Association Between Genetically Proxied Inhibition of HMG-CoA Reductase and Epithelial Ovarian Cancer
Authors: James Yarmolinsky, Caroline J. Bull, Emma E. Vincent, Jamie Robinson, Axel Walther, George Davey Smith, Sarah J. Lewis, Caroline L. Relton, Richard M. Martin
Journal: JAMA (2020)

<h3>Importance</h3> Preclinical and epidemiological studies indicate a potential chemopreventive role of statins in epithelial ovarian cancer risk. <h3>Objective</h3> To evaluate the association of genetically proxied inhibition of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (ie, genetic variants related to lower function of HMG-CoA reductase, target of statins) with epithelial ovarian cancer among the general population and in<i>BRCA1/2</i>mutation carriers. <h3>Design, Setting, and Participants</h3> Single-nucleotide polymorphisms (SNPs) in<i>HMGCR</i>,<i>NPC1L1</i>, and<i>PCSK9</i>associated with low-density lipoprotein (LDL) cholesterol in a genome-wide association study (GWAS) meta-analysis (N ≤196 475) were used to proxy therapeutic inhibition of HMG-CoA reductase, Niemann-Pick C1-Like 1 (NPC1L1) and proprotein convertase subtilisin/kexin type 9 (PCSK9), respectively. Summary statistics were obtained for these SNPs from a GWAS meta-analysis of case-control analyses of invasive epithelial ovarian cancer in the Ovarian Cancer Association Consortium (OCAC; N = 63 347) and from a GWAS meta-analysis of retrospective cohort analyses of epithelial ovarian cancer among<i>BRCA1/2 </i>mutation carriers in the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA; N = 31 448). Across the 2 consortia, participants were enrolled between 1973 and 2014 and followed up through 2015. OCAC participants came from 14 countries and CIMBA participants came from 25 countries. SNPs were combined into multi-allelic models and mendelian randomization estimates representing lifelong inhibition of targets were generated using inverse-variance weighted random-effects models. <h3>Exposures</h3> Primary exposure was genetically proxied inhibition of HMG-CoA reductase and secondary exposures were genetically proxied inhibition of NPC1L1 and PCSK9 and genetically proxied circulating LDL cholesterol levels. <h3>Main Outcomes and Measures</h3> Overall and histotype-specific invasive epithelial ovarian cancer (general population) and epithelial ovarian cancer (<i>BRCA1/2</i>mutation carriers), measured as ovarian cancer odds (general population) and hazard ratio (<i>BRCA1/2</i>mutation carriers). <h3>Results</h3> The OCAC sample included 22 406 women with invasive epithelial ovarian cancer and 40 941 control individuals and the CIMBA sample included 3887 women with epithelial ovarian cancer and 27 561 control individuals. Median ages for the cohorts ranged from 41.5 to 59.0 years and all participants were of European ancestry. In the primary analysis, genetically proxied HMG-CoA reductase inhibition equivalent to a 1-mmol/L (38.7-mg/dL) reduction in LDL cholesterol was associated with lower odds of epithelial ovarian cancer (odds ratio [OR], 0.60 [95% CI, 0.43-0.83];<i>P</i> = .002). In<i>BRCA1/2</i>mutation carriers, genetically proxied HMG-CoA reductase inhibition was associated with lower ovarian cancer risk (hazard ratio, 0.69 [95% CI, 0.51-0.93];<i>P</i> = .01). In secondary analyses, there were no significant associations of genetically proxied inhibition of NPC1L1 (OR, 0.97 [95% CI, 0.53-1.75];<i>P</i> = .91), PCSK9 (OR, 0.98 [95% CI, 0.85-1.13];<i>P</i> = .80), or circulating LDL cholesterol (OR, 0.98 [95% CI, 0.91-1.05];<i>P</i> = .55) with epithelial ovarian cancer. <h3>Conclusions and Relevance</h3> Genetically proxied inhibition of HMG-CoA reductase was significantly associated with lower odds of epithelial ovarian cancer. However, these findings do not indicate risk reduction from medications that inhibit HMG-CoA reductase; further research is needed to understand whether there is a similar association with such medications.