Cited by 470Lipid metabolism and disordersLipoproteins and Cardiovascular HealthParaoxonase enzyme and polymorphisms

ANGPTL3 deficiency and protection against coronary artery disease

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Stitziel, Nathan O., Khera, Amit V., Wang, Xiao, Bierhals, Andrew J., Vourakis, A. Christina, Sperry, Alexandra E., Natarajan, Pradeep, Klarin, Derek +20 more·2017·Journal of the American College of Cardiology

Abstract

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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Authors
Stitziel, N. O., Khera, A. V., Wang, X., Bierhals, A. J., Vourakis, A. C., Sperry, A. E., Natarajan, P., Klarin, D., Emdin, C. A., Zekavat, S. M., Nomura, A., Erdmann, J., Schunkert, H., Samani, N. J., Kraus, W. E., Shah, S. H., Yu, B., Boerwinkle, E., Rader, D. J., Gupta, N., Frossard, P. M., Rasheed, A., Danesh, J., Lander, E. S., Gabriel, S., Saleheen, D., Musunuru, K., & Kathiresan, S.
Affiliations
  • Washington University in St. Louis (US)
  • Broad Institute (US)
  • Harvard University (US)
  • Institute for Integrative and Experimental Genomics (DE)
  • German Centre for Cardiovascular Research (DE)
  • University of Leicester (GB)
  • Duke University (US)
  • Baylor College of Medicine (US)
  • University of Pennsylvania (US)
  • Center for Non-Communicable Diseases (PK)
  • University of Cambridge (GB)
Corresponding author
Stitziel, Nathan O.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2017-04
Volume
69
Issue
16
Pages
2054-2063
ISSN
0735-1097 (ISSN-L)
OpenAlex
W2604768034
Cited by
467
References
45
Citations by year
2026: 38 · 2025: 39 · 2024: 46 · 2023: 58 · 2022: 57 · 2021: 70 · 2020: 44 · 2019: 36 · 2018: 54 · 2017: 23 · 2015: 1
FWCI
33.23
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • mediaTUM (Technical University of Munich) (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by-nc-nd)
  • Apollo
Funders
  • Harvard Catalyst
  • National Institute for Health and Care Research (NF-SI-0512-10165)
  • British Heart Foundation (RG/08/014/24067)
  • National Institutes of Health (5t32hl007734-30, KL2TR001100)
  • Medical Research Council (MR/L003120/1)
  • National Heart, Lung, and Blood Institute (R01HL127564, K08HL114642, R33HL120781, R21HL120781, T-32HL007734, RC2HL101834, R01HL118744, R01HL131961)
  • National Human Genome Research Institute (UM1HG008895, U54HG003067, UM1HG008853)
  • Fogarty International Center (RC1TW008485)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
Keywords
ANGPTL3, coronary artery disease, loss-of-function mutations, myocardial infarction, triglycerides, LDL cholesterol, genetic risk, heterozygous carriers, hypolipidemic effect, first-degree relatives, loss-of-function screening
MeSH terms
Angiopoietin-like Proteins, Angiopoietin-Like Protein 3, Adult, Animals, Coronary Artery Disease, Female, Humans, Lipids, Male, Mice, Inbred C57BL, Middle Aged, Myocardial Infarction, Risk Factors, Case-Control Studies, Mice, Knockout, Mutation, Missense, Angiopoietins, Atherosclerosis

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