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  • Original Article
  • OPEN ACCESS

Association of LDLR rs1433099 with the Risk of NAFLD and CVD in Chinese Han Population

  • Yi Han1,2,
  • Yongshuo Zhang3,
  • Shousheng Liu4 ,
  • Guangxia Chen2,
  • Linlin Cao2 and
  • Yongning Xin1,* 
 Author information  Cite
Journal of Clinical and Translational Hepatology   2021;9(2):203-209

doi: 10.14218/JCTH.2020.00163

Abstract

Background and Aims

Recent genome-wide association studies have shown that low-density lipoprotein receptor (LDLR) rs1433099 polymorphism is associated with cardiovascular disease (CVD) risk in many countries. However, the association of LDLR rs1433099 with CVD in China has not been reported yet. There are no studies on LDLR rs1433099 and non-alcoholic fatty liver disease (NAFLD) as well. The purpose of this study was to investigate whether LDLR rs1433099 is related to CVD or NAFLD in the Chinese population.

Methods

LDLR rs1433099 polymorphism was genotyped in 507 individuals, including 140 healthy controls, 79 NAFLD patients, 185 CVD patients, and 103 patients with NAFLD combined with CVD. The expression of LDLR was tested by the sequence detection system, and clinical parameters were assessed by biochemical tests and physical examination.

Results

The genotype distribution of LDLR rs1433099 was not statistically different among the NAFLD group, the CVD group, the combined group, and the healthy control group (p>0.05). There was no significant correlation of LDLR rs1433099 genotypic distribution or allele frequency and the risk of NAFLD, CVD or NAFLD combined with CVD (p>0.05). In the CVD group, T allele carriers had higher alkaline phosphatase and gamma-glutamyl transpeptidase than non-carriers (p<0.05).

Conclusions

Our study demonstrated that the LDLR rs1433099 polymorphism is not a risk factor of NAFLD. The LDLR rs1433099 polymorphism may increase the risk of CVD through a mechanism involving alkaline phosphatase and gamma-glutamyl transpeptidase.

Keywords

LDLR rs1433099, C44857T, CVD, NAFLD, Gene polymorphism

Introduction

Non-alcoholic fatty liver disease (NAFLD) is becoming the most common chronic liver disease. The prevalence of NAFLD is constantly increasing, rising from 15% in 2005 to 25% in 2018.1 Approximately 27% of adults in Asia suffer from NAFLD, the rate of which is even higher in the Middle East and South America, with an estimated prevalence of 32% and 31% respectively.1 It was estimated in 2016 that the annual burden of NAFLD-related cases was $103 billion in the USA and 35 billion in four European countries per year.2

NAFLD consists of a broad spectrum of fatty liver disease, ranging from simple fatty infiltration in >5% of hepatocytes (steatosis), fatty infiltration plus inflammation, fibrosis, and ultimately cirrhosis, ending with liver failure and hepatocellular carcinoma.3 NAFLD is in close relationship with type 2 diabetes mellitus, obesity, and metabolic syndrome.4 Younossi et al.1 estimated that of all patients that have developed non-alcoholic steatohepatitis in the USA, 82% are obese, 48% have type 2 diabetes mellitus, 82% get hyperlipidemia, 76% are diagnosed with metabolic syndrome, and 70% suffer from hypertension. Biopsy remains the gold-standard for assessing the progression of NAFLD, but its side effects keep many patients away, especially in the early stage of fatty liver disease. The most commonly used biomarker of chronic liver disease to evaluate the function of the liver is alanine transaminase (ALT), while it has a low specificity.5

With the development of the genome-wide association studies, many gene loci modulating metabolism have been demonstrated to influence the risk of diseases.6PNPLA3 and TM6SF2 were of the first genes to be related to NAFLD.7,8 The low-density lipoprotein receptor (LDLR) is a widely distributed transmembrane glycoprotein regulating cholesterol homeostasis. Cells can internalize lipoprotein ligands, including chylomicrons, low-density lipoprotein (LDL), intermediate-density lipoprotein, or very-LDL mediated by LDL, facilitating cholesterol utilization.9 The gene for LDLR is located at 19p13.1–13.3 and spans 45 kb, including 18 exons and 17 introns.10 Early studies showed that mutations in LDLR can cause familial hypercholesterolemia, an autosomal dominant disorder characterized by severe hypercholesterolemia.11

C44857T (rs1433099) is a single nucleotide polymorphism within the 5′ region of the 3′ untranslated region of LDLR.12 Polisecki et al.13 found that carriers of the T allele at the C44857T locus had significantly lower levels of LDL-C, suggesting it as a decisive pathogenic factor of NAFLD and cardiovascular disease (CVD). However, the relationship between LDLR rs1433099 and NAFLD is still unknown. It remains unclear whether LDLR rs1433099 affects CVD risk in the Chinese population. Our study aimed to investigate whether LDLR rs1433099 is associated with NAFLD or CVD in the Chinese population.

