@article {22, title = {Human genetic insights into lipoproteins and risk of cardiometabolic disease.}, journal = {Curr Opin Lipidol}, volume = {28}, year = {2017}, month = {2017 Apr}, pages = {113-119}, abstract = {

PURPOSE OF REVIEW: Human genetic studies have been successfully used to identify genes and pathways relevant to human biology. Using genetic instruments composed of loci associated with human lipid traits, recent studies have begun to clarify the causal role of major lipid fractions in risk of cardiometabolic disease.

RECENT FINDINGS: The causal relationship between LDL cholesterol and coronary disease has been firmly established. Of the remaining two major fractions, recent studies have found that HDL cholesterol is not likely to be a causal particle in atherogenesis, and have instead shifted the causal focus to triglyceride-rich lipoproteins. Subsequent results are refining this view to suggest that triglycerides themselves might not be causal, but instead may be a surrogate for the causal cholesterol content within this fraction. Other studies have used a similar approach to address the association between lipid fractions and risk of type 2 diabetes. Beyond genetic variation in the target of statin medications, reduced LDL cholesterol associated with multiple genes encoding current or prospective drug targets associated with increased diabetic risk. In addition, genetically lower HDL cholesterol and genetically lower triglycerides both appear to increase risk of type 2 diabetes.

SUMMARY: Results of these and future human genetic studies are positioned to provide substantive insights into the causal relationship between lipids and human disease, and should highlight mechanisms with important implications for our understanding of human biology and future lipid-altering therapeutic development.

}, keywords = {Cardiovascular Diseases, Genetic Predisposition to Disease, Humans, Lipoproteins, Risk}, issn = {1473-6535}, doi = {10.1097/MOL.0000000000000389}, author = {Stitziel, Nathan O} } @article {8, title = {Genetic Risk, Adherence to a Healthy Lifestyle, and Coronary Disease.}, journal = {N Engl J Med}, volume = {375}, year = {2016}, month = {2016 Dec 15}, pages = {2349-2358}, abstract = {

BACKGROUND: Both genetic and lifestyle factors contribute to individual-level risk of coronary artery disease. The extent to which increased genetic risk can be offset by a healthy lifestyle is unknown.

METHODS: Using a polygenic score of DNA sequence polymorphisms, we quantified genetic risk for coronary artery disease in three prospective cohorts - 7814 participants in the Atherosclerosis Risk in Communities (ARIC) study, 21,222 in the Women{\textquoteright}s Genome Health Study (WGHS), and 22,389 in the Malm{\"o} Diet and Cancer Study (MDCS) - and in 4260 participants in the cross-sectional BioImage Study for whom genotype and covariate data were available. We also determined adherence to a healthy lifestyle among the participants using a scoring system consisting of four factors: no current smoking, no obesity, regular physical activity, and a healthy diet.

RESULTS: The relative risk of incident coronary events was 91\% higher among participants at high genetic risk (top quintile of polygenic scores) than among those at low genetic risk (bottom quintile of polygenic scores) (hazard ratio, 1.91; 95\% confidence interval [CI], 1.75 to 2.09). A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor), regardless of the genetic risk category. Among participants at high genetic risk, a favorable lifestyle was associated with a 46\% lower relative risk of coronary events than an unfavorable lifestyle (hazard ratio, 0.54; 95\% CI, 0.47 to 0.63). This finding corresponded to a reduction in the standardized 10-year incidence of coronary events from 10.7\% for an unfavorable lifestyle to 5.1\% for a favorable lifestyle in ARIC, from 4.6\% to 2.0\% in WGHS, and from 8.2\% to 5.3\% in MDCS. In the BioImage Study, a favorable lifestyle was associated with significantly less coronary-artery calcification within each genetic risk category.

CONCLUSIONS: Across four studies involving 55,685 participants, genetic and lifestyle factors were independently associated with susceptibility to coronary artery disease. Among participants at high genetic risk, a favorable lifestyle was associated with a nearly 50\% lower relative risk of coronary artery disease than was an unfavorable lifestyle. (Funded by the National Institutes of Health and others.).

}, keywords = {Aged, Cohort Studies, Coronary Disease, Cross-Sectional Studies, Female, Genetic Predisposition to Disease, Healthy Lifestyle, Humans, Incidence, Male, Middle Aged, Multifactorial Inheritance, Patient Compliance, Polymorphism, Genetic, Risk}, issn = {1533-4406}, doi = {10.1056/NEJMoa1605086}, author = {Khera, Amit V and Emdin, Connor A and Drake, Isabel and Natarajan, Pradeep and Bick, Alexander G and Cook, Nancy R and Chasman, Daniel I and Baber, Usman and Mehran, Roxana and Rader, Daniel J and Fuster, Valentin and Boerwinkle, Eric and Melander, Olle and Orho-Melander, Marju and Ridker, Paul M and Kathiresan, Sekar} }