TY - JOUR T1 - Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. JF - BMJ Y1 - 2014 A1 - Holmes, Michael V A1 - Dale, Caroline E A1 - Zuccolo, Luisa A1 - Silverwood, Richard J A1 - Guo, Yiran A1 - Ye, Zheng A1 - Prieto-Merino, David A1 - Dehghan, Abbas A1 - Trompet, Stella A1 - Wong, Andrew A1 - Cavadino, Alana A1 - Drogan, Dagmar A1 - Padmanabhan, Sandosh A1 - Li, Shanshan A1 - Yesupriya, Ajay A1 - Leusink, Maarten A1 - Sundström, Johan A1 - Hubacek, Jaroslav A A1 - Pikhart, Hynek A1 - Swerdlow, Daniel I A1 - Panayiotou, Andrie G A1 - Borinskaya, Svetlana A A1 - Finan, Chris A1 - Shah, Sonia A1 - Kuchenbaecker, Karoline B A1 - Shah, Tina A1 - Engmann, Jorgen A1 - Folkersen, Lasse A1 - Eriksson, Per A1 - Ricceri, Fulvio A1 - Melander, Olle A1 - Sacerdote, Carlotta A1 - Gamble, Dale M A1 - Rayaprolu, Sruti A1 - Ross, Owen A A1 - McLachlan, Stela A1 - Vikhireva, Olga A1 - Sluijs, Ivonne A1 - Scott, Robert A A1 - Adamkova, Vera A1 - Flicker, Leon A1 - Bockxmeer, Frank M van A1 - Power, Christine A1 - Marques-Vidal, Pedro A1 - Meade, Tom A1 - Marmot, Michael G A1 - Ferro, Jose M A1 - Paulos-Pinheiro, Sofia A1 - Humphries, Steve E A1 - Talmud, Philippa J A1 - Mateo Leach, Irene A1 - Verweij, Niek A1 - Linneberg, Allan A1 - Skaaby, Tea A1 - Doevendans, Pieter A A1 - Cramer, Maarten J A1 - van der Harst, Pim A1 - Klungel, Olaf H A1 - Dowling, Nicole F A1 - Dominiczak, Anna F A1 - Kumari, Meena A1 - Nicolaides, Andrew N A1 - Weikert, Cornelia A1 - Boeing, Heiner A1 - Ebrahim, Shah A1 - Gaunt, Tom R A1 - Price, Jackie F A1 - Lannfelt, Lars A1 - Peasey, Anne A1 - Kubinova, Ruzena A1 - Pajak, Andrzej A1 - Malyutina, Sofia A1 - Voevoda, Mikhail I A1 - Tamosiunas, Abdonas A1 - Maitland-van der Zee, Anke H A1 - Norman, Paul E A1 - Hankey, Graeme J A1 - Bergmann, Manuela M A1 - Hofman, Albert A1 - Franco, Oscar H A1 - Cooper, Jackie A1 - Palmen, Jutta A1 - Spiering, Wilko A1 - de Jong, Pim A A1 - Kuh, Diana A1 - Hardy, Rebecca A1 - Uitterlinden, André G A1 - Ikram, M Arfan A1 - Ford, Ian A1 - Hyppönen, Elina A1 - Almeida, Osvaldo P A1 - Wareham, Nicholas J A1 - Khaw, Kay-Tee A1 - Hamsten, Anders A1 - Husemoen, Lise Lotte N A1 - Tjønneland, Anne A1 - Tolstrup, Janne S A1 - Rimm, Eric A1 - Beulens, Joline W J A1 - Verschuren, W M Monique A1 - Onland-Moret, N Charlotte A1 - Hofker, Marten H A1 - Wannamethee, S Goya A1 - Whincup, Peter H A1 - Morris, Richard A1 - Vicente, Astrid M A1 - Watkins, Hugh A1 - Farrall, Martin A1 - Jukema, J Wouter A1 - Meschia, James A1 - Cupples, L Adrienne A1 - Sharp, Stephen J A1 - Fornage, Myriam A1 - Kooperberg, Charles A1 - LaCroix, Andrea Z A1 - Dai, James Y A1 - Lanktree, Matthew B A1 - Siscovick, David S A1 - Jorgenson, Eric A1 - Spring, Bonnie A1 - Coresh, Josef A1 - Li, Yun R A1 - Buxbaum, Sarah G A1 - Schreiner, Pamela J A1 - Ellison, R Curtis A1 - Tsai, Michael Y A1 - Patel, Sanjay R A1 - Redline, Susan A1 - Johnson, Andrew D A1 - Hoogeveen, Ron C A1 - Hakonarson, Hakon A1 - Rotter, Jerome I A1 - Boerwinkle, Eric A1 - de Bakker, Paul I W A1 - Kivimaki, Mika A1 - Asselbergs, Folkert W A1 - Sattar, Naveed A1 - Lawlor, Debbie A A1 - Whittaker, John A1 - Davey Smith, George A1 - Mukamal, Kenneth A1 - Psaty, Bruce M A1 - Wilson, James G A1 - Lange, Leslie A A1 - Hamidovic, Ajna A1 - Hingorani, Aroon D A1 - Nordestgaard, Børge G A1 - Bobak, Martin A1 - Leon, David A A1 - Langenberg, Claudia A1 - Palmer, Tom M A1 - Reiner, Alex P A1 - Keating, Brendan J A1 - Dudbridge, Frank A1 - Casas, Juan P KW - Adult KW - Aged KW - Alcohol Dehydrogenase KW - Alcohol Drinking KW - Biomarkers KW - Coronary Disease KW - Female KW - Genetic Markers KW - Genotype KW - Humans KW - Male KW - Mendelian Randomization Analysis KW - Middle Aged KW - Models, Statistical KW - Polymorphism, Single Nucleotide KW - Stroke AB -

