@article {9285, title = {Association of Rare Protein-Truncating DNA Variants in APOB or PCSK9 With Low-density Lipoprotein Cholesterol Level and Risk of Coronary Heart Disease.}, journal = {JAMA Cardiol}, year = {2023}, month = {2023 Feb 01}, abstract = {

IMPORTANCE: Protein-truncating variants (PTVs) in apolipoprotein B (APOB) and proprotein convertase subtilisin/kexin type 9 (PCSK9) are associated with significantly lower low-density lipoprotein (LDL) cholesterol concentrations. The association of these PTVs with coronary heart disease (CHD) warrants further characterization in large, multiracial prospective cohort studies.

OBJECTIVE: To evaluate the association of PTVs in APOB and PCSK9 with LDL cholesterol concentrations and CHD risk.

DESIGN, SETTING, AND PARTICIPANTS: This studied included participants from 5 National Heart, Lung, and Blood Institute (NHLBI) studies and the UK Biobank. NHLBI study participants aged 5 to 84 years were recruited between 1971 and 2002 across the US and underwent whole-genome sequencing. UK Biobank participants aged 40 to 69 years were recruited between 2006 and 2010 in the UK and underwent whole-exome sequencing. Data were analyzed from June 2021 to October 2022.

EXPOSURES: PTVs in APOB and PCSK9.

MAIN OUTCOMES AND MEASURES: Estimated untreated LDL cholesterol levels and CHD.

RESULTS: Among 19 073 NHLBI participants (10 598 [55.6\%] female; mean [SD] age, 52 [17] years), 139 (0.7\%) carried an APOB or PCSK9 PTV, which was associated with 49 mg/dL (95\% CI, 43-56) lower estimated untreated LDL cholesterol level. Over a median (IQR) follow-up of 21.5 (13.9-29.4) years, incident CHD was observed in 12 of 139 carriers (8.6\%) vs 3029 of 18 934 noncarriers (16.0\%), corresponding to an adjusted hazard ratio of 0.51 (95\% CI, 0.28-0.89; P = .02). Among 190 464 UK Biobank participants (104 831 [55.0\%] female; mean [SD] age, 57 [8] years), 662 (0.4\%) carried a PTV, which was associated with 45 mg/dL (95\% CI, 42-47) lower estimated untreated LDL cholesterol level. Estimated CHD risk by age 75 years was 3.7\% (95\% CI, 2.0-5.3) in carriers vs 7.0\% (95\% CI, 6.9-7.2) in noncarriers, corresponding to an adjusted hazard ratio of 0.51 (95\% CI, 0.32-0.81; P = .004).

CONCLUSIONS AND RELEVANCE: Among 209 537 individuals in this study, 0.4\% carried an APOB or PCSK9 PTV that was associated with less exposure to LDL cholesterol and a 49\% lower risk of CHD.

}, issn = {2380-6591}, doi = {10.1001/jamacardio.2022.5271}, author = {Dron, Jacqueline S and Patel, Aniruddh P and Zhang, Yiyi and Jurgens, Sean J and Maamari, Dimitri J and Wang, Minxian and Boerwinkle, Eric and Morrison, Alanna C and de Vries, Paul S and Fornage, Myriam and Hou, Lifang and Lloyd-Jones, Donald M and Psaty, Bruce M and Tracy, Russell P and Bis, Joshua C and Vasan, Ramachandran S and Levy, Daniel and Heard-Costa, Nancy and Rich, Stephen S and Guo, Xiuqing and Taylor, Kent D and Gibbs, Richard A and Rotter, Jerome I and Willer, Cristen J and Oelsner, Elizabeth C and Moran, Andrew E and Peloso, Gina M and Natarajan, Pradeep and Khera, Amit V} } @article {9388, title = {Association of Severe Hypercholesterolemia and Familial Hypercholesterolemia Genotype With Risk of Coronary Heart Disease.}, journal = {Circulation}, volume = {147}, year = {2023}, month = {2023 May 16}, pages = {1556-1559}, keywords = {Coronary Disease, Genotype, Humans, Hypercholesterolemia, Hyperlipoproteinemia Type II}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.123.064168}, author = {Zhang, Yiyi and Dron, Jacqueline S and Bellows, Brandon K and Khera, Amit V and Liu, Junxiu and Balte, Pallavi P and Oelsner, Elizabeth C and Amr, Sami Samir and Lebo, Matthew S and Nagy, Anna and Peloso, Gina M and Natarajan, Pradeep and Rotter, Jerome I and Willer, Cristen and Boerwinkle, Eric and Ballantyne, Christie M and Lutsey, Pamela L and Fornage, Myriam and Lloyd-Jones, Donald M and Hou, Lifang and Psaty, Bruce M and Bis, Joshua C and Floyd, James S and Vasan, Ramachandran S and Heard-Costa, Nancy L and Carson, April P and Hall, Michael E and Rich, Stephen S and Guo, Xiuqing and Kazi, Dhruv S and de Ferranti, Sarah D and Moran, Andrew E} } @article {9620, title = {Familial Hypercholesterolemia Variant and Cardiovascular Risk in Individuals With Elevated Cholesterol.}, journal = {JAMA Cardiol}, year = {2024}, month = {2024 Jan 31}, abstract = {

