preventive methods as well as identify the biochemical and molecular markers for the risk prediction and early detection of this common, yet potentially debilitating condition.
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Affiliation(s)
- C S Paththinige
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, 00800, Sri Lanka.
| | - N D Sirisena
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, 00800, Sri Lanka
| | - Vhw Dissanayake
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, 00800, Sri Lanka
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Lincoff AM, Nicholls SJ, Riesmeyer JS, Barter PJ, Brewer HB, Fox KAA, Gibson CM, Granger C, Menon V, Montalescot G, Rader D, Tall AR, McErlean E, Wolski K, Ruotolo G, Vangerow B, Weerakkody G, Goodman SG, Conde D, McGuire DK, Nicolau JC, Leiva-Pons JL, Pesant Y, Li W, Kandath D, Kouz S, Tahirkheli N, Mason D, Nissen SE. Evacetrapib and Cardiovascular Outcomes in High-Risk Vascular Disease. N Engl J Med 2017; 376:1933-1942. [PMID: 28514624 DOI: 10.1056/nejmoa1609581] [Citation(s) in RCA: 505] [Impact Index Per Article: 72.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The cholesteryl ester transfer protein inhibitor evacetrapib substantially raises the high-density lipoprotein (HDL) cholesterol level, reduces the low-density lipoprotein (LDL) cholesterol level, and enhances cellular cholesterol efflux capacity. We sought to determine the effect of evacetrapib on major adverse cardiovascular outcomes in patients with high-risk vascular disease. METHODS In a multicenter, randomized, double-blind, placebo-controlled phase 3 trial, we enrolled 12,092 patients who had at least one of the following conditions: an acute coronary syndrome within the previous 30 to 365 days, cerebrovascular atherosclerotic disease, peripheral vascular arterial disease, or diabetes mellitus with coronary artery disease. Patients were randomly assigned to receive either evacetrapib at a dose of 130 mg or matching placebo, administered daily, in addition to standard medical therapy. The primary efficacy end point was the first occurrence of any component of the composite of death from cardiovascular causes, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina. RESULTS At 3 months, a 31.1% decrease in the mean LDL cholesterol level was observed with evacetrapib versus a 6.0% increase with placebo, and a 133.2% increase in the mean HDL cholesterol level was seen with evacetrapib versus a 1.6% increase with placebo. After 1363 of the planned 1670 primary end-point events had occurred, the data and safety monitoring board recommended that the trial be terminated early because of a lack of efficacy. After a median of 26 months of evacetrapib or placebo, a primary end-point event occurred in 12.9% of the patients in the evacetrapib group and in 12.8% of those in the placebo group (hazard ratio, 1.01; 95% confidence interval, 0.91 to 1.11; P=0.91). CONCLUSIONS Although the cholesteryl ester transfer protein inhibitor evacetrapib had favorable effects on established lipid biomarkers, treatment with evacetrapib did not result in a lower rate of cardiovascular events than placebo among patients with high-risk vascular disease. (Funded by Eli Lilly; ACCELERATE ClinicalTrials.gov number, NCT01687998 .).
