Effects of apolipoprotein B on lifespan and risks of major diseases including type 2 diabetes: a mendelian randomisation analysis using outcomes in first-degree relatives

Background Apolipoprotein B (apoB) is emerging as the crucial lipoprotein trait for the role of lipoprotein lipids in the aetiology of coronary heart disease. In this study, we evaluated the effects of genetically predicted apoB on outcomes in first-degree relatives. Methods Data on lipoprotein lipids and disease outcomes in first-degree relatives were obtained from the UK Biobank study. We did a univariable mendelian randomisation analysis using a weighted genetic instrument for apoB. For outcomes with which apoB was associated at a false discovery rate (FDR) of less than 5%, multivariable mendelian randomisation analyses were done, including genetic instruments for LDL cholesterol and triglycerides. Associations between apoB and self-reported outcomes in first-degree relatives were characterised for 12 diseases (including heart disease, stroke, and hypertension) and parental vital status together with age at death. Estimates were inferred causal effects per 1 SD elevated lipoprotein trait (for apoB, 1 SD=0.24 g/L). Replication of estimates for lifespan and type 2 diabetes was done using conventional two-sample mendelian randomisation with summary estimates from genomewide association study consortia. Findings In univariable mendelian randomisation, genetically elevated apoB in participants was identified to lead to a shorter lifespan in parents (fathers: 0.89 years of life lost per 1 SD higher apoB in offspring, 95% CI 0.63-1.16, FDR-adjusted p=4.0 x 10-(10); mothers: 0.48 years of life lost per 1 SD higher apoB in offspring, 0.25-0.71, FDR-adjusted p=1.7 x 10(-4)). The effects were strengthened to around 2 years of life lost in multivariable mendelian randomisation and were replicated in conventional two-sample mendelian randomisation (odds ratio [OR] of surviving to the 90th centile of lifespan: 0.38 per 1 SD higher apoB in offspring, 95% CI 0.22-0.65). Genetically elevated apoB caused higher risks of heart disease in all first-degree relatives and a higher risk of stroke in mothers. Findings in first-degree relatives were replicated in two-sample multivariable mendelian randomisation, which identified apoB to increase (OR 2.32 per 1 SD higher apoB, 95% CI 1.49-3.61) and LDL cholesterol to decrease (0.34 per 1 SD higher LDL cholesterol, 0.21-0.54) the risk of type 2 diabetes. Interpretation Higher apoB shortens lifespan, increases risks of heart disease and stroke, and in multivariable analyses that account for LDL cholesterol, increases risk of diabetes. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

Automated summary

Genetically elevated apoB is associated with shorter lifespan in parents, increased risks of heart disease and stroke, and higher risk of diabetes, especially when accounting for LDL cholesterol.