Pro-inflammatory IL-1 genotype raises coronary disease risk from oxidized phospholipids seven-fold in younger patients, a study of 499 patients (J Am Coll Cardiol 2014)

Original title: Pro-inflammatory interleukin-1 genotypes potentiate the risk of coronary artery disease and cardiovascular events mediated by oxidized phospholipids and lipoprotein(a)

J Am Coll Cardiol · 12 February 2014 · 8

Tsimikas S, Duff GW, Berger PB, Rogus J, Huttner K, Clopton P, Brilakis E, Kornman KS, Witztum JL

This study measured IL-1 genotype, oxidized phospholipids on apoB-100 (OxPL/apoB), and Lp(a) in 499 patients undergoing coronary angiography, classifying patients as pro-inflammatory IL-1(+) or IL-1(-) based on three IL-1 gene cluster SNPs. Among IL-1(+) patients, the highest OxPL/apoB quartile carried significantly higher coronary artery disease (CAD) risk than the lowest (odds ratio 2.84, P=0.001), an effect stronger in patients 60 or younger (odds ratio 7.03, P<0.001); OxPL/apoB showed no CAD association in IL-1(-) patients. In patients 60 or younger, the IL-1(+) versus IL-1(-) interaction was significant for both OxPL/apoB (odds ratio 1.99, P=0.004) and Lp(a) (odds ratio 1.96, P<0.001). IL-1(+) patients above the median OxPL/apoB presented for catheterization a mean 3.9 years earlier (P=0.002) and had worse 4-year event-free survival (P=0.006) than other groups. The findings show pro-inflammatory IL-1 genotype amplifies coronary disease and cardiovascular event risk mediated by oxidized phospholipids and Lp(a), particularly in younger patients.

Original abstract

Objectives: The aim of this study was to assess the influence of pro-inflammatory interleukin (IL)-1 genotype status on the risk for coronary artery disease (CAD), defined as >50% diameter stenosis, and cardiovascular events mediated by oxidized phospholipids (OxPLs) and lipoprotein (Lp) (a).

Background: OxPLs are pro-inflammatory, circulate on Lp(a), and mediate CAD. Genetic variations in the IL-1 region are associated with increased inflammatory mediators.

Methods: IL-1 genotypes, OxPL on apolipoprotein B-100 (OxPL/apoB), and Lp(a) levels were measured in 499 patients undergoing coronary angiography. The composite genotype termed IL-1(+) was defined by 3 single-nucleotide polymorphisms in the IL-1 gene cluster associated with higher levels of pro-inflammatory cytokines. All other IL-1 genotypes were termed IL-1(-).

Results: Among IL-1(+) patients, the highest quartile of OxPL/apoB was significantly associated with a higher risk for CAD compared with the lowest quartile (odds ratio [OR]: 2.84; p = 0.001). This effect was accentuated in patients age ≤60 years (OR: 7.03; p < 0.001). In IL-1(-) patients, OxPL/apoB levels showed no association with CAD. The interaction was significant for OxPL/apoB (OR: 1.99; p = 0.004) and Lp(a) (OR: 1.96; p < 0.001) in the IL-1(+) group versus the IL-1(-) group in patients age ≤60 years but not in those age >60 years. In IL-1(+) patients age ≤60 years, after adjustment for established risk factors, high-sensitivity C-reactive protein, and Lp(a), OxPL/apoB remained an independent predictor of CAD. IL-1(+) patients above the median OxPL/apoB presented to the cardiac catheterization laboratory a mean of 3.9 years earlier (p = 0.002) and had worse 4-year event-free survival (death, myocardial infarction, stroke, and need for revascularization) compared with other groups (p = 0.006).

Conclusions: Our study suggests that IL-1 genotype status can stratify population risk for CAD and cardiovascular events mediated by OxPL. These data suggest a clinically relevant biological link between pro-inflammatory IL-1 genotype, oxidation of phospholipids, Lp(a), and genetic predisposition to CAD and cardiovascular events.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.