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Affiliation(s)
- A Michael Lincoff
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Stephen J Nicholls
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Jeffrey S Riesmeyer
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Philip J Barter
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - H Bryan Brewer
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Keith A A Fox
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - C Michael Gibson
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Christopher Granger
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Venu Menon
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Gilles Montalescot
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Daniel Rader
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Alan R Tall
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Ellen McErlean
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Kathy Wolski
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Giacomo Ruotolo
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Burkhard Vangerow
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Govinda Weerakkody
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Shaun G Goodman
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Diego Conde
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Darren K McGuire
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Jose C Nicolau
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Jose L Leiva-Pons
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Yves Pesant
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Weimin Li
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - David Kandath
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Simon Kouz
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Naeem Tahirkheli
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Denise Mason
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
| | - Steven E Nissen
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (A.M.L., V.M., E.M., K.W., D.M., S.E.N.); South Australian Heart and Medical Research Institute, University of Adelaide, Adelaide (S.J.N.), and School of Medical Sciences, University of New South Wales, Sydney (P.J.B.) - both in Australia; Eli Lilly, Indianapolis (J.S.R., G.R., B.V., G.W.); Washington Cardiovascular Associates, Medstar Research Institute, Washington, DC (H.B.B.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (K.A.A.F.); Beth Israel Deaconess Medical Center, Boston (C.M.G.); Duke University Medical Center, Durham, NC (C.G.); Université Sorbonne Paris 6, ACTION Study Group, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris (G.M.); Penn Heart and Vascular Center, Philadelphia (D.R.); Columbia University, New York (A.R.T.), and Saratoga Cardiology Associates, Saratoga Springs (D.K.) - both in New York; St. Michael's Hospital, Toronto (S.G.), Recherche Médicale Saint-Jérôme, Saint-Jérôme, QC (Y.P.), and Centre de Santé et de Services Sociaux du Nord de Lanaudière-Centre Hospitalier Régional de Lanaud, Saint-Charles-Borromée, QC (S.K.) - all in Canada; Instituto Cardiovascular de Buenos Aires, Buenos Aires (D.C.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Heart Institute (InCor)-University of São Paulo Medical School, São Paulo (J.C.N.); Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico (J.L.L.-P.); the First Affiliated Hospital of Harbin Medical University, Harbin, China (W.L.); and South Oklahoma Heart Research, Oklahoma City (N.T.)
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Bowman L, Chen F, Sammons E, Hopewell JC, Wallendszus K, Stevens W, Valdes- Marquez E, Wiviott S, Cannon CP, Braunwald E, Collins R, Landray MJ. Randomized Evaluation of the Effects of Anacetrapib through Lipid-modification (REVEAL)-A large-scale, randomized, placebo-controlled trial of the clinical effects of anacetrapib among people with established vascular disease: Trial design, recruitment, and baseline characteristics. Am Heart J 2017; 187:182-190. [PMID: 28454801 PMCID: PMC5419667 DOI: 10.1016/j.ahj.2017.02.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/08/2017] [Indexed: 01/14/2023]
Abstract
Patients with prior vascular disease remain at high risk for cardiovascular events despite intensive statin-based treatment. Inhibition of cholesteryl ester transfer protein by anacetrapib reduces low-density lipoprotein (LDL) cholesterol by around 25% to 40% and more than doubles high-density lipoprotein (HDL) cholesterol. However, it is not known if these apparently favorable lipid changes translate into reductions in cardiovascular events. METHODS The REVEAL study is a randomized, double-blind, placebo-controlled clinical trial that is assessing the efficacy and safety of adding anacetrapib to effective LDL-lowering treatment with atorvastatin for an average of at least 4years among patients with preexisting atherosclerotic vascular disease. The primary assessment is an intention-to-treat comparison among all randomized participants of the effects of allocation to anacetrapib on major coronary events (defined as the occurrence of coronary death, myocardial infarction, or coronary revascularization). RESULTS Between August 2011 and October 2013, 30,449 individuals in Europe, North America, and China were randomized to receive anacetrapib 100mg daily or matching placebo. Mean (SD) age was 67 (8) years, 84% were male, 88% had a history of coronary heart disease, 22% had cerebrovascular disease, and 37% had diabetes mellitus. At the randomization visit (after at least 8weeks on a protocol-defined atorvastatin regimen), mean plasma LDL cholesterol was 61 (15) mg/dL and HDL cholesterol was 40 (10) mg/dL. INTERPRETATION The REVEAL trial will provide a robust evaluation of the clinical efficacy and safety of adding anacetrapib to an effective statin regimen. Results are anticipated in 2017.
