Cited by 703Lipoproteins and Cardiovascular HealthLipid metabolism and disordersGenetic Associations and Epidemiology

The DOI matches its Crossref record; 44 of the 44 references it cites were found in a registry or an index; 18 of the 31 sources its claims cite were checked for support.

Association of Triglyceride-Lowering LPL Variants and LDL-C–Lowering LDLR Variants With Risk of Coronary Heart Disease

Open access

Abstract

Importance: Triglycerides and cholesterol are both carried in plasma by apolipoprotein B (ApoB)-containing lipoprotein particles. It is unknown whether lowering plasma triglyceride levels reduces the risk of cardiovascular events to the same extent as lowering low-density lipoprotein cholesterol (LDL-C) levels. Objective: To compare the association of triglyceride-lowering variants in the lipoprotein lipase (LPL) gene and LDL-C-lowering variants in the LDL receptor gene (LDLR) with the risk of cardiovascular disease per unit change in ApoB. Design, Setting, and Participants: Mendelian randomization analyses evaluating the associations of genetic scores composed of triglyceride-lowering variants in the LPL gene and LDL-C-lowering variants in the LDLR gene, respectively, with the risk of cardiovascular events among participants enrolled in 63 cohort or case-control studies conducted in North America or Europe between 1948 and 2017. Exposures: Differences in plasma triglyceride, LDL-C, and ApoB levels associated with the LPL and LDLR genetic scores. Main Outcomes and Measures: Odds ratio (OR) for coronary heart disease (CHD)-defined as coronary death, myocardial infarction, or coronary revascularization-per 10-mg/dL lower concentration of ApoB-containing lipoproteins. Results: A total of 654 783 participants, including 91 129 cases of CHD, were included (mean age, 62.7 years; 51.4% women). For each 10-mg/dL lower level of ApoB-containing lipoproteins, the LPL score was associated with 69.9-mg/dL (95% CI, 68.1-71.6; P = 7.1 × 10-1363) lower triglyceride levels and 0.7-mg/dL (95% CI, 0.03-1.4; P = .04) higher LDL-C levels; while the LDLR score was associated with 14.2-mg/dL (95% CI, 13.6-14.8; P = 1.4 × 10-465) lower LDL-C and 1.9-mg/dL (95% CI, 0.1-3.9; P = .04) lower triglyceride levels. Despite these differences in associated lipid levels, the LPL and LDLR scores were associated with similar lower risk of CHD per 10-mg/dL lower level of ApoB-containing lipoproteins (OR, 0.771 [95% CI, 0.741-0.802], P = 3.9 × 10-38 and OR, 0.773 [95% CI, 0.747-0.801], P = 1.1 × 10-46, respectively). In multivariable mendelian randomization analyses, the associations between triglyceride and LDL-C levels with the risk of CHD became null after adjusting for differences in ApoB (triglycerides: OR, 1.014 [95% CI, 0.965-1.065], P = .19; LDL-C: OR, 1.010 [95% CI, 0.967-1.055], P = .19; ApoB: OR, 0.761 [95% CI, 0.723-0.798], P = 7.51 × 10-20). Conclusions and Relevance: Triglyceride-lowering LPL variants and LDL-C-lowering LDLR variants were associated with similar lower risk of CHD per unit difference in ApoB. Therefore, the clinical benefit of lowering triglyceride and LDL-C levels may be proportional to the absolute change in ApoB.

Overview

Integrity signals

Registry

Crossref · 10.1001/jama.2018.20045

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

26 Own result · 9 Own interpretation · 7 Own method · 4 Partly supported · 2 Supported · 2 Supported so far · 2 Not supported · 2 No full text of the sources · 1 Sources not found · 1 No basis given · accuracy not yet measured

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Show all 38 claims

  • It may state two separate claims as one. 11
  • Probably not a substantial claim. 8
  • The quote only partly states this claim. 1
18 of 18
  • The paper relies on this without support.

    It is unknown whether lowering plasma triglyceride levels by targeting the LPL pathway will reduce the risk of cardiovascular events.

    “However, it is unknown whether lowering plasma triglyceride levels by targeting the LPL pathway will reduce the risk of cardiovascular events.”
  • The paper relies on this without support.

