Plasma urate concentration and risk of coronary heart disease: a Mendelian randomisation analysis.

Autor:	White J; UCL Genetics Institute, University College, London, UK. Electronic address: jon.white@ucl.ac.uk., Sofat R; Centre for Clinical Pharmacology, University College London, London, UK., Hemani G; MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK., Shah T; Institute of Cardiovascular Science and Farr Institute, University College London, London, UK., Engmann J; Institute of Cardiovascular Science and Farr Institute, University College London, London, UK., Dale C; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK., Shah S; Queensland Brain Institute, University of Queensland, QLD, Australia., Kruger FA; Institute of Cardiovascular Science and Farr Institute, University College London, London, UK., Giambartolomei C; UCL Genetics Institute, University College, London, UK., Swerdlow DI; Institute of Cardiovascular Science and Farr Institute, University College London, London, UK., Palmer T; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK., McLachlan S; Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK., Langenberg C; Institute of Cardiovascular Science and Farr Institute, University College London, London, UK; MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK., Zabaneh D; UCL Genetics Institute, University College, London, UK., Lovering R; Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, London, UK., Cavadino A; Population, Policy and Practice, UCL Institute of Child Health, University College London, London, UnK., Jefferis B; Department of Primary Care & Population Health, University College London, Royal Free Campus, London, UK., Finan C; Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK., Wong A; MRC Unit for Lifelong Health and Ageing at UCL, London, UK., Amuzu A; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK., Ong K; MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK; MRC Unit for Lifelong Health and Ageing at UCL, London, UK., Gaunt TR; MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK., Warren H; Department of Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Denstistry, Queen Mary University of London, London, UK; NIHR Barts Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK., Davies TL; School of Social and Community Medicine, University of Bristol, Bristol, UK., Drenos F; Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, London, UK; MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK., Cooper J; Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, London, UK., Ebrahim S; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK., Lawlor DA; MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK., Talmud PJ; Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, London, UK., Humphries SE; Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, Institute of Cardiovascular Science, University College London, London, UK., Power C; Population, Policy and Practice, UCL Institute of Child Health, University College London, London, UnK., Hypponen E; Population, Policy and Practice, UCL Institute of Child Health, University College London, London, UnK; School of Population Health and Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia., Richards M; MRC Unit for Lifelong Health and Ageing at UCL, London, UK., Hardy R; MRC Unit for Lifelong Health and Ageing at UCL, London, UK., Kuh D; MRC Unit for Lifelong Health and Ageing at UCL, London, UK., Wareham N; MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK., Ben-Shlomo Y; School of Social and Community Medicine, University of Bristol, Bristol, UK., Day IN; School of Social and Community Medicine, University of Bristol, Bristol, UK., Whincup P; Population Health Research Institute, St George's, University of London, London, UK., Morris R; Department of Primary Care & Population Health, University College London, Royal Free Campus, London, UK., Strachan MW; Metabolic Unit, Western General Hospital, Edinburgh, UK., Price J; Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK., Kumari M; Institute for Social and Economic Research, University of Essex, Colchester, UK., Kivimaki M; Department of Epidemiology & Public Health, UCL Institute of Epidemiology & Health Care, University College London, London, UK., Plagnol V; UCL Genetics Institute, University College, London, UK., Whittaker JC; Genetics Division, Research and Development, GlaxoSmithKline, Harlow, UK., Smith GD; MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK., Dudbridge F; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK., Casas JP; Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Institute of Cardiovascular Science and Farr Institute, University College London, London, UK., Holmes MV; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Department of Surgery and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: michael.holmes@ndph.ox.ac.uk., Hingorani AD; Institute of Cardiovascular Science and Farr Institute, University College London, London, UK.
Jazyk:	angličtina
Zdroj:	The lancet. Diabetes & endocrinology [Lancet Diabetes Endocrinol] 2016 Apr; Vol. 4 (4), pp. 327-36. Date of Electronic Publication: 2016 Jan 16.
DOI:	10.1016/S2213-8587(15)00386-1
Abstrakt:	Background: Increased circulating plasma urate concentration is associated with an increased risk of coronary heart disease, but the extent of any causative effect of urate on risk of coronary heart disease is still unclear. In this study, we aimed to clarify any causal role of urate on coronary heart disease risk using Mendelian randomisation analysis. Methods: We first did a fixed-effects meta-analysis of the observational association of plasma urate and risk of coronary heart disease. We then used a conventional Mendelian randomisation approach to investigate the causal relevance using a genetic instrument based on 31 urate-associated single nucleotide polymorphisms (SNPs). To account for potential pleiotropic associations of certain SNPs with risk factors other than urate, we additionally did both a multivariable Mendelian randomisation analysis, in which the genetic associations of SNPs with systolic and diastolic blood pressure, HDL cholesterol, and triglycerides were included as covariates, and an Egger Mendelian randomisation (MR-Egger) analysis to estimate a causal effect accounting for unmeasured pleiotropy. Findings: In the meta-analysis of 17 prospective observational studies (166 486 individuals; 9784 coronary heart disease events) a 1 SD higher urate concentration was associated with an odds ratio (OR) for coronary heart disease of 1·07 (95% CI 1·04-1·10). The corresponding OR estimates from the conventional, multivariable adjusted, and Egger Mendelian randomisation analysis (58 studies; 198 598 individuals; 65 877 events) were 1·18 (95% CI 1·08-1·29), 1·10 (1·00-1·22), and 1·05 (0·92-1·20), respectively, per 1 SD increment in plasma urate. Interpretation: Conventional and multivariate Mendelian randomisation analysis implicates a causal role for urate in the development of coronary heart disease, but these estimates might be inflated by hidden pleiotropy. Egger Mendelian randomisation analysis, which accounts for pleiotropy but has less statistical power, suggests there might be no causal effect. These results might help investigators to determine the priority of trials of urate lowering for the prevention of coronary heart disease compared with other potential interventions. Funding: UK National Institute for Health Research, British Heart Foundation, and UK Medical Research Council. (Copyright © 2016 White et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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