OBJECTIVE: To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease.

DESIGN: Mendelian randomisation meta-analysis of 56 epidemiological studies.

PARTICIPANTS: 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers.

MAIN OUTCOME MEASURES: Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption.

RESULTS: Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (-0.88 (-1.19 to -0.56) mm Hg), interleukin-6 levels (-5.2% (-7.8 to -2.4%)), waist circumference (-0.3 (-0.6 to -0.1) cm), and body mass index (-0.17 (-0.24 to -0.10) kg/m(2)). Rs1229984 A-allele carriers had lower odds of coronary heart disease (odds ratio 0.90 (0.84 to 0.96)). The protective association of the ADH1B rs1229984 A-allele variant remained the same across all categories of alcohol consumption (P=0.83 for heterogeneity). Although no association of rs1229984 was identified with the combined subtypes of stroke, carriers of the A-allele had lower odds of ischaemic stroke (odds ratio 0.83 (0.72 to 0.95)).

CONCLUSIONS: Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.

VL - 349 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25011450?dopt=Abstract ER - TY - JOUR T1 - HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: evidence from genetic analysis and randomised trials. JF - Lancet Y1 - 2015 A1 - Swerdlow, Daniel I A1 - Preiss, David A1 - Kuchenbaecker, Karoline B A1 - Holmes, Michael V A1 - Engmann, Jorgen E L A1 - Shah, Tina A1 - Sofat, Reecha A1 - Stender, Stefan A1 - Johnson, Paul C D A1 - Scott, Robert A A1 - Leusink, Maarten A1 - Verweij, Niek A1 - Sharp, Stephen J A1 - Guo, Yiran A1 - Giambartolomei, Claudia A1 - Chung, Christina A1 - Peasey, Anne A1 - Amuzu, Antoinette A1 - Li, KaWah A1 - Palmen, Jutta A1 - Howard, Philip A1 - Cooper, Jackie A A1 - Drenos, Fotios A1 - Li, Yun R A1 - Lowe, Gordon A1 - Gallacher, John A1 - Stewart, Marlene C W A1 - Tzoulaki, Ioanna A1 - Buxbaum, Sarah G A1 - van der A, Daphne L A1 - Forouhi, Nita G A1 - Onland-Moret, N Charlotte A1 - van der Schouw, Yvonne T A1 - Schnabel, Renate B A1 - Hubacek, Jaroslav A A1 - Kubinova, Ruzena A1 - Baceviciene, Migle A1 - Tamosiunas, Abdonas A1 - Pajak, Andrzej A1 - Topor-Madry, Roman A1 - Stepaniak, Urszula A1 - Malyutina, Sofia A1 - Baldassarre, Damiano A1 - Sennblad, Bengt A1 - Tremoli, Elena A1 - de Faire, Ulf A1 - Veglia, Fabrizio A1 - Ford, Ian A1 - Jukema, J Wouter A1 - Westendorp, Rudi G J A1 - de Borst, Gert Jan A1 - de Jong, Pim A A1 - Algra, Ale A1 - Spiering, Wilko A1 - Maitland-van der Zee, Anke H A1 - Klungel, Olaf H A1 - de Boer, Anthonius A1 - Doevendans, Pieter A A1 - Eaton, Charles B A1 - Robinson, Jennifer G A1 - Duggan, David A1 - Kjekshus, John A1 - Downs, John R A1 - Gotto, Antonio M A1 - Keech, Anthony C A1 - Marchioli, Roberto A1 - Tognoni, Gianni A1 - Sever, Peter S A1 - Poulter, Neil R A1 - Waters, David D A1 - Pedersen, Terje R A1 - Amarenco, Pierre A1 - Nakamura, Haruo A1 - McMurray, John J V A1 - Lewsey, James D A1 - Chasman, Daniel I A1 - Ridker, Paul M A1 - Maggioni, Aldo P A1 - Tavazzi, Luigi A1 - Ray, Kausik K A1 - Seshasai, Sreenivasa Rao Kondapally A1 - Manson, JoAnn E A1 - Price, Jackie F A1 - Whincup, Peter H A1 - Morris, Richard W A1 - Lawlor, Debbie A A1 - Smith, George Davey A1 - Ben-Shlomo, Yoav A1 - Schreiner, Pamela J A1 - Fornage, Myriam A1 - Siscovick, David S A1 - Cushman, Mary A1 - Kumari, Meena A1 - Wareham, Nick J A1 - Verschuren, W M Monique A1 - Redline, Susan A1 - Patel, Sanjay R A1 - Whittaker, John C A1 - Hamsten, Anders A1 - Delaney, Joseph A A1 - Dale, Caroline A1 - Gaunt, Tom R A1 - Wong, Andrew A1 - Kuh, Diana A1 - Hardy, Rebecca A1 - Kathiresan, Sekar A1 - Castillo, Berta A A1 - van der Harst, Pim A1 - Brunner, Eric J A1 - Tybjaerg-Hansen, Anne A1 - Marmot, Michael G A1 - Krauss, Ronald M A1 - Tsai, Michael A1 - Coresh, Josef A1 - Hoogeveen, Ronald C A1 - Psaty, Bruce M A1 - Lange, Leslie A A1 - Hakonarson, Hakon A1 - Dudbridge, Frank A1 - Humphries, Steve E A1 - Talmud, Philippa J A1 - Kivimaki, Mika A1 - Timpson, Nicholas J A1 - Langenberg, Claudia A1 - Asselbergs, Folkert W A1 - Voevoda, Mikhail A1 - Bobak, Martin A1 - Pikhart, Hynek A1 - Wilson, James G A1 - Reiner, Alex P A1 - Keating, Brendan J A1 - Hingorani, Aroon D A1 - Sattar, Naveed KW - Aged KW - Body Mass Index KW - Body Weight KW - Cholesterol, HDL KW - Cholesterol, LDL KW - Diabetes Mellitus, Type 2 KW - Female KW - Genetic Testing KW - Humans KW - Hydroxymethylglutaryl CoA Reductases KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Randomized Controlled Trials as Topic KW - Risk Factors AB -

BACKGROUND: Statins increase the risk of new-onset type 2 diabetes mellitus. We aimed to assess whether this increase in risk is a consequence of inhibition of 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), the intended drug target.

