A1 Refereed original research article in a scientific journal

Apolipoprotein A-I concentrations and risk of coronary artery disease: A Mendelian randomization study




AuthorsMinna K. Karjalainen, Michael V. Holmes, Qin Wang, Olga Anufrieva, Mika Kähönen, Terho Lehtimäki, Aki S. Havulinna, Kati Kristiansson, Veikko Salomaa, Markus Perola, Jorma S. Viikari, Olli T. Raitakari, Marjo-Riitta Järvelin, Mika Ala-Korpela, Johannes Kettunen

PublisherElsevier

Publication year2020

JournalAtherosclerosis

Journal name in sourceAtherosclerosis

Journal acronymAtherosclerosis

Volume299

First page 56

Last page63

Number of pages8

ISSN0021-9150

eISSN1879-1484

DOIhttps://doi.org/10.1016/j.atherosclerosis.2020.02.002

Self-archived copy’s web addresshttps://research.utu.fi/converis/portal/detail/Publication/46736406


Abstract
Background and aimsApolipoprotein A-I (apoA-I) infusions represent a potential novel therapeutic approach for the prevention of coronary artery disease (CAD). Although circulating apoA-I concentrations inversely associate with risk of CAD, the evidence base of this representing a causal relationship is lacking. The aim was to assess the causal role of apoA-I using human genetics.MethodsWe identified a variant (rs12225230) in APOA1 locus that associated with circulating apoA-I concentrations (p < 5 × 10−8) in 20,370 Finnish participants, and meta-analyzed our data with a previous GWAS of apoA-I. We obtained genetic estimates of CAD from UK Biobank and CARDIoGRAMplusC4D (totaling 122,733 CAD cases) and conducted a two-sample Mendelian randomization analysis. We compared our genetic findings to observational associations of apoA-I with risk of CAD in 918 incident CAD cases among 11,535 individuals from population-based prospective cohorts.ResultsApoA-I was associated with a lower risk of CAD in observational analyses (HR 0.81; 95%CI: 0.75, 0.88; per 1-SD higher apoA-I), with the association showing a dose-response relationship. Rs12225230 associated with apoA-I concentrations (per-C allele beta 0.076 SD; SE: 0.013; p = 1.5 × 10−9) but not with confounders. In Mendelian randomization analyses, apoA-I was not related to risk of CAD (OR 1.13; 95%CI: 0.98,1.30 per 1-SD higher apoA-I), which was different from the observational association. Similar findings were observed using an independent ABCA1 variant in sensitivity analysis.ConclusionsGenetic evidence fails to support a cardioprotective role for apoA-I. This is in line with the cumulative evidence showing that HDL-related phenotypes are unlikely to have a protective role in CAD.

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