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Abdel Maksoud SM, El-Garf WT, Ali OS, Shaaban GM, Amer NN. Association of Cholesterol Ester Transfer Protein Taq IB Polymorphism With Acute Coronary Syndrome in Egyptian National Patients. Lab Med 2017; 48:154-165. [PMID: 28387842 DOI: 10.1093/labmed/lmw071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The association between cholesterol ester transfer protein (CETP) Taq IB polymorphism and coronary artery disease (CAD) has been studied in different populations. Acute coronary syndrome (ACS) is a group of clinical symptoms within acute myocardial ischemia, including unstable angina (UA) and myocardial infarction (MI). Because there are no data reported in the literature concerning the cholesteryl ester transfer protein (CETP) Taq IB polymorphism in Egyptians, our study aimed to investigate the frequency of different CETP Taq IB genotypes in Egyptian patients with ACS and in healthy control individuals. Methods The current study was conducted with 70 hospitalized patients who had been diagnosed with ACS and 30 controls. We used real-time polymerase chain reaction (RT-PCR) to determine CETP Taq IB in individuals with different genotypes. Results The frequency of the GA genotype was significantly lower in UA patients, compared with the control group ( P <.05). Conclusions The frequency of the CETP Taq IB genotypes and alleles in all groups was similar to that in other ethnic groups. Individuals with the Taq IB GA genotype may have a lower risk of UA.
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Affiliation(s)
| | - Wael T El-Garf
- Department of Molecular Genetics, National Research Center
| | - Ola S Ali
- Biochemistry Department, Faculty of Pharmacy (Girls), Al Azhar University
| | | | - Noha N Amer
- Biochemistry Department, Faculty of Pharmacy (Girls), Al Azhar University
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Shahid SU, Shabana NA, Cooper JA, Rehman A, Humphries SE. Common variants in the genes of triglyceride and HDL-C metabolism lack association with coronary artery disease in the Pakistani subjects. Lipids Health Dis 2017; 16:24. [PMID: 28143480 PMCID: PMC5282842 DOI: 10.1186/s12944-017-0419-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/20/2017] [Indexed: 11/16/2022] Open
Abstract
Background Serum Triglyceride (TG) and High Density Lipoprotein (HDL-C) levels are modifiable coronary artery disease (CAD) risk factors. Polymorphisms in the genes regulating TG and HDL-C levels contribute to the development of CAD. The objective of the current study was to investigate the effect of four such single nucleotide polymorphism (SNPs) in the genes for Lipoprotein Lipase (LPL) (rs328, rs1801177), Apolipoprotein A5 (APOA5) (rs66279) and Cholesteryl ester transfer protein (CETP) (rs708272) on HDL-C and TG levels and to examine the association of these SNPs with CAD risk. Methods A total of 640 subjects (415 cases, 225 controls) were enrolled in the study. The SNPs were genotyped by KASPar allelic discrimination technique. Serum HDL-C and TG were determined by spectrophotometric methods. Results The population under study was in Hardy Weinberg equilibrium and minor allele of SNP rs1801177 was completely absent in the studied subjects. The SNPs were association with TG and HDL-C levels was checked through regression analysis. For rs328, the effect size of each risk allele on TG and HDL-C (mmol/l) was 0.16(0.08) and −0.11(0.05) respectively. Similarly, the effect size of rs662799 for TG and HDL-C was 0.12(0.06) and −0.13(0.0.3) and that of rs708272 was 0.08(0.04) and 0.1(0.03) respectively. The risk allele frequencies of the SNPs were higher in cases than controls, but the difference was not significant (p > 0.05) and SNPs were not associated with CAD risk (p > 0.05). The combined gene score of four SNPs significantly raised TG and lowered HDL-C but did not increase CAD risk. Conclusion The studied SNPs were associated with TG and HDL-C levels, but not with CAD in Pakistani population under study. Electronic supplementary material The online version of this article (doi:10.1186/s12944-017-0419-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saleem Ullah Shahid
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan, 54590.
| | - N A Shabana
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan, 54590
| | - Jackie A Cooper
- Centre of Cardiovascular Genetics, British Heart Foundation Laboratories, University College London, London, WC1E6JF, UK, England
| | - Abdul Rehman
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan, 54590
| | - Steve E Humphries
- Centre of Cardiovascular Genetics, British Heart Foundation Laboratories, University College London, London, WC1E6JF, UK, England
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Rosenson RS, Koenig W. Mendelian Randomization Analyses for Selection of Therapeutic Targets for Cardiovascular Disease Prevention: a Note of Circumspection. Cardiovasc Drugs Ther 2016; 30:65-74. [PMID: 26797681 DOI: 10.1007/s10557-016-6642-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Genetic factors identified from genome-wide association studies have been used to understand causative variants for complex diseases. Studies conducted on large populations of individuals from many geographical regions have provided insights into genetic pathways involved in the causal pathway for atherosclerotic cardiovascular disease. A single genetic trait may ineffectively evaluate the pathway of interest, and it may not account for other complementary genetic pathways that may be activated at various stages of the disease process or evidence-based therapies that alter the molecular and cellular milieu.
