Published online before print May 12, 2003, doi: 10.1161/01.CIR.0000068311.40161.28
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(Circulation. 2003;107:2416.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Variants of Toll-Like Receptor 4 Modify the Efficacy of Statin Therapy and the Risk of Cardiovascular Events
From the Department of Cardiology (S.M.B., R.J.G.P.), the Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Laboratory for Experimental Internal Medicine (P.H.R.), the Department of Vascular Medicine (J.J.P.K.), Academic Medical Center, Amsterdam; and the Department of Cardiology (W.R.P.A., E.E.v.d.W., J.W.J.), Leiden University Medical Center, Leiden, Interuniversity Cardiology Institute of the Netherlands (W.R.P.A., J.W.J.), Utrecht, The Netherlands.
Correspondence to Dr J.W. Jukema, Leiden University Medical Center, Department of Cardiology C5-P, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail j.w.jukema{at}lumc.nl
Background— Atherosclerosis is increasingly considered to be a chronic inflammatory process. We examined whether genetic variants of the toll-like receptor 4 (TLR4), which are correlated with impaired innate immunity and with progression of carotid atherosclerosis, are also associated with coronary atherosclerosis and predict the risk of cardiovascular events.
Methods and Results— Two polymorphisms of the TLR4 gene (Asp299Gly and Thr399Ile) were determined in 655 men with angiographically documented coronary atherosclerosis. All patients participated in a prospective cholesterol-lowering trial evaluating the effect on coronary artery disease and were randomly assigned to either pravastatin or placebo for 2 years. There were no significant differences between genetically defined subgroups with respect to baseline risk factors, treatment, or in-trial changes of lipid, lipoprotein, or angiographic measurements. Genotype was not associated with progression of atherosclerosis. In the pravastatin group, 299Gly carriers had a lower risk of cardiovascular events during follow-up than noncarriers (2.0% versus 11.5%, P=0.045). Among noncarriers, pravastatin reduced the risk of cardiovascular events from 18.1% to 11.5% (P=0.03), whereas among 299Gly carriers this risk was strikingly reduced from 29.6% to 2.0% (P=0.0002, P=0.025 for interaction).
Conclusions— Among symptomatic men with documented coronary artery disease, the TLR4 Asp299Gly polymorphism was associated with the risk of cardiovascular events. This variant also modified the efficacy of pravastatin in preventing cardiovascular events, such that carriers of the variant allele had significantly more benefit from pravastatin treatment.
Key Words: atherosclerosis • statins • cardiovascular diseases • inflammation • receptors
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