Cited by 923Lipid metabolism and disordersLipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and Lipoproteins

Loss-of-Function Mutations in APOC3 and Risk of Ischemic Vascular Disease

Open access
Jørgensen, Anders Berg, Frikke-Schmidt, Ruth, Nordestgaard, Børge G., Tybjærg-Hansen, Anne·2014·New England Journal of Medicine

Abstract

BACKGROUND: High plasma levels of nonfasting triglycerides are associated with an increased risk of ischemic cardiovascular disease. Whether lifelong low levels of nonfasting triglycerides owing to mutations in the gene encoding apolipoprotein C3 (APOC3) are associated with a reduced risk of ischemic cardiovascular disease in the general population is unknown. METHODS: Using data from 75,725 participants in two general-population studies, we first tested whether low levels of nonfasting triglycerides were associated with reduced risks of ischemic vascular disease and ischemic heart disease. Second, we tested whether loss-of-function mutations in APOC3, which were associated with reduced levels of nonfasting triglycerides, were also associated with reduced risks of ischemic vascular disease and ischemic heart disease. During follow-up, ischemic vascular disease developed in 10,797 participants, and ischemic heart disease developed in 7557 of these 10,797 participants. RESULTS: Participants with nonfasting triglyceride levels of less than 1.00 mmol per liter (90 mg per deciliter) had a significantly lower incidence of cardiovascular disease than those with levels of 4.00 mmol per liter (350 mg per deciliter) or more (hazard ratio for ischemic vascular disease, 0.43; 95% confidence interval [CI], 0.35 to 0.54; hazard ratio for ischemic heart disease, 0.40; 95% CI, 0.31 to 0.52). Heterozygosity for loss-of-function mutations in APOC3, as compared with no APOC3 mutations, was associated with a mean reduction in nonfasting triglyceride levels of 44% (P<0.001). The cumulative incidences of ischemic vascular disease and ischemic heart disease were reduced in heterozygotes as compared with noncarriers of APOC3 mutations (P=0.009 and P=0.05, respectively), with corresponding risk reductions of 41% (hazard ratio, 0.59; 95% CI, 0.41 to 0.86; P=0.007) and 36% (hazard ratio, 0.64; 95% CI, 0.41 to 0.99; P=0.04). CONCLUSIONS: Loss-of-function mutations in APOC3 were associated with low levels of triglycerides and a reduced risk of ischemic cardiovascular disease. (Funded by the European Union and others.).

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1056/nejmoa1308027

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Loss-of-function variants in APOC3 confer protection against coronary artery disease, independent of LDL cholesterol levels.

    “loss-of-function variants in APOC3 confer protection against coronary artery disease, independent of LDL cholesterol levels [60, 112]”

    From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [112]

    The Abstract reports a reduced risk of ischemic heart disease among carriers of APOC3 loss-of-function mutations, supporting the protection claim. The paper’s reported risk analysis adjusts for age, sex, smoking, hypertension, physical inactivity, and alcohol consumption, but not LDL cholesterol; it therefore does not establish the claimed independence from LDL cholesterol levels. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Rare loss-of-function mutations in the LPL gene are associated with higher plasma triglyceride levels and a higher risk of cardiovascular disease.

    “rare loss-of-function mutations in the lipoprotein lipase (LPL) gene are associated with higher plasma triglyceride levels and a higher risk of cardiovascular disease”

    From Association of Triglyceride-Lowering <i>LPL</i> Variants and LDL-C–Lowering <i>LDLR</i> Variants With Risk of Coronary Heart Disease (2019) · cites this paper as [10]

    The Abstract (page unavailable) supports the general association between higher triglyceride levels and greater cardiovascular risk. It does not report an association for loss-of-function mutations in the LPL gene: the mutations studied are in APOC3, and they are associated with lower triglyceride levels and reduced risk. The Discussion mentions lipoprotein lipase as an enzyme inhibited by apolipoprotein C3, not as the mutated gene. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • Rare loss-of-function mutations in APOC3, ANGPTL3, and ANGPTL4 are associated with lower triglyceride levels and a corresponding lower risk of cardiovascular disease.

    “while rare, loss-of-function mutations in the APOC3, ANGPTL3, and ANGPTL4 genes, which encode for natural inhibitors of LPL, are associated with lower triglyceride levels and a corresponding lower risk of cardiovascular disease.[9][10][11][12][13]”

    From Association of Triglyceride-Lowering <i>LPL</i> Variants and LDL-C–Lowering <i>LDLR</i> Variants With Risk of Coronary Heart Disease (2019) · cites this paper as [10]

    The Results and Discussion report that APOC3 loss-of-function mutations are associated with lower nonfasting triglycerides and reduced risk of ischemic cardiovascular disease. The paper also describes apolipoprotein C3 as inhibiting lipoprotein lipase, but the passages do not establish the claimed associations for ANGPTL3 or ANGPTL4. Page numbers were not available in our copy. (LLM, conf=0.90)

    Experimental — accuracy not yet measured
  • Loss-of-function mutations of ApoC-III are associated with a lower risk of CVD.

    “In contrary, loss-of-function mutations of the ApoC-III are associated with a lower risk of CVD [170–172].”
  • Apolipoprotein C-III is a central regulator of triglyceride metabolism that limits the clearance of triglyceride-rich lipoproteins through inhibition of lipoprotein lipase and hepatic uptake of triglyceride-rich lipoprotein remnants.

    “Apolipoprotein C-III is a central regulator of triglyceride metabolism that limits the clearance of triglyceride-rich lipoproteins through inhibition of lipoprotein lipase and hepatic uptake of triglyceride-rich lipoprotein remnants. 6-8”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 39 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [38]38. Voight BF, Peloso GM, Orho-Melander M, et al. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. Lancet 2012;380: 572-80. [Erratum, Lancet 2012;380:564.]

Cited by

Sorted by citations

Authors
Jørgensen, A. B., Frikke-Schmidt, R., Nordestgaard, B. G., & Tybjærg-Hansen, A.
Affiliations
University of Copenhagen (DK)
Venue
New England Journal of Medicine
Published
2014-07-03
Volume
371
Issue
1
Pages
32-41
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2052644460
Cited by
919
References
39
Citations by year
2026: 50 · 2025: 76 · 2024: 49 · 2023: 46 · 2022: 65 · 2021: 64 · 2020: 95 · 2019: 71 · 2018: 71 · 2017: 99 · 2016: 113 · 2015: 87 · 2014: 32 · 2013: 1
FWCI
75.40
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Funders
  • Gentofte Hospital
  • Rigshospitalet
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
apolipoprotein C-III, ischemic vascular disease, ischemic heart disease, cardiovascular risk, heterozygosity, genetic variants, triglyceride lowering, general population, hypertriglyceridemia, genetic epidemiology, Mendelian randomization
MeSH terms
Adult, Aged, Female, Genotype, Humans, Ischemia, Cholesterol, LDL, Liver, Male, Middle Aged, Mutation, Risk Factors, Triglycerides, Incidence, Myocardial Ischemia, Sequence Analysis, DNA, Apolipoprotein C-III, Exome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review