METHODS: We used single nucleotide polymorphisms in the HMGCR gene, rs17238484 (for the main analysis) and rs12916 (for a subsidiary analysis) as proxies for HMGCR inhibition by statins. We examined associations of these variants with plasma lipid, glucose, and insulin concentrations; bodyweight; waist circumference; and prevalent and incident type 2 diabetes. Study-specific effect estimates per copy of each LDL-lowering allele were pooled by meta-analysis. These findings were compared with a meta-analysis of new-onset type 2 diabetes and bodyweight change data from randomised trials of statin drugs. The effects of statins in each randomised trial were assessed using meta-analysis.

FINDINGS: Data were available for up to 223 463 individuals from 43 genetic studies. Each additional rs17238484-G allele was associated with a mean 0·06 mmol/L (95% CI 0·05-0·07) lower LDL cholesterol and higher body weight (0·30 kg, 0·18-0·43), waist circumference (0·32 cm, 0·16-0·47), plasma insulin concentration (1·62%, 0·53-2·72), and plasma glucose concentration (0·23%, 0·02-0·44). The rs12916 SNP had similar effects on LDL cholesterol, bodyweight, and waist circumference. The rs17238484-G allele seemed to be associated with higher risk of type 2 diabetes (odds ratio [OR] per allele 1·02, 95% CI 1·00-1·05); the rs12916-T allele association was consistent (1·06, 1·03-1·09). In 129 170 individuals in randomised trials, statins lowered LDL cholesterol by 0·92 mmol/L (95% CI 0·18-1·67) at 1-year of follow-up, increased bodyweight by 0·24 kg (95% CI 0·10-0·38 in all trials; 0·33 kg, 95% CI 0·24-0·42 in placebo or standard care controlled trials and -0·15 kg, 95% CI -0·39 to 0·08 in intensive-dose vs moderate-dose trials) at a mean of 4·2 years (range 1·9-6·7) of follow-up, and increased the odds of new-onset type 2 diabetes (OR 1·12, 95% CI 1·06-1·18 in all trials; 1·11, 95% CI 1·03-1·20 in placebo or standard care controlled trials and 1·12, 95% CI 1·04-1·22 in intensive-dose vs moderate dose trials).

INTERPRETATION: The increased risk of type 2 diabetes noted with statins is at least partially explained by HMGCR inhibition.

FUNDING: The funding sources are cited at the end of the paper.