Methods

Subjects

This study was permitted by the hospital ethical committee of Qingdao Municipal Hospital (Qingdao, China), following the principles of the Declaration of Helsinki and its appendices.14 The study selected 367 in-patients of Qingdao Municipal Hospital from January 2018 to September 2019, including 79 NAFLD patients (NAFLD group), 185 CVD patients (CVD group), and 103 patients with NAFLD combined with CVD (NAFLD combined with CVD group, the combined group). NAFLD patients were selected from the Department of Gastroenterology; CVD patients and NAFLD combined with CVD patients were selected from the Department of Cardiology. At the same time, 140 healthy controls were selected from the Health Examination Center of Qingdao Municipal Hospital. All individuals were unrelated, ethnically Chinese Han adults.

The diagnosis of NAFLD met the standards of the “Guidelines for Prevention and Treatment of Non-alcoholic Fatty Liver Disease”15 and was confirmed by β-ultrasonography. CVD was diagnosed by coronary angiography of the coronary artery or its branches. Excluded were patients with alcoholic hepatitis, viral or autoimmune hepatitis, drug-induced hepatitis, acute fatty liver of pregnancy, and other causes of liver disease, as well as aortic dissection, atrial fibrillation, rheumatic immune disease, cardiomyopathy, aortic arteritis, etc. that may cause secondary CVD. Healthy controls were confirmed by biochemical indicators combined with findings from ultrasound examination.

Specimen and data collection

After 12 hours of fasting, 8 mL of venous blood was collected routinely into two EDTA anti-coagulant tubes (designated as A and B respectively), with 4 mL in each. Tube A was used to detect biochemical indexes, including ALT, aspartate aminotransferase (AST), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT). Tube B was centrifuged and stored at −80 °C for genotyping. The basic information, such as name, sex, and age of the subjects, was gathered by a standard questionnaire. Height and body mass was measured with professional instruments, and the body mass index (BMI) was calculated.

Genotyping

Genomic DNA was isolated from peripheral blood using a purification kit (Bio Miao Biological Technology, Beijing, China). The rs1433099 polymorphism of LDLR was detected by polymerase chain reaction (PCR) using the following primers designed and synthesized for LDLR polymorphism: 5′-ACGTTGGATGAATGATGCCACTTCCCAGAG-3′, 5′-ACGTTGGATGAAGGTAACCGGGTGTCTCAG-3′. PCR amplification was performed under the following conditions: 5 m at 94 °C, then 45 cycles before denaturation at 94 °C for 20 s, annealing at 56 °C for 30 s, and elongation for 1 m at 72 °C. For direct DNA sequencing, the ABI Prism sequence detection system ABI veriti-384 (Foster City, CA, USA) was applied for the assay of LDLR genotypes. The average genotype call rate was above 95% and the genotype concordance rate of blind replicates was above 99%.

Statistical analysis

Statistical analysis was carried out using SPSS Statistics software, version 24.0 (IBM Corp., Armonk, NY, USA). When comparing the general clinical data among the four groups, the count data were compared by the χ2 test. The measurement data, not in accordance with normality and homogeneity of variance by Kolmogorov-Smirnov test, were expressed as median (quartile), compared by Kruskal-Wallis H test. For indexes with statistical differences by rank-sum test, the results were corrected by Bonferroni correction. The χ2 test was used to analyze whether the distribution of LDLR rs1433099 genotypes conformed to the law of Hardy-Weinberg genetic equilibrium to avoid the lack of population representativeness. The χ2 test was used to analyze the differences of LDLR rs1433099 genotype distribution and allele frequency among the four groups. Logistic regression analysis was performed to analyze the relationship between polymorphism and disease risk. Student’s t-test, Kruskal-Wallis test, and rank-sum test were used to evaluate the association of LDLR rs1433099 genotypic distribution with clinical characteristics. A p-value of <0.05 was considered statistically significant.

Results

Clinical characteristics of the individuals

We investigated 507 individuals in total. Table 1 shows the clinical characteristics and serum lipid levels of the subjects as well as comparisons of groups in sex (χ2 test) and other clinical parameters (Kruskal-Wallis test). NAFLD vs. control group: BMI, ALT, TG, GGT, and FBG of the NAFLD group are higher than those of the control group, while age is lower than that of the control group (|Z|=3.053∼17.418, p<0.05). CVD vs. control group: age, ALT, TC, GGT, ALP, and FBG of the CVD group are higher than those of the control group, while TG, HDL-C, and LDL-C are lower than those of the control group (|Z|=2.828∼10.768, p<0.05). Combined group vs. control group: age, BMI, ALT, TC, GGT, ALP, and FBG of the combined group are higher than those of the control group, while TG, HDL-C, and LDL-C of the combined group are lower than those of the control group (|Z|=3.065∼11.713, p<0.05). Combined group vs. NAFLD group: age, ALP, and FBG of the combined group are higher than those of the NAFLD group, while TG, HDL-C, and LDL-C are lower than those of the NAFLD group (|Z|=3.685–9.803, p<0.05).

