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Holmes MV, Simon T, Exeter HJ, Folkersen L, Asselbergs FW, Guardiola M, Cooper JA, Palmen J, Hubacek JA, Carruthers KF, Horne BD, Brunisholz KD, Mega JL, van Iperen EPA, Li M, Leusink M, Trompet S, Verschuren JJW, Hovingh GK, Dehghan A, Nelson CP, Kotti S, Danchin N, Scholz M, Haase CL, Rothenbacher D, Swerdlow DI, Kuchenbaecker KB, Staines-Urias E, Goel A, van 't Hooft F, Gertow K, de Faire U, Panayiotou AG, Tremoli E, Baldassarre D, Veglia F, Holdt LM, Beutner F, Gansevoort RT, Navis GJ, Mateo Leach I, Breitling LP, Brenner H, Thiery J, Dallmeier D, Franco-Cereceda A, Boer JMA, Stephens JW, Hofker MH, Tedgui A, Hofman A, Uitterlinden AG, Adamkova V, Pitha J, Onland-Moret NC, Cramer MJ, Nathoe HM, Spiering W, Klungel OH, Kumari M, Whincup PH, Morrow DA, Braund PS, Hall AS, Olsson AG, Doevendans PA, Trip MD, Tobin MD, Hamsten A, Watkins H, Koenig W, Nicolaides AN, Teupser D, Day INM, Carlquist JF, Gaunt TR, Ford I, Sattar N, Tsimikas S, Schwartz GG, Lawlor DA, Morris RW, Sandhu MS, Poledne R, Maitland-van der Zee AH, Khaw KT, Keating BJ, van der Harst P, Price JF, Mehta SR, Yusuf S, Witteman JCM, Franco OH, Jukema JW, de Knijff P, Tybjaerg-Hansen A, Rader DJ, Farrall M, Samani NJ, Kivimaki M, Fox KAA, Humphries SE, Anderson JL, Boekholdt SM, Palmer TM, Eriksson P, Paré G, Hingorani AD, Sabatine MS, Mallat Z, Casas JP, Talmud PJ. Secretory phospholipase A(2)-IIA and cardiovascular disease: a mendelian randomization study. J Am Coll Cardiol 2013; 62:1966-1976. [PMID: 23916927 PMCID: PMC3826105 DOI: 10.1016/j.jacc.2013.06.044] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 05/22/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to investigate the role of secretory phospholipase A2 (sPLA2)-IIA in cardiovascular disease. BACKGROUND Higher circulating levels of sPLA2-IIA mass or sPLA2 enzyme activity have been associated with increased risk of cardiovascular events. However, it is not clear if this association is causal. A recent phase III clinical trial of an sPLA2 inhibitor (varespladib) was stopped prematurely for lack of efficacy. METHODS We conducted a Mendelian randomization meta-analysis of 19 general population studies (8,021 incident, 7,513 prevalent major vascular events [MVE] in 74,683 individuals) and 10 acute coronary syndrome (ACS) cohorts (2,520 recurrent MVE in 18,355 individuals) using rs11573156, a variant in PLA2G2A encoding the sPLA2-IIA isoenzyme, as an instrumental variable. RESULTS PLA2G2A rs11573156 C allele associated with lower circulating sPLA2-IIA mass (38% to 44%) and sPLA2 enzyme activity (3% to 23%) per C allele. The odds ratio (OR) for MVE per rs11573156 C allele was 1.02 (95% confidence interval [CI]: 0.98 to 1.06) in general populations and 0.96 (95% CI: 0.90 to 1.03) in ACS cohorts. In the general population studies, the OR derived from the genetic instrumental variable analysis for MVE for a 1-log unit lower sPLA2-IIA mass was 1.04 (95% CI: 0.96 to 1.13), and differed from the non-genetic observational estimate (OR: 0.69; 95% CI: 0.61 to 0.79). In the ACS cohorts, both the genetic instrumental variable and observational ORs showed a null association with MVE. Instrumental variable analysis failed to show associations between sPLA2 enzyme activity and MVE. CONCLUSIONS Reducing sPLA2-IIA mass is unlikely to be a useful therapeutic goal for preventing cardiovascular events.
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Affiliation(s)
- Michael V Holmes
- Faculty of Population Health Sciences, University College London, London, United Kingdom.
