Background Limited evidence exists regarding the utility of genetic risk scores (GRS) in predicting recurrent cardiovascular events after acute coronary syndrome (ACS). We sought to determine whether a GRS would predict early recurrent cardiovascular events within 1 year of ACS. Methods & Results Participants admitted with acute coronary syndromes from the RISCA, PRAXY, and TRIUMPH cohorts, were genotyped for 30 single nucleotide polymorphisms (SNPs) associated with coronary artery disease (CAD) or myocardial infarction (MI) in prior genome wide association studies. A 30 SNP CAD/MI GRS was constructed. The primary endpoint was defined as all-cause mortality, recurrent ACS or cardiac re-hospitalization within 1 year of ACS admission. Results across all cohorts for the 30 SNP CAD/MI GRS were pooled using a random-effects model. There were 1040 patients from the RISCA cohort, 691 patients from the PRAXY cohort, and 1772 patients from the TRIUMPH cohort included in the analysis and 389 occurrences of the primary endpoint of recurrent events at 1-year post-ACS. In unadjusted and fully adjusted analyses, a 30 SNP GRS was not significantly associated with recurrent events (HR per allele 0.97 (95%CI 0.91–1.03) for RISCA, HR 0.99 (95%CI 0.93–1.05) for PRAXY, 0.98 (95%CI 0.94–1.02) for TRIUMPH, and 0.98 (95%CI 0.95–1.01) for the pooled analysis). Addition of this GRS to the GRACE risk model did not significantly improve risk prediction. Conclusion The 30 MI SNP GRS was not associated with recurrent events 1-year post ACS in pooled analyses across cohorts and did not improve risk discrimination or reclassification indices. Our results suggest that the genetic etiology of early events post-ACS may differ from later events.

Among individuals with a first ACS, a GRS composed of 30 SNPs is associated with younger age of presentation. Although genetic predisposition modestly contributes to earlier ACS, a heavy burden of TRF is associated with markedly earlier ACS.

Mechanisms to increase plasma high-density lipoprotein (HDL) or to promote egress of cholesterol from cholesterol-loaded cells (e.g., foam cells from atherosclerotic lesions) remain an important target to regress heart disease. Reconstituted HDL (rHDL) serves as a valuable vehicle to promote cellular cholesterol efflux in vitro and in vivo. rHDL were prepared with wild type apolipoprotein (apo) A-I and the rare variant, apoA-I Milano (M), and each apolipoprotein was reconstituted with phosphatidylcholine (PC) or sphingomyelin (SM). The four distinct rHDL generated were incubated with CHO cells, J774 macrophages, and BHK cells in cellular cholesterol efflux assays. In each cell type, apoA-I(M) SM-rHDL promoted the greatest cholesterol efflux. In BHK cells, the cholesterol efflux capacities of all four distinct rHDL were greatly enhanced by increased expression of ABCG1. Efflux to PC-containing rHDL was stimulated by transfection of a nonfunctional ABCA1 mutant (W590S), suggesting that binding to ABCA1 represents a competing interaction. This interpretation was confirmed by binding experiments. The data show that cholesterol efflux activity is dependent upon the apoA-I protein employed, as well as the phospholipid constituent of the rHDL. Future studies designed to optimize the efflux capacity of therapeutic rHDL may improve the value of this emerging intervention strategy.

T he low-density lipoprotein (LDL) receptor pathway plays a major role in the regulation of the plasma level of LDL in humans. When clearance of LDL particles through the LDL receptor pathway is markedly impaired or abolished, as in familial hypercholesterolemia, 1 profound elevations in plasma LDL result. At the other extreme, more effective clearance of LDL particles by the LDL receptor pathway is the major mechanism by which statins lower plasma LDL. However, these changes in the activity of the LDL receptor pathway are produced by disease or pharmacological intervention and are not evidence of its physiological role.The LDL receptor pathway paradigm stipulates that intracellular cholesterol homeostasis is based on a reciprocal relationship between the rate at which cholesterol within an LDL particle enters the cell through the LDL receptor pathway and the rate at which cholesterol and LDL receptors are synthesized within the cell.2 In brief, cholesterol that enters the cell within an LDL particle is released from the particle in the lysosome and equilibrates with the cholesterol in the endoplasmic reticulum (ER) membrane. The cholesterol mass within the ER membrane determines the activity of the sterol regulatory element-binding protein 2 (SREBP2) pathway, which regulates the synthesis of cholesterol and the LDL receptor.3-5 Additional, more rapid, adaptation mechanisms exist, including esterification of cholesterol by acyl CoA:cholesterol acyltransferase (ACAT) and acute inhibition of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCoA reductase, the rate-limiting step of endogenous cholesterol biosynthesis) by hydroxysterols. 6,7 The regulatory paradigm of the LDL receptor pathway is a simple, closed-loop, seesaw homeostatic model: increased uptake is followed by decreased synthesis; decreased synthesis is followed by increased uptake. However, this paradigm was based on studies in cultured fibroblasts, a cell that plays no important role in total body cholesterol homeostasis and a cell with little capacity to secrete cholesterol. In contrast, © 2013 American Heart Association, Inc. Objective-The hypothesis that cholesterol that enters the cell within low-density lipoprotein (LDL) particles rapidly equilibrates with the regulatory pool of intracellular cholesterol and maintains cholesterol homeostasis by reducing cholesterol and LDL receptor synthesis was validated in the fibroblast but not in the hepatocyte. Accordingly, the present studies were designed to compare the effects of cholesterol that enters the hepatocyte within an LDL particle with those of cholesterol that enters via other lipoprotein particles. Approach and Results-We measured cholesterol synthesis and esterification in hamster hepatocytes treated with LDL and other lipoprotein particles, including chylomicron remnants and VLDL. Endogenous cholesterol synthesis was not significantly reduced by uptake of LDL, but cholesterol esterification (280%) and acyl CoA:cholesterol acyltransferase 2 expression (870%) were increased. In contrast, ...