Table 1

Clinical characteristics of individuals in the four study groups

Control, n=140NAFLD, n=79CVD, n=185Combined, n=103p1*p2*p3*p4*
Sex, M/F60/8057/22120/6567/36<0.001<0.0010.0010.308
Age, years52.5 (42–59)43 (39–45)67 (60–76)62 (56–67)<0.001<0.001<0.001<0.001
BMI, kg/m223.71 (21.26–25.95)26.26 (23.44–28.09)24.54 (22.52–26.72)25.26 (23.78–26.77)<0.0010.214<0.0011.000
ALT, U/L17.79 (12.51–23.68)25.82 (21.71–32.33)21.71 (15.04–32.02)22.63 (15.64–32.78)<0.0010.0010.0040.098
AST, U/L20.75 (17.71–24.84)21.19 (18.31–24.05)21.84 (17.09–33.68)22.09 (16.83–32.46)––––
TG, mmol/L5.11 (4.60–5.72)5.99 (5.34–6.17)4.47 (3.78–5.37)4.27 (3.77–5.55)<0.001<0.001<0.001<0.001
TC, mmol/L1.12 (0.87–1.57)1.03 (1.03–1.59)1.33 (0.96–1.83)1.39 (0.94–2.17)0.9370.0280.0131.000
HDL-C, mmol/L1.29 (1.05–1.50)1.21 (1.08–1.35)1.01 (0.85–1.16)1.05 (0.88–1.19)1.000<0.001<0.001<0.001
LDL-C, mmol/L3.06 (2.65–3.62)3.27 (2.88–3.59)2.66 (2.08–3.33)2.53 (2.12–3.40)0.853<0.0010.002<0.001
GGT, U/L19.90 (14.96–30.26)30.63 (21.21–49.62)27.19 (19.14–44.29)26.43 (18.88–38.98)<0.001<0.0010.0020.292
ALP, U/L70.26 (58.89–83.81)66.17 (55.65–81.47)82.90 (64.86–107.72)81.09 (73.51–98.01)1.000<0.001<0.001<0.001
FBG, mmol/L4.51 (4.00–5.15)4.83 (4.70–4.96)5.23 (4.55–6.75)5.48 (4.81–6.47)0.014<0.001<0.0010.001

P1, NAFLD vs. control; P2, CVD vs. control; P3, Combined vs. control; P4, Combined vs. NAFLD.

*All p-values are Bonferroni corrected.

Abbreviations: NAFLD, non-alcoholic fatty liver disease; CVD, cardiovascular disease; BMI, body mass index; ALT, alanine transaminase; AST, aspartate aminotransferase; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; GGT, gamma-glutamyl transpeptidase; ALP, alkaline phosphatase; FBG, fasting blood glucose.

LDLR rs1433099 genotypes and allele distribution

The genotype distribution of the LDLR rs1433099 corresponds to the Hardy-Weinberg equilibrium in NAFLD, CVD, combined and control groups (pControl=0.681, pNAFLD=0.986, pCVD=0.796, pCombined=0.723). The distribution of LDLR rs1433099 genotypes is shown in Table 2, and there is no significant difference between patients with the NAFLD group, the CVD group, the combined group, and the healthy controls (p>0.05).

Table 2

Correlation of the rs1433099 polymorphism in the LDLR gene with NAFLD and CVD

Control, n=140NAFLD, n=79CVD, n=185Combined, n=103
GenotypesCC70 (50.00%)43 (54.43%)96 (51.89%)62 (60.19%)
CT62 (44.29%)30 (37.97%)78 (42.16%)33 (32.04%)
TT8 (5.71%)6 (7.59%)11 (5.95%)8 (7.77%)
AllelesC202 (72.14%)116 (73.42%)270 (72.97%)157 (76.21%)
T78 (27.86%)42 (26.58%)100 (27.03%)49 (23.79%)

Abbreviations: NAFLD, non-alcoholic fatty liver disease; CVD, cardiovascular disease.

Association of LDLR rs1433099 genotypic distribution and allele frequency with the risk of NAFLD and CVD

Table 3 shows the unconditional logistic regression model analysis for genotypes and alleles of rs1433099. There is no significant correlation between LDLR rs1433099 genotypic distribution or allele frequency for the risk of NAFLD, CVD or NAFLD combined with CVD (p>0.05). We observed no significant difference after adjustment for age, sex, and BMI (p>0.05).

