Delighted to share our study led by
@tigerstatdoc demonstrating the genetic generalizability of LDL-cholesterol's association with coronary artery disease across 1M individuals globally
evidence.nejm.org/doi/full/1… @NEJMEvidence
While clinical trials of LDL-C-lowering medicines have shown improvement in CAD risk, they generally don't reflect the breadth of patients we evaluate for such medicines. Subgroup analyses in trials to assess for differences are generally very underpowered as they are not the main intention of trials.
The world's human genetic data is (1) larger and covers many more communities and geographies than clinical trials, and (2) can enable causal inference methodologies across these groups.
We assembled data across the US, Europe, Middle East, and South Asia to examine this relationship across individuals of African, admixed American, East Asian, European, Middle Eastern, and South Asian ancestry.
Adjusting for variability in allele frequencies and performance, harmonized the same LDL-C effect, we observed (1) a significant positive association with CAD and (2) heterogeneity in this association.
While this is not a substitute for clinical trials reflecting the breadth of patients we see, the results (1) provide reassurance regarding current clinical practice extrapolating existing trials of LDL-C-lowering therapies, (2) the relationship between LDL-C and CAD appears generally robust across communities & solidifies this as a core pathway for CAD risk reduction, and (3) indicates that investment in adequately powered LDL-C-lowering therapy trials in other communities is likely to yield favorable returns.
Many thanks to the team!
@skoyamamd @HornsbyWhitney @gina_peloso @aklfahed @wallacemwang & others