Cited by 862Genetic Associations and EpidemiologyLipoproteins and Cardiovascular HealthLipid metabolism and disorders

Common variants associated with plasma triglycerides and risk for coronary artery disease

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Do, Ron, Willer, Cristen J, Schmidt, Ellen M, Sengupta, Sebanti, Gao, Chi, Peloso, Gina M, Gustafsson, Stefan, Kanoni, Stavroula +255 more·2013·Nature Genetics

Abstract

Sekar Kathiresan and colleagues examine 185 common variants using a modified mendelian randomization approach and provide evidence supporting a causal role of triglyceride-rich lipoproteins in the development of coronary artery disease. Triglycerides are transported in plasma by specific triglyceride-rich lipoproteins; in epidemiological studies, increased triglyceride levels correlate with higher risk for coronary artery disease (CAD). However, it is unclear whether this association reflects causal processes. We used 185 common variants recently mapped for plasma lipids (P < 5 × 10−8 for each) to examine the role of triglycerides in risk for CAD. First, we highlight loci associated with both low-density lipoprotein cholesterol (LDL-C) and triglyceride levels, and we show that the direction and magnitude of the associations with both traits are factors in determining CAD risk. Second, we consider loci with only a strong association with triglycerides and show that these loci are also associated with CAD. Finally, in a model accounting for effects on LDL-C and/or high-density lipoprotein cholesterol (HDL-C) levels, the strength of a polymorphism's effect on triglyceride levels is correlated with the magnitude of its effect on CAD risk. These results suggest that triglyceride-rich lipoproteins causally influence risk for CAD.

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Crossref · 10.1038/ng.2795

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  • Enhanced clearance of triglyceride-rich lipoproteins and their remnants mitigates atherosclerotic cardiovascular disease risk.

    “These findings have been further corroborated in studies examining ANGPTL4 and LPL variants, all reinforcing the concept that enhanced clearance of TRLs and their remnants mitigates ASCVD risk [27].”

    From Targeting Triglycerides in Cardiovascular Disease Prevention: Evidence, Mechanisms, and Emerging Therapies (2026) · cites this paper as [27]

    The discussion passage labelled Abstract (page not supplied) says that greater LPL activity lowers triglycerides and that an LPL gain-of-function variant is associated with lower CAD risk. It also describes remnant particles as potentially pro-atherogenic. The copy does not report ANGPTL4-variant findings or establish that enhanced clearance of TRLs and their remnants is the mechanism reducing risk. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • The finding by Do et al. supported the notion that plasma TG levels are an independent causal risk factor for coronary artery disease.

    “This finding supported the notion that plasma TG levels are an independent causal risk factor for CAD”

    From The Forgotten Lipids: Triglycerides, Remnant Cholesterol, and Atherosclerotic Cardiovascular Disease Risk (2019) · cites this paper as [116]

    The Abstract (page unavailable) reports that genetic effects on triglycerides correlate with CAD risk after accounting for effects on LDL-C and HDL-C, supporting the cited finding. But it concludes that triglyceride-rich lipoproteins may causally influence CAD, not that plasma triglyceride levels themselves are an independent causal risk factor. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Mendelian randomization analyses confirm a causal relationship between lifelong TRL elevation and ASCVD.

    “Observational cohorts demonstrate that higher TG and remnant cholesterol predict cardiovascular events independently of LDL-C, while Mendelian randomization analyses confirm a causal relationship between lifelong TRL elevation and ASCVD.”

    From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [55]

    The paper’s concluding passage (labelled Abstract in our copy; page unavailable) says its genetic analyses provide evidence that plasma triglycerides likely reflect processes causal for coronary artery disease. Its limitations passage cautions that the variants also affect other lipids and are not ideal Mendelian-randomization instruments. The claim overstates this as confirmation that lifelong elevation of triglyceride-rich lipoproteins (TRLs) itself causes the broader outcome of ASCVD. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Lower triglyceride levels, when accompanied by lower apolipoprotein B levels, are associated with lower cardiovascular risk.