Table 3

LDLR rs1433099 genotypes, alleles, and risk of NAFLD and CVD

NAFLD vs. control
CVD vs. control
Combined vs. control
Combined vs. NAFLD
OR (95% CI)p*OR (95% CI)p*OR (95% CI)p*OR (95% CI)p*
Genotypes
  CC10.52910.73510.11610.436
  CT+TT0.84 (0.48–1.46)0.93 (0.60–1.44)0.66 (0.40–1.11)0.79 (0.44–1.43)
Allele
  C10.77410.81410.31310.542
  T0.94 (0.60–1.46)0.96 (0.68–1.36)0.81 (0.53–1.22)0.862 (0.535–1.389)
Adjusted Genotypes
  CC10.27310.45010.19810.358
  CT+TT0.68 (0.34–1.35)0.80 (0.45–1.42)0.67 (0.37–1.23)0.43 (0.07–2.64)
Allele
  C10.72210.34010.34410.444
  T0.91 (0.53–1.55)0.81 (0.52–1.26)0.79 (0.49–1.28)0.571 (0.136–2.401)

*All p-values are Bonferroni corrected.

Abbreviations: NAFLD, non-alcoholic fatty liver disease; CVD, cardiovascular disease; OR, odds ratio; CI, confidence interval.

Association of LDLR rs1433099 genotypic distribution with clinical characteristics

Table 4 shows clinical characteristics in LDLR rs1433099 T carriers and non-carriers. Statistical analysis indicates no significant difference between the T-carriers and non-carriers among all subjects (p>0.05). Further analysis among the three genotypes suggests no statistical difference as well (Table 5; p>0.05). Analysis of clinical characteristics of LDLR rs1433099 in each group shows that T-carriers have higher ALP and GGT than non-carriers in the CVD group (Table 6; p<0.05).

Table 4

Clinical characteristics of LDLR rs1433099 T carriers and non-carriers

CC, n=271CT+TT, n=236p
Sex, M/F154/117150/860.123
Age, years57.84±14.0257.44±13.680.743
BMI, kg/m224.97 (22.53–27.14)24.67 (22.86–26.47)0.385
ALT, U/L21.71 (15.49–30.21)20.92 (14.80–31.92)0.952
AST, U/L21.19 (18.01–25.83)22.02 (18.17–27.59)0.375
TG, mmol/L4.99±1.184.87±1.200.252
TC, mmol/L1.30 (0.96–1.86)1.26 (0.90–1.76)0.434
HDL-C, mmol/L1.10 (0.94–1.31)1.12 (0.94–1.29)0.962
LDL-C, mmol/L2.90 (2.33–3.45)2.94 (2.28–3.46)0.683
GGT, U/L25.21 (17.97–38.14)26.74 (18.50–42.04)0.526
ALP, U/L74.59 (61.30–91.52)79.38 (64.15–97.37)0.052
FBG, mmol/L4.91 (4.55–5.72)4.97 (4.49–5.98)0.530

Abbreviations: BMI, body mass index; ALT, alanine transaminase; AST, aspartate aminotransferase; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; GGT, gamma-glutamyl transpeptidase; ALP, alkaline phosphatase; FBG, fasting blood glucose.

Table 5

Analysis of clinical characteristics for LDLR rs1433099 C/T genotypes

CC, n=271CT, n=203TT, n=33p
Sex, M/F154/117127/7623/100.225
Age, years59 (46–67)59 (46–66)60 (51–68)0.556
BMI, kg/m224.87±3.3524.70±3.2424.85±2.950.850
ALT, U/L21.71 (15.49–30.21)20.88 (15.21–32.33)21.67 (13.28–30.21)0.947
AST, U/L21.19 (18.01–25.83)22.04 (18.15–28.09)21.19 (17.95–25.43)0.653
TG, mmol/L4.99±1.184.88±1.194.78±1.300.466
TC, mmol/L1.30 (0.96–1.86)1.25 (0.90–1.79)1.41 (0.92–1.67)0.601
HDL-C, mmol/L1.10 (0.94–1.31)1.12 (0.95–1.29)1.01 (0.88–1.32)0.678
LDL-C, mmol/L2.90 (2.33–3.45)2.96 (2.29–3.45)2.93 (2.22–3.64)0.918
GGT, U/L25.21 (17.97–38.14)26.53 (18.49–42.97)29.46 (18.51–38.91)0.818
ALP, U/L74.59 (61.30–91.52)80.28 (63.92–98.34)78.06 (65.18–92.93)0.148
FBG, mmol/L4.91 (4.55–5.72)4.95 (4.47–5.84)5.00 (4.63–6.51)0.552

Abbreviations: BMI, body mass index; ALT, alanine transaminase; AST, aspartate aminotransferase; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; GGT, gamma-glutamyl transpeptidase; ALP, alkaline phosphatase; FBG, fasting blood glucose.

