Separating the mechanism-based and off-target actions of cholesteryl ester transfer protein inhibitors with CETP gene polymorphisms

Reecha Sofat, Aroon D. Hingorani, Liam Smeeth, Steve E. Humphries, Philippa J. Talmud, Jackie Cooper, Tina Shah, Manjinder S. Sandhu, Sally L. Ricketts, S. Matthijs Boekholdt, Nicholas Wareham, Kay Tee Khaw, Meena Kumari, Mika Kivimaki, Michael Marmot, Folkert W. Asselbergs, Pim Van Der Harst, Robin P.F. Dullaart, Gerjan Navis, Dirk J. Van VeldhuisenWiek H. Van Gilst, John F. Thompson, Pamela McCaskie, Lyle J. Palmer, Marcello Arca, Fabiana Quagliarini, Carlo Gaudio, François Cambien, Viviane Nicaud, Odette Poirer, Vilmundur Gudnason, Aaron Isaacs, Jacqueline C.M. Witteman, Cornelia M. Van Duijn, Michael Pencina, Ramachandran S. Vasan, Ralph B. D'Agostino, Jose Ordovas, Tricia Y. Li, Sakari Kakko, Heikki Kauma, Markku J. Savolainen, Y. Antero Kesäniemi, Anton Sandhofer, Bernhard Paulweber, Jose V. Sorli, Akimoto Goto, Shinji Yokoyama, Kenji Okumura, Benjamin D. Horne, Chris Packard, Dilys Freeman, Ian Ford, Naveed Sattar, Valerie McCormack, Debbie A. Lawlor, Shah Ebrahim, George Davey Smith, John J.P. Kastelein, John Deanfield, Juan P. Casas

Research output: Contribution to journalArticlepeer-review

75 Scopus citations


Background: Cholesteryl ester transfer protein (CETP) inhibitors raise high-density lipoprotein (HDL) cholesterol, but torcetrapib, the first-in-class inhibitor tested in a large outcome trial, caused an unexpected blood pressure elevation and increased cardiovascular events. Whether the hypertensive effect resulted from CETP inhibition or an off-target action of torcetrapib has been debated. We hypothesized that common single-nucleotide polymorphisms in the CETP gene could help distinguish mechanism-based from off-target actions of CETP inhibitors to inform on the validity of CETP as a therapeutic target. Methods and Results: We compared the effect of CETP single-nucleotide polymorphisms and torcetrapib treatment on lipid fractions, blood pressure, and electrolytes in up to 67 687 individuals from genetic studies and 17 911 from randomized trials. CETP single-nucleotide polymorphisms and torcetrapib treatment reduced CETP activity and had a directionally concordant effect on 8 lipid and lipoprotein traits (total, low-density lipoprotein, and HDL cholesterol; HDL2; HDL3; apolipoproteins A-I and B; and triglycerides), with the genetic effect on HDL cholesterol (0.13 mmol/L, 95% confidence interval [CI] 0.11 to 0.14 mmol/L) being consistent with that expected of a 10-mg dose of torcetrapib (0.13 mmol/L, 95% CI 0.10 to 0.15). In trials, 60 mg of torcetrapib elevated systolic and diastolic blood pressure by 4.47 mm Hg (95% CI 4.10 to 4.84 mm Hg) and 2.08 mm Hg (95% CI 1.84 to 2.31 mm Hg), respectively. However, the effect of CETP single-nucleotide polymorphisms on systolic blood pressure (0.16 mm Hg, 95% CI-0.28 to 0.60 mm Hg) and diastolic blood pressure (-0.04 mm Hg, 95% CI-0.36 to 0.28 mm Hg) was null and significantly different from that expected of 10 mg of torcetrapib. Conclusions: Discordance in the effects of CETP single-nucleotide polymorphisms and torcetrapib treatment on blood pressure despite the concordant effects on lipids indicates the hypertensive action of torcetrapib is unlikely to be due to CETP inhibition or shared by chemically dissimilar CETP inhibitors. Genetic studies could find a place in drug-development programs as a new source of randomized evidence for drug-target validation in humans.

Original languageEnglish (US)
Pages (from-to)52-62
Number of pages11
Issue number1
StatePublished - Jan 2010
Externally publishedYes


  • Epidemiology
  • Genetics
  • High-density lipoproteins
  • Pharmacology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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