VL - 385 IS - 9965 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25262344?dopt=Abstract ER - TY - JOUR T1 - Mendelian randomization of blood lipids for coronary heart disease. JF - Eur Heart J Y1 - 2015 A1 - Holmes, Michael V A1 - Asselbergs, Folkert W A1 - Palmer, Tom M A1 - Drenos, Fotios A1 - Lanktree, Matthew B A1 - Nelson, Christopher P A1 - Dale, Caroline E A1 - Padmanabhan, Sandosh A1 - Finan, Chris A1 - Swerdlow, Daniel I A1 - Tragante, Vinicius A1 - van Iperen, Erik P A A1 - Sivapalaratnam, Suthesh A1 - Shah, Sonia A1 - Elbers, Clara C A1 - Shah, Tina A1 - Engmann, Jorgen A1 - Giambartolomei, Claudia A1 - White, Jon A1 - Zabaneh, Delilah A1 - Sofat, Reecha A1 - McLachlan, Stela A1 - Doevendans, Pieter A A1 - Balmforth, Anthony J A1 - Hall, Alistair S A1 - North, Kari E A1 - Almoguera, Berta A1 - Hoogeveen, Ron C A1 - Cushman, Mary A1 - Fornage, Myriam A1 - Patel, Sanjay R A1 - Redline, Susan A1 - Siscovick, David S A1 - Tsai, Michael Y A1 - Karczewski, Konrad J A1 - Hofker, Marten H A1 - Verschuren, W Monique A1 - Bots, Michiel L A1 - van der Schouw, Yvonne T A1 - Melander, Olle A1 - Dominiczak, Anna F A1 - Morris, Richard A1 - Ben-Shlomo, Yoav A1 - Price, Jackie A1 - Kumari, Meena A1 - Baumert, Jens A1 - Peters, Annette A1 - Thorand, Barbara A1 - Koenig, Wolfgang A1 - Gaunt, Tom R A1 - Humphries, Steve E A1 - Clarke, Robert A1 - Watkins, Hugh A1 - Farrall, Martin A1 - Wilson, James G A1 - Rich, Stephen S A1 - de Bakker, Paul I W A1 - Lange, Leslie A A1 - Davey Smith, George A1 - Reiner, Alex P A1 - Talmud, Philippa J A1 - Kivimaki, Mika A1 - Lawlor, Debbie A A1 - Dudbridge, Frank A1 - Samani, Nilesh J A1 - Keating, Brendan J A1 - Hingorani, Aroon D A1 - Casas, Juan P KW - Case-Control Studies KW - Cholesterol, HDL KW - Coronary Artery Disease KW - Female KW - Gene Frequency KW - Genotype KW - Genotyping Techniques KW - Humans KW - Male KW - Mendelian Randomization Analysis KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Risk Assessment KW - Triglycerides AB -

AIMS: To investigate the causal role of high-density lipoprotein cholesterol (HDL-C) and triglycerides in coronary heart disease (CHD) using multiple instrumental variables for Mendelian randomization.

METHODS AND RESULTS: We developed weighted allele scores based on single nucleotide polymorphisms (SNPs) with established associations with HDL-C, triglycerides, and low-density lipoprotein cholesterol (LDL-C). For each trait, we constructed two scores. The first was unrestricted, including all independent SNPs associated with the lipid trait identified from a prior meta-analysis (threshold P < 2 × 10(-6)); and the second a restricted score, filtered to remove any SNPs also associated with either of the other two lipid traits at P ≤ 0.01. Mendelian randomization meta-analyses were conducted in 17 studies including 62,199 participants and 12,099 CHD events. Both the unrestricted and restricted allele scores for LDL-C (42 and 19 SNPs, respectively) associated with CHD. For HDL-C, the unrestricted allele score (48 SNPs) was associated with CHD (OR: 0.53; 95% CI: 0.40, 0.70), per 1 mmol/L higher HDL-C, but neither the restricted allele score (19 SNPs; OR: 0.91; 95% CI: 0.42, 1.98) nor the unrestricted HDL-C allele score adjusted for triglycerides, LDL-C, or statin use (OR: 0.81; 95% CI: 0.44, 1.46) showed a robust association. For triglycerides, the unrestricted allele score (67 SNPs) and the restricted allele score (27 SNPs) were both associated with CHD (OR: 1.62; 95% CI: 1.24, 2.11 and 1.61; 95% CI: 1.00, 2.59, respectively) per 1-log unit increment. However, the unrestricted triglyceride score adjusted for HDL-C, LDL-C, and statin use gave an OR for CHD of 1.01 (95% CI: 0.59, 1.75).

CONCLUSION: The genetic findings support a causal effect of triglycerides on CHD risk, but a causal role for HDL-C, though possible, remains less certain.

VL - 36 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24474739?dopt=Abstract ER -