Table 6

Analysis of clinical characteristics in LDLR rs1433099 T carriers and non-carriers of each group

pControl*pNAFLD*pCVD*
Age, years0.6080.8470.532
BMI, kg/m20.5120.4560.701
ALT, U/L0.3760.2760.524
AST, U/L0.4970.2670.349
TG, mmol/L0.5630.4770.157
TC, mmol/L0.5220.7010.957
HDL-C, mmol/L0.5820.6190.595
LDL-C, mmol/L0.1700.4000.392
GGT, U/L0.1790.9290.002#
ALP, U/L0.1810.3700.024#
FBG, mmol/L0.4880.2280.312

*Significance of each group comparing CT+TT and CC individuals.

#T carriers have higher ALP and GGT in the CVD group.

Abbreviations: NAFLD, non-alcoholic fatty liver disease; CVD, cardiovascular disease; BMI, body mass index; ALT, alanine transaminase; AST, aspartate aminotransferase; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; GGT, gamma-glutamyl transpeptidase; ALP, alkaline phosphatase; FBG, fasting blood glucose.

Discussion

LDLR is a cell-surface receptor that removes excessive LDL from plasma and maintains the circulating cholesterol level.16 LDLR is closely related to metabolic syndrome.17 In the whole population, 0.2–0.5% of people have heterozygous mutations in LDLR.18

Recently, international experts reached a consensus recommending a change in name from NAFLD to metabolic (dysfunction)-associated fatty liver disease,19 emphasizing it as a consequence of metabolic syndrome. Lipotoxicity is the initial factor in NAFLD development. Former studies showed that LDLR rs1433099 mutation can induce dyslipidemia,12,13,20 suggesting that it may influence the risk of NAFLD. We explored the relationship between LDLR rs1433099 and NAFLD for the first time. But this research shows no association for LDLR rs1433099 polymorphism with the incidence of NAFLD.

LDLR also has a close relationship with the development of atherosclerosis.21,22 Abnormal LDLR alleles in the human manifest as familial hypercholesterolemia, with dramatically increased risk of CVD.9,18 The severity of atherosclerosis is in correlation with the level and activity of liver LDLR.23

Previously, Anand et al.24 conducted the INTERHEART case-control study, which included 8,795 individuals of European, South Asian, Arab, Iranian, and Nepalese origin. The investigators found that LDLR rs1433099 is associated with a lower apolipoprotein B/A1 ratio, an indicator proportional to the narrowness of coronary artery (p=0.0022). No direct correlation between LDLR rs1433099 and myocardial infarction was found. Takeuchi et al.20 investigated the relationship of LDLR rs1433099 and the risk of CVD in Japan from 12,066 individuals. Their study indicated a strong association of LDLR rs1433099 genotype with the risk of CVD (p=2.1×10−7). However, clinical parameters between our study and the Japanese study did not show a significant difference. The inconsistent results between this study and the previous study may be contributed by the smaller sample size and differences in region and ethnicity.

Our data indicate that LDLR rs1433099 T-carriers have higher ALP and GGT than non-carriers in the CVD group. Numerous studies have revealed the association of CVD with ALP and GGT. A cross-sectional research study including 5,995 individuals found that elevated serum ALP is correlated with peripheral arterial disease.25 A Korean study including 3,091 participants indicated an independently positive relationship of ALP with carotid-femoral pulse wave velocity, a surrogate marker for arterial stiffness.26 Many studies have shown that GGT is correlated with traditional risk factors for CVD, such as TC, LDL-C, glucose, insulin, BMI, etc.27–32 Further studies showed that higher GGT may increase cardiovascular mortality,33–38 and is an independent predictor for future cardiovascular mortality.39,40 Even within the normal range, higher GGT is associated with CVD risk factors,41–44 suggesting GGT as a superior marker for predicting CVD risk.45 Kunutsor et al.46 performed a meta-analysis including 20 GGT-related studies and 4 ALP-related studies, and found that baseline levels of ALP and GGT are each positively related to CVD risk. Recently, a dose-response meta-analysis including 23 studies with 1,067,922 participants revealed a direct relationship between ALP and GGT levels and the risk of CVD mortality.47 While the specific mechanisms remain unclear for the moment, increasing evidence has demonstrated that ALP and GGT can promote CVD by facilitating oxidative stress and vascular calcification.48,49

We can conclude that LDLR rs1433099 polymorphism may increase the risk of CVD through ALP and GGT, from this first related research study in China; moreover, these findings are consistent with previous findings.20,24

Our study has the following limitations. First, selection bias may exist since subjects comprised only a small sample size of patients in Qingdao district. Second, this study was confined to Chinese Han population in northern China, possibly with racial and geographical bias. Third, this study did not grade the severity of NAFLD patients. Further studies with more subjects should be conducted to illustrate the relationship of LDLR rs1433099 polymorphism with the risk of NAFLD in other ethnicities.