    “However, genetic studies suggest that lower triglyceride levels, when accompanied by lower apolipoprotein B levels, are associated with lower CV risk”

    From Association Between Triglyceride Lowering and Reduction of Cardiovascular Risk Across Multiple Lipid-Lowering Therapeutic Classes: A Systematic Review and Meta-Regression Analysis of Randomized Controlled Trials (2019) · cites this paper as [6]

    The paper reports that variants associated with lower triglycerides and lower LDL cholesterol tend to be associated with lower coronary artery disease risk (results passage, page unavailable). It does not report the claimed condition of lower apolipoprotein B levels; LDL cholesterol is not the same measurement. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • On a mg/dL basis, the association of triglycerides with major vascular events is less strong than that for LDL-C.

    “but also that, on a mg/dL basis, the association of triglycerides with major vascular events is less strong as that for LDL-C.6,8,35”

    From Association Between Triglyceride Lowering and Reduction of Cardiovascular Risk Across Multiple Lipid-Lowering Therapeutic Classes: A Systematic Review and Meta-Regression Analysis of Randomized Controlled Trials (2019) · cites this paper as [6]

    The paper reports associations of both triglycerides and LDL-C with coronary artery disease across lipid-associated SNPs (Abstract; page unavailable). It does not compare their association strengths per mg/dL or assess the broader outcome of major vascular events. The Online Methods specify that lipid effects were measured in standard-deviation units, not mg/dL. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Authors
Do, R., Willer, C. J., Schmidt, E. M., Sengupta, S., Gao, C., Peloso, G. M., Gustafsson, S., Kanoni, S., Ganna, A., Chen, J., Buchkovich, M. L., Mora, S., Beckmann, J. S., Bragg-Gresham, J. L., Chang, H.-Y., Demirkan, A., Den Hertog, H. M., Donnelly, L. A., Ehret, G. B., Esko, T., Feitosa, M. F., Ferreira, T., Fischer, K., Fontanillas, P., Fraser, R. M., Freitag, D. F., Gurdasani, D., Heikkilä, K., Hyppönen, E., Isaacs, A., Jackson, A. U., Johansson, Å., Johnson, T., Kaakinen, M., Kettunen, J., Kleber, M. E., Li, X., Luan, J., Lyytikäinen, L.-P., Magnusson, P. K. E., Mangino, M., Mihailov, E., Montasser, M. E., Müller-Nurasyid, M., Nolte, I. M., O'Connell, J. R., Palmer, C. D., Perola, M., Petersen, A.-K., Sanna, S., Saxena, R., Service, S. K., Shah, S., Shungin, D., Sidore, C., Song, C., Strawbridge, R. J., Surakka, I., Tanaka, T., Teslovich, T. M., Thorleifsson, G., Van den Herik, E. G., Voight, B. F., Volcik, K. A., Waite, L. L., Wong, A., Wu, Y., Zhang, W., Absher, D., Asiki, G., Barroso, I., Been, L. F., Bolton, J. L., Bonnycastle, L. L., Brambilla, P., Burnett, M. S., Cesana, G., Dimitriou, M., Doney, A. S. F., Döring, A., Elliott, P., Epstein, S. E., Eyjolfsson, G. I., Gigante, B., Goodarzi, M. O., Grallert, H., Gravito, M. L., Groves, C. J., Hallmans, G., Hartikainen, A.-L., Hayward, C., Hernandez, D., Hicks, A. A., Holm, H., Hung, Y.-J., Illig, T., Jones, M. R., Kaleebu, P., Kastelein, J. J. P., Khaw, K.-T., Kim, E., Klopp, N., Komulainen, P., Kumari, M., Langenberg, C., Lehtimäki, T., Lin, S.