Objective-Although animal studies indicate that liver X receptor alpha (LXR␣) might influence risk of atherosclerosis, data in humans remain scarce. We tested the hypothesis that genetic variation in LXR␣ associates with risk of ischemic vascular disease and/or plasma lipid and lipoprotein levels in the general population. Methods and Results-We studied 10,281 white persons of Danish ancestry from a general population cohort, including 1,986 in whom ischemic heart disease (IHD) developed, and 989 in whom ischemic cerebrovascular disease developed. We examined another 51,429 white persons of Danish ancestry from a general population study, including 3,789 with IHD. We genotyped 10 genetic variants identified by resequencing LXR␣. Homozygosity for Ϫ840AA/ Ϫ115AA(ϭ2.7%) predicted hazard ratios of 1.3 (95% confidence interval, 1.0 -1.7) for IHD, 1.6 (1.2-2.2) for myocardial infarction, and 1.7 (1.3-2.4) for ischemic cerebrovascular disease. The corresponding odds ratios in the second cohort were 1.1 (0.9 -1.4) for IHD and 1.5 (1.1-2.0) for myocardial infarction. In the combined studies, odds ratios were 1.2 (1.0 -1.4) for IHD and 1.5 (1.2-1.9) for myocardial infarction. Homozygosity for Ϫ840AA/Ϫ115AA did not associate with lipid or lipoprotein levels. LXR␣ Ϫ1830TϾC (tagging the haplotype Ϫ1830C/Ϫ840A/Ϫ115A, all r 2 Ն0.97) associated with 91% increased transcriptional activity. Key Words: coronary heart disease Ⅲ epidemiology Ⅲ gene mutations Ⅲ ischemic heart disease Ⅲ stroke L iver X receptor alpha (LXR␣) is a nuclear receptor that plays a central role in both lipid metabolism and inflammation. 1 LXR␣ is activated by increased intracellular levels of oxysterols, a breakdown product of cholesterol, and orchestrates the removal of cholesterol from peripheral tissues by regulating genes involved in reverse cholesterol transport. 2 Other downstream effects of LXR␣ activation include increases in catabolism, biliary excretion, and conversion to fatty acids of cholesterol. 3 Furthermore, LXR␣ modulates the immune response via an antiinflammatory effect on macrophages. 4 Because plasma cholesterol levels as well as inflammatory processes are key players in the development of the atherosclerotic plaque, a possible role of LXR␣ in ischemic cardiovascular and ischemic cerebrovascular disease (ICVD) has been the focus of intense research. 1 Several studies have demonstrated that LXR␣ agonists attenuate the development of atherosclerosis in mice and protect against neuronal damage in animal models of ischemic stroke (IS). 5,6 Further underpinning a possible role of LXR␣ in ischemic vascular disease is the observation that LXR␣ knockout mice display an increased susceptibility to atherosclerosis and IS. 6,7 However, data pertaining to LXR␣ biology in humans remain scarce.
Conclusion-This study suggests that functional genetic variation inWe hypothesized that genetic variation in LXR␣ might influence risk of ischemic vascular disease and/or plasma lipid and lipoprotein levels in the general population. To test this hypothesis, w...