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ANGPTL3 Deficiency and Protection Against Coronary Artery Disease
Nathan O Stitziel1, Amit V Khera2, Xiao Wang3
1Cardiovascular Division, Department of Medicine, Department of Genetics, and McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri.
Insights
ANGPTL3 deficiency significantly lowers coronary artery disease (CAD) risk. Individuals with ANGPTL3 loss-of-function mutations showed reduced lipid levels and a 34% lower odds of CAD, indicating protection.
Area of Science:
- Genetics and Cardiovascular Medicine
- Lipid Metabolism Research
- Mendelian Disorders
Background:
- Familial combined hypolipidemia results from ANGPTL3 gene mutations.
- The impact of ANGPTL3 deficiency on coronary artery disease (CAD) risk is not well understood.
Purpose of the Study:
- To investigate the association between ANGPTL3 deficiency and CAD risk.
- Utilize family studies, population-based data, and biomarker analysis.
Main Methods:
- Assessed coronary atherosclerosis via CT angiography in individuals with complete ANGPTL3 deficiency.
- Analyzed ANGPTL3 loss-of-function (LOF) mutations in a large population study (21,980 CAD cases, 158,200 controls).
- Measured ANGPTL3 levels in patients with myocardial infarction (MI) and controls.
Main Results:
- Individuals with complete ANGPTL3 deficiency had no coronary atherosclerotic plaque.
- Heterozygous carriers of ANGPTL3 LOF mutations showed reduced triglycerides and LDL cholesterol.
- Carrier status was linked to a 34% reduction in CAD odds (OR 0.66, p=0.04).
- Lowest ANGPTL3 levels correlated with reduced MI odds (aOR 0.65, p<0.001).
Conclusions:
- ANGPTL3 deficiency is associated with protection against coronary artery disease.
- Genetic variations in ANGPTL3 influence cardiovascular risk.
Background:
Familial combined hypolipidemia, a Mendelian condition characterized by substantial reductions in all 3 major lipid fractions, is caused by mutations that inactivate the gene angiopoietin-like 3 (ANGPTL3). Whether ANGPTL3 deficiency reduces risk of coronary artery disease (CAD) is unknown.
Objectives:
The study goal was to leverage 3 distinct lines of evidence-a family that included individuals with complete (compound heterozygote) ANGPTL3 deficiency, a population based-study of humans with partial (heterozygote) ANGPTL3 deficiency, and biomarker levels in patients with myocardial infarction (MI)-to test whether ANGPTL3 deficiency is associated with lower risk for CAD.
Methods:
We assessed coronary atherosclerotic burden in 3 individuals with complete ANGPTL3 deficiency and 3 wild-type first-degree relatives using computed tomography angiography. In the population, ANGPTL3 loss-of-function (LOF) mutations were ascertained in up to 21,980 people with CAD and 158,200 control subjects. LOF mutations were defined as nonsense, frameshift, and splice-site variants, along with missense variants resulting in <25% of wild-type ANGPTL3 activity in a mouse model. In a biomarker study, circulating ANGPTL3 concentration was measured in 1,493 people who presented with MI and 3,232 control subjects.
Results:
The 3 individuals with complete ANGPTL3 deficiency showed no evidence of coronary atherosclerotic plaque. ANGPTL3 gene sequencing demonstrated that approximately 1 in 309 people was a heterozygous carrier for an LOF mutation. Compared with those without mutation, heterozygous carriers of ANGPTL3 LOF mutations demonstrated a 17% reduction in circulating triglycerides and a 12% reduction in low-density lipoprotein cholesterol. Carrier status was associated with a 34% reduction in odds of CAD (odds ratio: 0.66; 95% confidence interval: 0.44 to 0.98; p = 0.04). Individuals in the lowest tertile of circulating ANGPTL3 concentrations, compared with the highest, had reduced odds of MI (adjusted odds ratio: 0.65; 95% confidence interval: 0.55 to 0.77; p < 0.001).
Conclusions:
ANGPTL3 deficiency is associated with protection from CAD.
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