-Y., Lindström, J., Loos, R. J. F., Mach, F., McArdle, W. L., Meisinger, C., Mitchell, B. D., Müller, G., Nagaraja, R., Narisu, N., Nieminen, T. V. M., Nsubuga, R. N., Olafsson, I., Ong, K. K., Palotie, A., Papamarkou, T., Pomilla, C., Pouta, A., Rader, D. J., Reilly, M. P., Ridker, P. M., Rivadeneira, F., Rudan, I., Ruokonen, A., Samani, N., Scharnagl, H., Seeley, J., Silander, K., Stančáková, A., Stirrups, K., Swift, A. J., Tiret, L., Uitterlinden, A. G., van Pelt, L. J., Vedantam, S., Wainwright, N., Wijmenga, C., Wild, S. H., Willemsen, G., Wilsgaard, T., Wilson, J. F., Young, E. H., Zhao, J. H., Adair, L. S., Arveiler, D., Assimes, T. L., Bandinelli, S., Bennett, F., Bochud, M., Boehm, B. O., Boomsma, D. I., Borecki, I. B., Bornstein, S. R., Bovet, P., Burnier, M., Campbell, H., Chakravarti, A., Chambers, J. C., Chen, Y.-D. I., Collins, F. S., Cooper, R. S., Danesh, J., Dedoussis, G., de Faire, U., Feranil, A. B., Ferrières, J., Ferrucci, L., Freimer, N. B., Gieger, C., Groop, L. C., Gudnason, V., Gyllensten, U., Hamsten, A., Harris, T. B., Hingorani, A., Hirschhorn, J. N., Hofman, A., Hovingh, G. K., Hsiung, C. A., Humphries, S. E., Hunt, S. C., Hveem, K., Iribarren, C., Järvelin, M.-R., Jula, A., Kähönen, M., Kaprio, J., Kesäniemi, A., Kivimaki, M., Kooner, J. S., Koudstaal, P. J., Krauss, R. M., Kuh, D., Kuusisto, J., Kyvik, K. O., Laakso, M., Lakka, T. A., Lind, L., Lindgren, C. M., Martin, N. G., März, W., McCarthy, M. I., McKenzie, C. A., Meneton, P., Metspalu, A., Moilanen, L., Morris, A. D., Munroe, P. B., Njølstad, I., Pedersen, N. L., Power, C., Pramstaller, P. P., Price, J. F., Psaty, B. M., Quertermous, T., Rauramaa, R., Saleheen, D., Salomaa, V., Sanghera, D. K., Saramies, J., Schwarz, P. E. H., Sheu, W. H.-H., Shuldiner, A. R., Siegbahn, A., Spector, T. D., Stefansson, K., Strachan, D. P., Tayo, B. O., Tremoli, E., Tuomilehto, J., Uusitupa, M., van Duijn, C. M., Vollenweider, P., Wallentin, L., Wareham, N. J., Whitfield, J. B., Wolffenbuttel, B. H. R., Altshuler, D., Ordovas, J. M., Boerwinkle, E., Palmer, C. N. A., Thorsteinsdottir, U., Chasman, D. I., Rotter, J. I., Franks, P. W., Ripatti, S., Cupples, L. A., Sandhu, M. S., Rich, S. S., Boehnke, M., Deloukas, P., Mohlke, K. L., Ingelsson, E., Abecasis, G. R., Daly, M. J., Neale, B. M., & Kathiresan, S.
Affiliations
  • Broad Institute (US)
  • University of Michigan (US)
  • Uppsala University (SE)
  • Wellcome Sanger Institute (GB)
  • University of North Carolina at Chapel Hill (US)
  • Brigham and Women's Hospital (US)
  • Centre Hospitalier Universitaire Vaudois (CH)
  • National Health Research Institutes (TW)
  • Erasmus MC (NL)
  • University of Dundee (GB)
  • Johns Hopkins University (US)
  • Washington University in St. Louis (US)
  • Centre for Human Genetics (GB)
  • University of Tartu (EE)
  • University of Edinburgh (GB)
  • University of Cambridge (GB)
  • University College London (GB)
  • Queen Mary University of London (GB)
  • University of Oulu (FI)
  • University of Helsinki (FI)
  • Universität Ulm (DE)
  • Cedars-Sinai Medical Center (US)
  • Addenbrooke's Hospital (GB)
  • Tampere University (FI)
  • Karolinska Institutet (SE)
  • King's College London (GB)
  • University of Maryland, Baltimore (US)
  • University Medical Center Groningen (NL)
  • Helmholtz Munich (DE)
  • Institute of Genetic and Biomedical Research (IT)
  • Massachusetts General Hospital (US)
  • University of California, Los Angeles (US)
  • Lund University (SE)
  • University of Sassari (IT)
  • Karolinska University Hospital (SE)
  • National Institutes of Health (US)
  • University of Pennsylvania (US)
  • The University of Texas Health Science Center at Houston (US)
  • HudsonAlpha Institute for Biotechnology (US)
  • MRC Unit for Lifelong Health and Ageing (GB)
  • National Health Service (GB)
  • MRC/UVRI & LSHTM Uganda Research Unit (UG)
  • University of Oklahoma Health Sciences Center (US)
  • University of Milano-Bicocca (IT)
  • MedStar Health Research Institute (US)
