Objective-Familial combined hyperlipidemia (FCHL) characterized by high serum total cholesterol and/or triglycerides (TGs) is a common dyslipidemia predisposing to coronary artery disease (CAD). Recently, the upstream transcription factor 1 (USF1) was linked and associated with FCHL and TGs in Finnish FCHL families. Here we examined the previously associated rs3737787 SNP in extended Dutch FCHL families (nϭ532) and in a cohort of US subjects who underwent diagnostic coronary angiography (nϭ1533). Methods and Results-In males of the Dutch FCHL families, we observed significant sex-dependent associations between the common allele of rs3737787 and FCHL, TGs, and related metabolic traits (Pϭ0.02 to 0.006). In the U.S. Whites, sex-dependent associations with TGs and related metabolic traits were observed for the common allele of rs3737787 in males (Pϭ0.04 to 0.02) and rare allele in females (Pϭ0.05 to 0.002). This intriguing relationship was further supported by the highly significant genotype x sex interactions observed for TGs in the Dutch and TGs and body mass index (BMI) in U.S. White subjects with CAD (Pϭ0.0005 to 0.00004). Key Words: upstream transcription factor 1 Ⅲ familial combined hyperlipidemia Ⅲ coronary artery disease Ⅲ association Ⅲ lipids F amilial combined hyperlipidemia (FCHL) is a common familial dyslipidemia with a population prevalence of 1% to 2%. 1 Importantly, FCHL is observed in up to 20% of premature coronary artery disease (CAD) patients. 2 In addition to high serum total cholesterol (TC) and triglycerides (TGs), low plasma levels of high-density lipoprotein cholesterol (HDL-C), small dense low-density lipoprotein particles, and elevated apolipoprotein B (apoB) are also often observed in FCHL. 1,2 Association between FCHL and variants of the upstream transcription factor 1 (USF1) located in the FCHL-linked chromosome 1q21 region was originally identified by Pajukanta et al in Finnish FCHL families. 3 Several independent studies have investigated the USF1 variants in samples ascertained for FCHL or risk factors for premature CAD. 2,4 -6 The common allele of rs3737787 or SNPs in linkage disequilibrium (LD) with this SNP were associated with FCHL or one of its component traits in each of these studies. Komulainen et al investigated USF1 variants in a population-based prospective Finnish cohort and observed an association of USF1 with cardiovascular disease and mortality among females, demonstrating a consequence of USF1 at the population level in Finns. 7 In many of these studies, there is evidence of sex specificity, with the common allele of rs3737787 showing strongest evidence for association with high TGs in males. 2,3,7 Interestingly, in females, the minor allele seems to be associated with elevated lipids, as well as cardiovascular disease and mortality. 7 The underlying functional mechanisms explaining this replicated sex specificity are currently unknown.
Conclusion-These