Cholesterol ester transfer protein: a therapeutic target in atherosclerosis?

Integrated probability of coronary heart disease subject to the -308 tumor necrosis factor-alpha SNP: a Bayesian meta-analysis

We present a meta-analysis of independent studies on the potential implication in the occurrence of coronary heart disease (CHD) of the single-nucleotide polymorphism (SNP) at the −308 position of the tumor necrosis factor alpha (TNF-alpha) gene. We use Bayesian analysis to integrate independent data sets and to infer statistically robust measurements of correlation. Bayesian hypothesis testing indicates that there is no preference for the hypothesis that the −308 TNF-alpha SNP is related to the occurrence of CHD, in the Caucasian or in the Asian population, over the null hypothesis. As a measure of correlation, we use the probability of occurrence of CHD conditional on the presence of the SNP, derived as the posterior probability of the Bayesian meta-analysis. The conditional probability indicates that CHD is not more likely to occur when the SNP is present, which suggests that the −308 TNF-alpha SNP is not implicated in the occurrence of CHD.

New horizons for cholesterol ester transfer protein inhibitors

High-density lipoprotein (HDL) cholesterol levels bear an inverse relationship to cardiovascular risk. To date, however, no intervention specifically targeting HDL has been demonstrated to reduce cardiovascular risk. Cholesterol ester transfer protein (CETP) mediates transfer of cholesterol ester from HDL to apolipoprotein B-containing particles. Most, but not all observational cohort studies indicate that genetic polymorphisms of CETP associated with reduced activity and higher HDL cholesterol levels are also associated with reduced cardiovascular risk. Some, but not all studies indicate that CETP inhibition in rabbits retards atherosclerosis, whereas transgenic CETP expression in mice promotes atherosclerosis. Torcetrapib, the first CETP inhibitor to reach phase III clinical development, was abandoned due to excess mortality associated with increases in aldosterone and blood pressure. Two other CETP inhibitors have entered phase III clinical development. Anacetrapib is a potent inhibitor of CETP that produces very large increases in HDL cholesterol and large reductions in low-density lipoprotein (LDL) cholesterol, beyond those achieved with statins. Dalcetrapib is a less potent CETP inhibitor that produces smaller increases in HDL cholesterol with minimal effect on LDL cholesterol. Both agents appear to allow efflux of cholesterol from macrophages to HDL in vitro, and neither agent affects blood pressure or aldosterone in vivo. Two large cardiovascular outcomes trials, one with anacetrapib and one with dalcetrapib, should provide a conclusive test of the hypothesis that inhibition of CETP decreases cardiovascular risk.

A Bayesian approach to the probability of coronary heart disease subject to the -308 tumor necrosis factor-α SNP

We study the correlation of the occurrence of coronary heart disease (CHD) with the presence of the single-nucleotide polymorphism (SNP) at the -308 position of the tumor necrosis factor alpha (TNF-α) gene. We also consider the influence of the occurrence of type 2 diabetes (t2DM). Using Bayesian inference, we first pursue a bottom-up approach to compute the working hypothesis and the probabilities derivable from the data. We then pursue a top-down approach by modelling the signal pathway that causally connects the SNP with the emergence of CHD. We compute the functional form of the probability of CHD conditional on the presence of the SNP in terms of both the statistical and biochemical properties of the system. From the probability of occurrence of a disease conditional on a given risk factor, we explore the possibility of extracting information on the pathways involved in the occurrence of the disease. This is a first study that we want to systematise into a comprehensive formalism to be applied to the inference of the mechanism connecting the risk factors to the disease.