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Relative effects of LDL-C on ischemic stroke and coronary disease: A Mendelian randomization study.
- Source :
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Neurology [Neurology] 2019 Mar 12; Vol. 92 (11), pp. e1176-e1187. Date of Electronic Publication: 2019 Feb 20. - Publication Year :
- 2019
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Abstract
- Objective: To examine the causal relevance of lifelong differences in low-density lipoprotein cholesterol (LDL-C) for ischemic stroke (IS) relative to that for coronary heart disease (CHD) using a Mendelian randomization approach.<br />Methods: We undertook a 2-sample Mendelian randomization, based on summary data, to estimate the causal relevance of LDL-C for risk of IS and CHD. Information from 62 independent genetic variants with genome-wide significant effects on LDL-C levels was used to estimate the causal effects of LDL-C for IS and IS subtypes (based on 12,389 IS cases from METASTROKE) and for CHD (based on 60,801 cases from CARDIoGRAMplusC4D). We then assessed the effects of LDL-C on IS and CHD for heterogeneity.<br />Results: A 1 mmol/L higher genetically determined LDL-C was associated with a 50% higher risk of CHD (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.32-1.68, p = 1.1 × 10 <superscript>-8</superscript> ). By contrast, the causal effect of LDL-C was much weaker for IS (OR 1.12, 95% CI 0.96-1.30, p = 0.14; p for heterogeneity = 2.6 × 10 <superscript>-3</superscript> ) and, in particular, for cardioembolic stroke (OR 1.06, 95% CI 0.84-1.33, p = 0.64; p for heterogeneity = 8.6 × 10 <superscript>-3</superscript> ) when compared with that for CHD.<br />Conclusions: In contrast with the consistent effects of LDL-C-lowering therapies on IS and CHD, genetic variants that confer lifelong LDL-C differences show a weaker effect on IS than on CHD. The relevance of etiologically distinct IS subtypes may contribute to the differences observed.<br /> (Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)
- Subjects :
- Causality
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Hyperlipidemias drug therapy
Hyperlipidemias genetics
Hypolipidemic Agents therapeutic use
Mendelian Randomization Analysis
Brain Ischemia epidemiology
Cholesterol, LDL blood
Coronary Disease epidemiology
Hyperlipidemias epidemiology
Stroke epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1526-632X
- Volume :
- 92
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Neurology
- Publication Type :
- Academic Journal
- Accession number :
- 30787162
- Full Text :
- https://doi.org/10.1212/WNL.0000000000007091