IMPORTANCE: Familial hypercholesterolemia (FH) is a genetic disorder that often results in severely high low-density lipoprotein cholesterol (LDL-C) and high risk of premature coronary heart disease (CHD). However, the impact of FH variants on CHD risk among individuals with moderately elevated LDL-C is not well quantified.

OBJECTIVE: To assess CHD risk associated with FH variants among individuals with moderately (130-189 mg/dL) and severely (>=190 mg/dL) elevated LDL-C and to quantify excess CHD deaths attributable to FH variants in US adults.

DESIGN, SETTING, AND PARTICIPANTS: A total of 21 426 individuals without preexisting CHD from 6 US cohort studies (Atherosclerosis Risk in Communities study, Coronary Artery Risk Development in Young Adults study, Cardiovascular Health Study, Framingham Heart Study Offspring cohort, Jackson Heart Study, and Multi-Ethnic Study of Atherosclerosis) were included, 63 of whom had an FH variant. Data were collected from 1971 to 2018, and the median (IQR) follow-up was 18 (13-28) years. Data were analyzed from March to May 2023.

EXPOSURES: LDL-C, cumulative past LDL-C, FH variant status.

MAIN OUTCOMES AND MEASURES: Cox proportional hazards models estimated associations between FH variants and incident CHD. The Cardiovascular Disease Policy Model projected excess CHD deaths associated with FH variants in US adults.

RESULTS: Of the 21 426 individuals without preexisting CHD (mean [SD] age 52.1 [15.5] years; 12 041 [56.2\%] female), an FH variant was found in 22 individuals with moderately elevated LDL-C (0.3\%) and in 33 individuals with severely elevated LDL-C (2.5\%). The adjusted hazard ratios for incident CHD comparing those with and without FH variants were 2.9 (95\% CI, 1.4-6.0) and 2.6 (95\% CI, 1.4-4.9) among individuals with moderately and severely elevated LDL-C, respectively. The association between FH variants and CHD was slightly attenuated when further adjusting for baseline LDL-C level, whereas the association was no longer statistically significant after adjusting for cumulative past LDL-C exposure. Among US adults 20 years and older with no history of CHD and LDL-C 130 mg/dL or higher, more than 417 000 carry an FH variant and were projected to experience more than 12 000 excess CHD deaths in those with moderately elevated LDL-C and 15 000 in those with severely elevated LDL-C compared with individuals without an FH variant.

CONCLUSIONS AND RELEVANCE: In this pooled cohort study, the presence of FH variants was associated with a 2-fold higher CHD risk, even when LDL-C was only moderately elevated. The increased CHD risk appeared to be largely explained by the higher cumulative LDL-C exposure in individuals with an FH variant compared to those without. Further research is needed to assess the value of adding genetic testing to traditional phenotypic FH screening.

}, issn = {2380-6591}, doi = {10.1001/jamacardio.2023.5366}, author = {Zhang, Yiyi and Dron, Jacqueline S and Bellows, Brandon K and Khera, Amit V and Liu, Junxiu and Balte, Pallavi P and Oelsner, Elizabeth C and Amr, Sami Samir and Lebo, Matthew S and Nagy, Anna and Peloso, Gina M and Natarajan, Pradeep and Rotter, Jerome I and Willer, Cristen and Boerwinkle, Eric and Ballantyne, Christie M and Lutsey, Pamela L and Fornage, Myriam and Lloyd-Jones, Donald M and Hou, Lifang and Psaty, Bruce M and Bis, Joshua C and Floyd, James S and Vasan, Ramachandran S and Heard-Costa, Nancy L and Carson, April P and Hall, Michael E and Rich, Stephen S and Guo, Xiuqing and Kazi, Dhruv S and de Ferranti, Sarah D and Moran, Andrew E} }