    Both triglycerides and cholesterol are carried in plasma by ApoB-containing lipoprotein particles.

    “Both triglycerides and cholesterol are carried in plasma by apolipoprotein B (ApoB)-containing lipoprotein particles.”
  • The paper relies on this without support.

    All ApoB-containing lipoproteins have a single ApoB molecule.

    “Because all ApoB-containing lipoproteins, including triglyceriderich lipoprotein particles and LDL particles, have a single ApoB molecule”
  • The paper relies on this without support.

    ApoB-containing particles are secreted by the liver as VLDL particles, which principally contain triglycerides, some cholesterol, and 1 molecule of ApoB.

    “These particles are secreted by the liver as VLDL particles, which principally contain triglycerides, some cholesterol, and 1 molecule of ApoB.”
  • The paper relies on this without support.

    Lipoprotein lipase removes most of the triglycerides from VLDL particles to convert them into triglyceride-depleted cholesterol-carrying LDL particles, which are then removed from plasma by hepatic LDL receptors.

    “Lipoprotein lipase removes most of the triglycerides from these particles to convert the triglyceride-rich VLDL particles into triglyceridedepleted cholesterol-carrying LDL particles, which are then removed from plasma by hepatic LDL receptors.”
5 of 5

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Each contradiction between two passages listed here was confirmed by an independent check.

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Metadata

Authors
Ference, B. A., Kastelein, J. J. P., Ray, K. K., Ginsberg, H. N., Chapman, M. J., Packard, C. J., Laufs, U., Oliver-Williams, C., Wood, A. M., Butterworth, A. S., Di Angelantonio, E., Danesh, J., Nicholls, S. J., Bhatt, D. L., Sabatine, M. S., & Catapano, A. L.
Affiliations
  • University of Cambridge (GB)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Imperial College London (GB)
  • Columbia University (US)
  • Inserm (FR)
  • University of Glasgow (GB)
  • Leipzig University (DE)
  • MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
  • Monash University (AU)
  • Brigham and Women's Hospital (US)
  • University of Milan (IT)
Corresponding author
Ference, Brian A.
Venue
JAMA
Published
2019-01-29
Volume
321
Issue
4
Pages
364
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W2911290113
Cited by
703
References
39
Citations by year
2026: 59 · 2025: 83 · 2024: 119 · 2023: 88 · 2022: 69 · 2021: 111 · 2020: 100 · 2019: 72
FWCI
63.33
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • JAMA (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Explore Bristol Research (acceptedVersion, other-oa)
  • Bristol Research (University of Bristol) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion)
  • Apollo
Funders
  • Amgen
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca
  • GlaxoSmithKline
  • Sanofi
  • Biogen
  • CSL Behring
  • NHS Blood and Transplant
  • Regeneron Pharmaceuticals
  • Wellcome Trust
  • Ironwood Pharmaceuticals, Incorporated
  • Amarin Corporation
  • Anthera
  • InfraRedx
  • National Institute for Health and Care Research (NF-SI-0617-10113)
  • British Heart Foundation (RG/18/13/33946, RG/13/13/30194)
  • Bupa Foundation
  • European Commission
  • Eisai
  • Evelyn Trust
  • Esperion Therapeutics
  • Medical Research Council
  • Homerton College, University of Cambridge
  • National Heart, Lung, and Blood Institute
  • Fogarty International Center
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
Keywords
lipoprotein lipase, LDL receptor, apolipoprotein B, triglycerides, LDL cholesterol, coronary artery disease, cardiovascular risk, genetic score, lipoprotein particles, cardiovascular events, myocardial infarction, coronary revascularization, coronary death
MeSH terms
Loss of Function Mutation, Apolipoproteins B, Coronary Disease, Female, Humans, Lipoprotein Lipase, Cholesterol, LDL, Male, Middle Aged, Prospective Studies, Receptors, LDL, Risk Factors, Triglycerides, Genetic Variation, Case-Control Studies, Genetic Predisposition to Disease, Metabolic Networks and Pathways, Mendelian Randomization Analysis

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