Conclusions

In conclusion, this study addressed that there was no association between LDLR rs1433099 polymorphism and incidence of NAFLD, for the first time. The LDLR rs1433099 T allele was found to significantly affect serum ALP and GGT in the CVD group. We can assume that LDLR rs1433099 polymorphism may influence the risk of CVD by ALP and GGT. The variant may be a risk factor in the early stage. Further studies on a large-scale population of subjects and of different ethnicity are needed to estimate the impact of LDLR rs1433099 on CVD and NAFLD patients. Further research on the role of LDLR rs1433099 in CVD might help to enhance the application of future therapeutic strategies and interventions.

Abbreviations

ALP: 

alkaline phosphatase

ALT: 

alanine transaminase

AST: 

aspartate aminotransferase

BMI: 

body mass index

CVD: 

cardiovascular disease

FBG: 

fasting blood glucose

GGT: 

gamma-glutamyl transpeptidase

HDL-C: 

high-density lipoprotein cholesterol

LDL: 

low-density lipoprotein

LDL-C: 

low-density lipoprotein cholesterol

LDLR: 

low-density lipoprotein receptor

NAFLD: 

non-alcoholic fatty liver disease

PCR: 

polymerase chain reaction

TC: 

total cholesterol

TG: 

triglyceride

Declarations

Acknowledgement

We thank Dr. Zhenzhen Zhao for the assistance in this study.

Data sharing statement

All data generated or analyzed in this study are available from the corresponding author for the reasonable request.

Funding

This study was supported by grants from the National Natural Science Foundation of China (No. 31770837).

Conflict of interest

The authors have no conflict of interests related to this publication.

Authors’ contributions

Design and data interpretation (YNX, YH, YSZ), manuscript writing (YH, SSL), critical revision of the manuscript (YSZ, SSL, GXC, LLC). All authors reviewed and commented on the manuscript and approved the final version.