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Affiliation(s)
- Robert S Rosenson
- Cardiometabolics Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA.
| | - Wolfgang Koenig
- Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
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Włodarczyk M, Wrzosek M, Nowicka G, Jabłonowska-Lietz B. Impact of variants in CETP and apo AI genes on serum HDL cholesterol levels in men and women from the Polish population. Arch Med Sci 2016; 12:1188-1198. [PMID: 27904507 PMCID: PMC5108385 DOI: 10.5114/aoms.2016.60870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/03/2015] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Polymorphisms in the cholesterol ester transfer protein (CETP) gene and apolipoprotein AI (apo AI) gene are identified as the most common genetic factors influencing high-density lipoprotein cholesterol (HDL cholesterol) levels. Low HDL cholesterol is an important risk factor for cardiovascular disease. We investigated the effect of the TaqIB polymorphism of the CETP gene and the 75G/A polymorphism of the apo AI gene on the HDL cholesterol concentration in a sample of Polish adults. MATERIAL AND METHODS A total of 621 subjects, 414 women and 207 men, were included in this study. Lipid levels were measured using standard protocols, and apolipoprotein AI was determined by immunoturbidimetric assay. CETP and apo AI genotyping was performed using a restriction fragment length polymorphism based method. RESULTS Significantly lower HDL cholesterol concentrations were found in B1B1 homozygotes than in carriers of the B2 allele of the TaqIB polymorphism in the CETP gene among both men and women. In GG homozygotes of the 75G/A polymorphism in the apo AI gene lower HDL cholesterol levels were observed, but the difference did not reach statistical significance. A statistically significant association of low HDL cholesterol (< 25th percentile) with CETP genotypes was found in women (p < 0.0001) and in men (p = 0.0368). CONCLUSIONS These data demonstrate a significant impact of the TaqIB polymorphism in the CETP gene on HDL cholesterol levels in the studied Polish population, while the effect of the 75G/A polymorphism in the apo AI gene appears not to be significant.
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Affiliation(s)
- Marta Włodarczyk
- Department of Pharmacogenomics, Department of Biochemistry and Clinical Chemistry, Faculty of Pharmacy with Division of Laboratory Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Wrzosek
- Department of Pharmacogenomics, Department of Biochemistry and Clinical Chemistry, Faculty of Pharmacy with Division of Laboratory Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Nowicka
- Department of Pharmacogenomics, Department of Biochemistry and Clinical Chemistry, Faculty of Pharmacy with Division of Laboratory Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Beata Jabłonowska-Lietz
- Center of Promotion of Healthy Nutrition and Physical Activity, National Food and Nutrition Institute, Warsaw, Poland
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Latsuzbaia A, Jaddoe VWV, Hofman A, Franco OH, Felix JF. Associations of genetic variants for adult lipid levels with lipid levels in children. The Generation R Study. J Lipid Res 2016; 57:2185-2192. [PMID: 27777320 DOI: 10.1194/jlr.p066902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 10/19/2016] [Indexed: 01/14/2023] Open
Abstract
Lipid concentrations are heritable traits. Recently, the number of known genetic loci associated with lipid levels in adults increased from 95 to 157. The effects of these 157 loci have not been tested in children. Considering that lipid levels track from childhood to adulthood, we studied to determine whether these variants already affected lipid concentrations in a large group of 2,645 children with a median age of 6.0 years (95% range 5.7-7.3 years) from the population-based Generation R Study. Twenty-eight SNPs associated with TGs, 39 SNPs associated with total cholesterol (TC), 28 SNPs associated with LDL cholesterol (LDL-C), and 56 SNPs associated with HDL cholesterol (HDL-C) were analyzed individually and combined into genetic risk scores (GRSs). All risk scores were associated with their specific outcomes. The differences in mean absolute lipid and lipoprotein values between the 10% of children with the highest lipid or lipoprotein GRS versus the 10% with the lowest score were 0.28, 0.25, 0.32, and 0.30 mmol/l for TGs, TC, LDL-C, and HDL-C, respectively. In conclusion, we show for the first time that GRSs based on 157 SNPs associated with adult lipid concentrations are associated with lipid levels in children. The genetic background of these phenotypes at least partly overlaps between children and adults.