  • Harokopio University of Athens (GR)
  • Imperial College London (GB)
  • University of Oxford (GB)
  • Umeå University (SE)
  • Oulu University Hospital (FI)
  • Western General Hospital (GB)
  • Eurac Research (IT)
  • Tri-Service General Hospital (TW)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Taichung Veterans General Hospital (TW)
  • Finnish Institute for Health and Welfare (FI)
  • University Hospital of Geneva (CH)
  • University of Bristol (GB)
  • National Institute on Aging (US)
  • University of Leicester (GB)
  • Medical University of Graz (AT)
  • University of East Anglia (GB)
  • University of Eastern Finland (FI)
  • Inserm (FR)
  • Vrije Universiteit Amsterdam (NL)
  • UiT The Arctic University of Norway (NO)
  • Université de Strasbourg (FR)
  • Stanford Medicine (US)
  • Azienda Sanitaria di Firenze (IT)
  • University of the West Indies (JM)
  • Nanyang Technological University (SG)
  • University Hospital Carl Gustav Carus (DE)
  • Loyola University Medical Center (US)
  • University of San Carlos (PH)
  • Hôpital Rangueil (FR)
  • Icelandic Heart Association (IS)
  • British Heart Foundation (GB)
  • University of Utah (US)
  • Norwegian University of Science and Technology (NO)
  • Kaiser Permanente (US)
  • University of Southern Denmark (DK)
  • QIMR Berghofer Medical Research Institute (AU)
  • Kuopio University Hospital (FI)
  • Group Health Cooperative (US)
  • South Karelia Central Hospital (FI)
  • German Center for Diabetes Research (DE)
  • St George's, University of London (GB)
  • University of Milan (IT)
  • Universität für Weiterbildung Krems (AT)
  • Harvard University (US)
  • Boston University (US)
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Corresponding author
  • Daly, Mark J
  • Neale, Benjamin M
  • Kathiresan, Sekar
ORCID
Venue
Nature Genetics
Published
2013-10-06
Volume
45
Issue
11
Pages
1345-1352
ISSN
  • 1061-4036 (ISSN-L)
  • 1546-1718
OpenAlex
W2163969089
Cited by
862
References
35
Citations by year
2026: 27 · 2025: 43 · 2024: 41 · 2023: 62 · 2022: 59 · 2021: 73 · 2020: 69 · 2019: 80 · 2018: 84 · 2017: 75 · 2016: 107 · 2015: 74 · 2014: 60 · 2013: 4 · 2012: 1
FWCI
54.19
Type
journal article
Language
en
Open access
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Funders
  • Massachusetts General Hospital (R01HL107816)
  • Donovan Family Foundation (R01HL107816)
  • Wellcome Trust (100891, 090532)
  • National Institute for Health and Care Research (NF-SI-0512-10165, NF-SI-0512-10135)
  • British Heart Foundation (PG/08/094/26019, RG/08/008/25291, RG/08/014/24067)
  • Fondation Leducq (T32HL007208)
  • National Institutes of Health (UL1TR000124)
  • Canadian Institutes of Health Research
  • Medical Research Council (MR/K013351/1, MR/L003120/1, MC_UU_12015/2, MC_UU_12015/1, MR/K013491/1)
  • Economic and Social Research Council (ES/J023299/1)
  • National Heart, Lung, and Blood Institute (U01HL069757, R01HL105756, R01HL107816, T32HL007208, R01HL109946)
  • National Human Genome Research Institute (T32HG000040)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK072193, P30DK020572, R01DK093757, P30DK063491)
  • National Center for Advancing Translational Sciences
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Keywords
plasma triglycerides, coronary artery disease, triglyceride-rich lipoproteins, common genetic variants, Mendelian randomization, LDL cholesterol, HDL cholesterol, causal inference
MeSH terms
Biological Transport, Coronary Artery Disease, Humans, Cholesterol, HDL, Cholesterol, LDL, Risk Factors, Triglycerides, Polymorphism, Single Nucleotide

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