References

  1. Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 2018;15(1):11-20 View Article
  2. Younossi ZM, Blissett D, Blissett R, Henry L, Stepanova M, Younossi Y, et al. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. Hepatology 2016;64(5):1577-1586 View Article
  3. Friedman SL, Neuschwander-Tetri BA, Rinella M, Sanyal AJ. Mechanisms of NAFLD development and therapeutic strategies. Nat Med 2018;24(7):908-922 View Article
  4. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol 2015;62(1 Suppl):S47-64 View Article
  5. Vilar-Gomez E, Chalasani N. Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers. J Hepatol 2018;68(2):305-315 View Article
  6. Fan JG, Kim SU, Wong VW. New trends on obesity and NAFLD in Asia. J Hepatol 2017;67(4):862-873 View Article
  7. Wong VW, Wong GL, Tse CH, Chan HL. Prevalence of the TM6SF2 variant and non-alcoholic fatty liver disease in Chinese. J Hepatol 2014;61(3):708-709 View Article
  8. Romeo S, Kozlitina J, Xing C, Pertsemlidis A, Cox D, Pennacchio LA, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet 2008;40(12):1461-1465 View Article
  9. Go GW, Mani A. Low-density lipoprotein receptor (LDLR) family orchestrates cholesterol homeostasis. Yale J Biol Med 2012;85(1):19-28
  10. Do R, Stitziel NO, Won HH, Jørgensen AB, Duga S, Angelica Merlini P, et al. Exome sequencing identifies rare LDLR and APOA5 alleles conferring risk for myocardial infarction. Nature 2015;518(7537):102-106 View Article
  11. Varret M, Rabès JP, Collod-Béroud G, Junien C, Boileau C, Béroud C. Software and database for the analysis of mutations in the human LDL receptor gene. Nucleic Acids Res 1997;25(1):172-180 View Article
  12. Muallem H, North KE, Kakoki M, Wojczynski MK, Li X, Grove M, et al. Quantitative effects of common genetic variations in the 3’UTR of the human LDL-receptor gene and their associations with plasma lipid levels in the atherosclerosis risk in communities study. Hum Genet 2007;121(3-4):421-431 View Article
  13. Polisecki E, Muallem H, Maeda N, Peter I, Robertson M, McMahon AD, et al. Genetic variation at the LDL receptor and HMG-CoA reductase gene loci, lipid levels, statin response, and cardiovascular disease incidence in PROSPER. Atherosclerosis 2008;200(1):109-114 View Article
  14. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013;310(20):2191-2194 View Article
  15. Fan JG, Wei L, Zhuang H, On behalf of the National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association; Fatty Liver Disease Expert Committee, Chinese Medical Doctor Association. Guidelines of prevention and treatment of nonalcoholic fatty liver disease (2018, China). J Dig Dis 2019;20(4):163-173 View Article
  16. Zhong S, Li L, Zhang YL, Zhang L, Lu J, Guo S, et al. Acetaldehyde dehydrogenase 2 interactions with LDLR and AMPK regulate foam cell formation. J Clin Invest 2019;129(1):252-267 View Article
  17. Jin WY, Zhao ZY. Progress on association between low-density lipoprotein receptor and metabolic syndrome. Zhejiang Da Xue Xue Bao Yi Xue Ban 2015;44(1):101-107
  18. Benito-Vicente A, Uribe KB, Jebari S, Galicia-Garcia U, Ostolaza H, Martin C. Validation of LDLr activity as a tool to improve genetic diagnosis of familial hypercholesterolemia: a retrospective on functional characterization of LDLr variants. Int J Mol Sci 2018;19(6):1676 View Article
  19. Fouad Y, Wa Fouad Y, Waked I, Bollipo S, Gomaa A, Ajlouni Y, et al. What’s in a name? Renaming ‘NAFLD’ to ‘MAFLD’. Liver Int 2020;40(6):1254-1261 View Article
  20. Takeuchi F, Isono M, Katsuya T, Yokota M, Yamamoto K, Nabika T, et al. Association of genetic variants influencing lipid levels with coronary artery disease in Japanese individuals. PLoS One 2012;7(9):e46385 View Article
  21. Zhao Y, Yang Y, Xing R, Cui X, Xiao Y, Xie L, et al. Hyperlipidemia induces typical atherosclerosis development in Ldlr and Apoe deficient rats. Atherosclerosis 2018;271:26-35 View Article
  22. Davis BT, Wang XJ, Rohret JA, Struzynski JT, Merricks EP, Bellinger DA, et al. Targeted disruption of LDLR causes hypercholesterolemia and atherosclerosis in Yucatan miniature pigs. PLoS One 2014;9(4):e93457 View Article
  23. Zhao H, Li Y, He L, Pu W, Yu W, Li Y, et al. In vivo AAV-CRISPR/Cas9-mediated gene editing ameliorates atherosclerosis in familial hypercholesterolemia. Circulation 2020;141(1):67-79 View Article
  24. Anand SS, Xie C, Paré G, Montpetit A, Rangarajan S, McQueen MJ, et al. Genetic variants associated with myocardial infarction risk factors in over 8000 individuals from five ethnic groups: The INTERHEART genetics study. Circ Cardiovasc Genet 2009;2(1):16-25 View Article
  25. Cheung BM, Ong KL, Wong LY. Elevated serum alkaline phosphatase and peripheral arterial disease in the United States National Health and Nutrition Examination Survey 1999-2004. Int J Cardiol 2009;135(2):156-161 View Article
  26. Lee JH, Lee JW, Lee YJ. The relationship between serum alkaline phosphatase and arterial stiffness in Korean adults. J Atheroscler Thromb 2019;26(12):1084-1091 View Article
  27. Bobrus-Chociej A, Flisiak-Jackiewicz M, Daniluk U, Wojtkowska M, Kłusek-Oksiuta M, Tarasów E, et al. Estimation of gamma-glutamyl transferase as a suitable simple biomarker of the cardiovascular risk in children with non-alcoholic fatty liver disease. Acta Biochim Pol 2018;65(4):539-544 View Article
