Evidence for a major gene accounting for mild elevation in LDL cholesterol: The NHLBI family heart study

Studies of rare Mendelian disorders of low density lipoprotein cholesterol (LDL-C) metabolism have identified specific genetic mutations in the LDL re ceptor and apolipoprotein B. Although these rare mutations account for a sm all proportion of LDL-C variation, twin and adoption studies indicate that at least 50 % of the overall LDL-C observed variation is genetically determ ined. In a heterogeneous sample of 3227 subjects from the NHLBI Family Hear t Study collected from four US centres, we find evidence for a common major gene accounting for mild elevations (1.25 standard deviations) in LDL-C. T he analysis favored a recessive model with a frequency of 0.52 for the gene influencing elevated LDL-C, phenotypic means of 113 mg/dl for the normal g enotypes and 146 mg/dl for the abnormal genotype, and a significant polygen ic heritability. This statistically-inferred major gene accounted for 24 % of the variation in LDL-C, with polygenes accounting for another 28% of the variation. Using parameters for major gene transmission estimated in the s egregation analysis, LDL-C showed no linkage to the LDL receptor gene (LDLR ), nor to the apolipoprotein E gene (APOE), nor to the cholesterol 7 alpha- hydroxylase gene (CYP7A1), indicating the major gene effect influencing mil d elevation in LDL-C is not explained by any of these candidate loci.