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Affiliation(s)
- Ardashel Latsuzbaia
- The Generation R Study Group Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Departments of Epidemiology Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Hofman
- Departments of Epidemiology Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Oscar H Franco
- Departments of Epidemiology Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands .,Departments of Epidemiology Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Ganesan M, Nizamuddin S, Katkam SK, Kumaraswami K, Hosad UK, Lobo LL, Kutala VK, Thangaraj K. c.*84G>A Mutation in CETP Is Associated with Coronary Artery Disease in South Indians. PLoS One 2016; 11:e0164151. [PMID: 27768712 PMCID: PMC5074517 DOI: 10.1371/journal.pone.0164151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/20/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is one of the leading causes of mortality worldwide. It is a multi-factorial disease and several studies have demonstrated that the genetic factors play a major role in CAD. Although variations in cholesteryl ester transfer protein (CETP) gene are reported to be associated with CAD, this gene has not been studied in South Indian populations. Hence we evaluated the CETP gene variations in CAD patients of South Indian origin. METHODS We sequenced all the exons, exon-intron boundaries and UTRs of CETP in 323 CAD patients along with 300 ethnically and age matched controls. Variations observed in CETP were subjected to various statistical analyses. RESULTS AND DISCUSSION Our analysis revealed a total of 13 variations. Of these, one3'UTRvariant rs1801706 (c.*84G>A) was significantly associated with CAD (genotype association test: OR = 2.16, 95% CI: 1.50-3.10, p = 1.88x10-5 and allelic association test: OR = 1.92, 95% CI: 1.40-2.63, p = 2.57x10-5). Mutant allele "A" was observed to influence the higher concentration of mRNA (p = 7.09×10-3, R2 = 0.029 and β = 0.2163). Since expression of CETP has been shown to be positively correlated with the risk of CAD, higher frequency of "A" allele (patients: 22.69% vs.controls: 13%) reveals that c.*84G>A is a risk factor for CAD in South Indians. CONCLUSIONS This is the first report of the CETP gene among South Indians CAD patients. Our results suggest that rs1801706 (c.*84G>A) is a risk factor for CAD in South Indian population.
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Affiliation(s)
- Mala Ganesan
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | | | | | - Konda Kumaraswami
- Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
| | | | | | - Vijay Kumar Kutala
- Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
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Abstract
There are several established lipid-modifying agents, including statins, fibrates, niacin, and ezetimibe, that have been shown in randomized clinical outcome trials to reduce the risk of having an atherosclerotic cardiovascular event. However, in many people, the risk of having an event remains unacceptably high despite treatment with these established agents. This has stimulated the search for new therapies designed to reduce residual cardiovascular risk. New approaches that target atherogenic lipoproteins include: 1) inhibition of proprotein convertase subtilisin/kexin type 9 to increase removal of atherogenic lipoproteins from plasma; 2) inhibition of the synthesis of apolipoprotein (apo) B, the main protein component of atherogenic lipoproteins; 3) inhibition of microsomal triglyceride transfer protein to block the formation of atherogenic lipoproteins; 4) inhibition of adenosine triphosphate citrate lyase to inhibit the synthesis of cholesterol; 5) inhibition of the synthesis of lipoprotein(a), a factor known to cause atherosclerosis; 6) inhibition of apoC-III to reduce triglyceride-rich lipoproteins and to enhance high-density lipoprotein (HDL) functionality; and 7) inhibition of cholesteryl ester transfer protein, which not only reduces the concentration of atherogenic lipoproteins but also increases the level and function of the potentially antiatherogenic HDL fraction. Other new therapies that specifically target HDLs include infusions of reconstituted HDLs, HDL delipidation, and infusions of apoA-I mimetic peptides that mimic some of the functions of HDLs. This review describes the scientific basis and rationale for developing these new therapies and provides a brief summary of established therapies.
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Affiliation(s)
- Philip J Barter
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Kerry-Anne Rye
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
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