Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Hum Genomics. 2024 Jul 3;18(1):76. doi: 10.1186/s40246-024-00643-3.
BACKGROUND: Lipid-lowering drugs are widely used among the elderly, with some studies suggesting links to muscle-related symptoms. However, the causality remains uncertain. METHODS: Using the Mendelian randomization (MR) approach, we assessed the causal effects of genetically proxied reduced low-density lipoprotein cholesterol (LDL-C) through inhibitions of hydroxy-methyl-glutaryl-CoA reductase (HMGCR), proprotein convertase subtilisin/kexin type 9 (PCSK9), and Niemann-Pick C1-like 1 (NPC1L1) on sarcopenia-related traits, including low hand grip strength, appendicular lean mass, and usual walking pace. A meta-analysis was conducted to combine the causal estimates from different consortiums. RESULTS: Using LDL-C pooled data predominantly from UK Biobank, genetically proxied inhibition of HMGCR was associated with higher appendicular lean mass (beta = 0.087, P = 7.56 × 10) and slower walking pace (OR = 0.918, P = 6.06 × 10). In contrast, inhibition of PCSK9 may reduce appendicular lean mass (beta = -0.050, P = 1.40 × 10), while inhibition of NPC1L1 showed no causal impact on sarcopenia-related traits. These results were validated using LDL-C data from Global Lipids Genetics Consortium, indicating that HMGCR inhibition may increase appendicular lean mass (beta = 0.066, P = 2.17 × 10) and decelerate walking pace (OR = 0.932, P = 1.43 × 10), whereas PCSK9 inhibition could decrease appendicular lean mass (beta = -0.048, P = 1.69 × 10). Meta-analysis further supported the robustness of these causal associations. CONCLUSIONS: Genetically proxied HMGCR inhibition may increase muscle mass but compromise muscle function, PCSK9 inhibition could result in reduced muscle mass, while NPC1L1 inhibition is not associated with sarcopenia-related traits and this class of drugs may serve as viable alternatives to sarcopenia individuals or those at an elevated risk.
背景:降脂药在老年人中广泛使用,一些研究表明与肌肉相关症状有关。然而,因果关系仍不确定。
方法:我们使用孟德尔随机化(MR)方法,通过评估羟甲基戊二酰基辅酶 A 还原酶(HMGCR)、前蛋白转化酶枯草杆菌蛋白酶/激肽释放酶 9(PCSK9)和 Niemann-Pick C1 样 1(NPC1L1)的遗传相关性,来评估降低低密度脂蛋白胆固醇(LDL-C)对与肌肉减少症相关的特征的因果效应,包括低手握力、四肢瘦体重和通常的行走速度。对来自不同联盟的因果估计值进行了荟萃分析。
结果:使用主要来自英国生物库的 LDL-C 汇总数据,遗传相关性 HMGCR 抑制与较高的四肢瘦体重(β=0.087,P=7.56×10)和较慢的行走速度(OR=0.918,P=6.06×10)相关。相反,PCSK9 的抑制可能会降低四肢瘦体重(β=-0.050,P=1.40×10),而 NPC1L1 的抑制对与肌肉减少症相关的特征没有因果影响。这些结果使用来自全球脂质遗传学联盟的 LDL-C 数据进行了验证,表明 HMGCR 抑制可能会增加四肢瘦体重(β=0.066,P=2.17×10)并减缓行走速度(OR=0.932,P=1.43×10),而 PCSK9 的抑制会降低四肢瘦体重(β=-0.048,P=1.69×10)。荟萃分析进一步支持了这些因果关联的稳健性。
结论:遗传相关性 HMGCR 抑制可能会增加肌肉质量,但会损害肌肉功能,PCSK9 抑制可能会导致肌肉质量减少,而 NPC1L1 抑制与肌肉减少症相关特征无关,这类药物可能是肌肉减少症患者或处于高风险人群的可行替代方案。
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