  28. Bradley R, Fitzpatrick AL, Jenny NS, Lee DH, Jacobs DR. Associations between total serum GGT activity and metabolic risk: MESA. Biomark Med 2013;7(5):709-721 View Article
  29. Bradley RD, Fitzpatrick AL, Jacobs DR, Lee DH, Swords Jenny N, Herrington D. Associations between γ-glutamyltransferase (GGT) and biomarkers of atherosclerosis: the Multi-ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2014;233(2):387-393 View Article
  30. Franzini M, Paolicchi A, Fornaciari I, Ottaviano V, Fierabracci V, Maltinti M, et al. Cardiovascular risk factors and gamma-glutamyltransferase fractions in healthy individuals. Clin Chem Lab Med 2010;48(5):713-717 View Article
  31. Lee DS, Evans JC, Robins SJ, Wilson PW, Albano I, Fox CS, et al. Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the framingham heart study. Arterioscler Thromb Vasc Biol 2007;27(1):127-133 View Article
  32. Li DD, Xu T, Cheng XQ, Wu W, Ye YC, Guo XZ, et al. Serum gamma-glutamyltransferase levels are associated with cardiovascular risk factors in China: a nationwide population-based study. Sci Rep 2018;8(1):16533 View Article
  33. Choi KM, Han K, Park S, Chung HS, Kim NH, Yoo HJ, et al. Implication of liver enzymes on incident cardiovascular diseases and mortality: a nationwide population-based cohort study. Sci Rep 2018;8(1):3764 View Article
  34. Kengne AP, Czernichow S, Stamatakis E, Hamer M, Batty GD. Gamma-glutamyltransferase and risk of cardiovascular disease mortality in people with and without diabetes: pooling of three British Health Surveys. J Hepatol 2012;57(5):1083-1089 View Article
  35. Kim JG, Chang K, Choo EH, Lee JM, Seung KB. Serum gamma-glutamyl transferase is a predictor of mortality in patients with acute myocardial infarction. Medicine (Baltimore) 2018;97(29):e11393 View Article
  36. Ndrepepa G, Braun S, Schunkert H, Laugwitz KL, Kastrati A. Gamma-glutamyl transferase and prognosis in patients with coronary artery disease. Clin Chim Acta 2016;452:155-160 View Article
  37. Wannamethee G, Ebrahim S, Shaper AG. Gamma-glutamyltransferase: determinants and association with mortality from ischemic heart disease and all causes. Am J Epidemiol 1995;142(7):699-708 View Article
  38. Yi SW, Lee SH, Hwang HJ, Yi JJ. Gamma-glutamyltransferase and cardiovascular mortality in Korean adults: A cohort study. Atherosclerosis 2017;265:102-109 View Article
  39. Du G, Song Z, Zhang Q. Gamma-glutamyltransferase is associated with cardiovascular and all-cause mortality: a meta-analysis of prospective cohort studies. Prev Med 2013;57(1):31-37 View Article
  40. Loomba R, Doycheva I, Bettencourt R, Cohen B, Wassel CL, Brenner D, et al. Serum γ-glutamyltranspeptidase predicts all-cause, cardiovascular and liver mortality in older adults. J Clin Exp Hepatol 2013;3(1):4-11 View Article
  41. Kazemi-Shirazi L, Endler G, Winkler S, Schickbauer T, Wagner O, Marsik C. Gamma glutamyltransferase and long-term survival: is it just the liver?. Clin Chem 2007;53(5):940-946 View Article
  42. Lim JS, Kim YJ, Chun BY, Yang JH, Lee DH, Kam S. The association between serum GGT level within normal range and risk factors of cardiovascular diseases. J Prev Med Public Health 2005;38(1):101-6
  43. Strasak AM, Kelleher CC, Klenk J, Brant LJ, Ruttmann E, Rapp K, et al. Longitudinal change in serum gamma-glutamyltransferase and cardiovascular disease mortality: a prospective population-based study in 76,113 Austrian adults. Arterioscler Thromb Vasc Biol 2008;28(10):1857-1865 View Article
  44. Wang J, Zhang D, Huang R, Li X, Huang W. Gamma-glutamyltransferase and risk of cardiovascular mortality: a dose-response meta-analysis of prospective cohort studies. PLoS One 2017;12(2):e0172631 View Article
  45. Park EO, Bae EJ, Park BH, Chae SW. The associations between liver enzymes and cardiovascular risk factors in adults with mild dyslipidemia. J Clin Med 2020;9(4):1147 View Article
  46. Kunutsor SK, Apekey TA, Khan H. Liver enzymes and risk of cardiovascular disease in the general population: a meta-analysis of prospective cohort studies. Atherosclerosis 2014;236(1):7-17 View Article
  47. Rahmani J, Miri A, Namjoo I, Zamaninour N, Maljaei MB, Zhou K, et al. Elevated liver enzymes and cardiovascular mortality: a systematic review and dose-response meta-analysis of more than one million participants. Eur J Gastroenterol Hepatol 2019;31(5):555-562 View Article
  48. Haarhaus M, Brandenburg V, Kalantar-Zadeh K, Stenvinkel P, Magnusson P. Alkaline phosphatase: a novel treatment target for cardiovascular disease in CKD. Nat Rev Nephrol 2017;13(7):429-442 View Article
  49. Ndrepepa G, Colleran R, Kastrati A. Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease. Clin Chim Acta 2018;476:130-138 View Article
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  • Journal of Clinical and Translational Hepatology
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  • eISSN 2310-8819

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Association of LDLR rs1433099 with the Risk of NAFLD and CVD in Chinese Han Population

Yi Han, Yongshuo Zhang, Shousheng Liu, Guangxia Chen, Linlin Cao, Yongning Xin
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