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Department of Clinical Pharmacology, URC-EST, Paris, France; Université Pierre et Marie Curie, Paris, France; INSERM, U 698, Paris, France
| | - Holly J Exeter
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Lasse Folkersen
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Durrer Center for Cardiogenetic Research, Amsterdam, the Netherlands
| | - Montse Guardiola
- Unitat de Recerca en Lípids i Arteriosclerosi, IISPV, Universitat Rovira i Virgili, CIBERDEM, Reus, Spain
| | - Jackie A Cooper
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Jutta Palmen
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Jaroslav A Hubacek
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Kathryn F Carruthers
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Jessica L Mega
- TIMI Study Group, Divison of Cardiovascular Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Erik P A van Iperen
- Durrer Center for Cardiogenetic Research, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Mingyao Li
- Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Maarten Leusink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, United Kingdom
| | - Salma Kotti
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Department of Clinical Pharmacology, URC-EST, Paris, France
| | - Nicolas Danchin
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France; Université Paris Descartes, Paris V, Paris, France
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany; LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Christiane L Haase
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Division of Clinical Epidemiology & Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Daniel I Swerdlow
- Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Karoline B Kuchenbaecker
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Eleonora Staines-Urias
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anuj Goel
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Ferdinand van 't Hooft
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Karl Gertow
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Ulf de Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andrie G Panayiotou
- Cyprus Cardiovascular Educational and Research Trust, Nicosia, Cyprus and Cyprus International Institute for Environmental and Public Health in association with the Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Elena Tremoli
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Universitá di Milano, Milan, Italy; Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Damiano Baldassarre
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Universitá di Milano, Milan, Italy; Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Lesca M Holdt
- LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, University Hospital Munich (LMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Frank Beutner
- LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Ron T Gansevoort
- University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Gerjan J Navis
- University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Irene Mateo Leach
- University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Lutz P Breitling
- Division of Clinical Epidemiology & Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology & Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Joachim Thiery
- LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Dhayana Dallmeier
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
| | - Anders Franco-Cereceda
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jolanda M A Boer
- Department for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jeffrey W Stephens
- Diabetes Research Group, Institute of Life Sciences, College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Marten H Hofker
- Department of Pathology and Medical Biology, Medical Biology Section, Molecular Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alain Tedgui
- Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands
| | - André G Uitterlinden
- Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Vera Adamkova
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Pitha
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Meena Kumari
- Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Peter H Whincup
- Division of Population Health Sciences and Education, St George's, University of London, London, United Kingdom
| | - David A Morrow
- TIMI Study Group, Divison of Cardiovascular Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Peter S Braund
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Alistair S Hall
- Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, United Kingdom
| | - Anders G Olsson
- Stockholm Heart Center, Stockholm, and Linköping University, Linkőping, Sweden
| | - Pieter A Doevendans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mieke D Trip
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin D Tobin
- Departments of Health Sciences & Genetics, University of Leicester, Leicester, United Kingdom
| | - Anders Hamsten
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Hugh Watkins
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
| | - Andrew N Nicolaides
- Department of Vascular Surgery, Imperial College, London, United Kingdom; Cyprus Cardiovascular Educational and Research Trust, Nicosia, Cyprus
| | - Daniel Teupser
- LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, University Hospital Munich (LMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ian N M Day
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Department of Clinical Pharmacology, URC-EST, Paris, France
| | - John F Carlquist
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Tom R Gaunt
- MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), and Bristol Genetic Epidemiology Laboratories (BGEL), School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Sotirios Tsimikas
- Division of Cardiovascular Diseases, Department of Medicine, University of California San Diego, La Jolla, California
| | - Gregory G Schwartz
- VA Medical Center and University of Colorado School of Medicine, Denver, Colorado
| | - Debbie A Lawlor
- MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), and Bristol Genetic Epidemiology Laboratories (BGEL), School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Richard W Morris
- Department of Primary Care & Population Health, University College London, Royal Free Campus, London, United Kingdom
| | - Manjinder S Sandhu
- VA Medical Center and University of Colorado School of Medicine, Denver, Colorado
| | - Rudolf Poledne
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Brendan J Keating
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pim van der Harst
- University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Jackie F Price
- Centre for Population Health Sciences, University of Edinburgh, United Kingdom
| | - Shamir R Mehta
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Interventional Cardiology, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jaqueline C M Witteman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands
| | - J Wouter Jukema
- Durrer Center for Cardiogenetic Research, Amsterdam, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
| | - Peter de Knijff
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne Tybjaerg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel J Rader
- Preventive Cardiovascular Medicine, Penn Heart and Vascular Center, Philadelphia, Pennsylvania
| | - Martin Farrall
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, United Kingdom
| | - Mika Kivimaki
- Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Jeffrey L Anderson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - S Matthijs Boekholdt
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Tom M Palmer
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Per Eriksson
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Guillaume Paré
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Genetic and Molecular Epidemiology Laboratory, McMaster University, Hamilton, Ontario, Canada
| | - Aroon D Hingorani
- Faculty of Population Health Sciences, University College London, London, United Kingdom; Centre for Clinical Pharmacology, Division of Medicine, University College London, London, United Kingdom
| | - Marc S Sabatine
- TIMI Study Group, Divison of Cardiovascular Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Ziad Mallat
- Inserm U970, Paris-Cardiovascular Research Center, Paris, France; Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Juan P Casas
- Faculty of Population Health Sciences, University College London, London, United Kingdom; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Philippa J Talmud
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
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