- Wu, Peitao;
- Moon, Jee-Young;
- Daghlas, Iyas;
- Franco, Giulianini;
- Porneala, Bianca;
- Ahmadizar, Fariba;
- Richardson, Tom;
- Isaksen, Jonas;
- Hindy, Georgy;
- Yao, Jie;
- Sitlani, Colleen;
- Raffield, Laura;
- Yanek, Lisa;
- Feitosa, Mary;
- Cuadrat, Rafael;
- Qi, Qibin;
- Arfan Ikram, M;
- Ellervik, Christina;
- Ericson, Ulrika;
- Goodarzi, Mark;
- Brody, Jennifer;
- Lange, Leslie;
- Mercader, Josep;
- Vaidya, Dhananjay;
- An, Ping;
- Schulze, Matthias;
- Masana, Lluis;
- Ghanbari, Mohsen;
- Olesen, Morten;
- Cai, Jianwen;
- Guo, Xiuqing;
- Floyd, James;
- Jäger, Susanne;
- Province, Michael;
- Kalyani, Rita;
- Psaty, Bruce;
- Orho-Melander, Marju;
- Ridker, Paul;
- Kanters, Jørgen;
- Uitterlinden, Andre;
- Davey Smith, George;
- Gill, Dipender;
- Kaplan, Robert;
- Kavousi, Maryam;
- Raghavan, Sridharan;
- Chasman, Daniel;
- Rotter, Jerome;
- Meigs, James;
- Florez, Jose;
- Dupuis, Josée;
- Liu, Ching-Ti;
- Merino, Jordi
OBJECTIVE: LDL cholesterol (LDLc)-lowering drugs modestly increase body weight and type 2 diabetes risk, but the extent to which the diabetogenic effect of lowering LDLc is mediated through increased BMI is unknown. RESEARCH DESIGN AND METHODS: We conducted summary-level univariable and multivariable Mendelian randomization (MR) analyses in 921,908 participants to investigate the effect of lowering LDLc on type 2 diabetes risk and the proportion of this effect mediated through BMI. We used data from 92,532 participants from 14 observational studies to replicate findings in individual-level MR analyses. RESULTS: A 1-SD decrease in genetically predicted LDLc was associated with increased type 2 diabetes odds (odds ratio [OR] 1.12 [95% CI 1.01, 1.24]) and BMI (β = 0.07 SD units [95% CI 0.02, 0.12]) in univariable MR analyses. The multivariable MR analysis showed evidence of an indirect effect of lowering LDLc on type 2 diabetes through BMI (OR 1.04 [95% CI 1.01, 1.08]) with a proportion mediated of 38% of the total effect (P = 0.03). Total and indirect effect estimates were similar across a number of sensitivity analyses. Individual-level MR analyses confirmed the indirect effect of lowering LDLc on type 2 diabetes through BMI with an estimated proportion mediated of 8% (P = 0.04). CONCLUSIONS: These findings suggest that the diabetogenic effect attributed to lowering LDLc is partially mediated through increased BMI. Our results could help advance understanding of adipose tissue and lipids in type 2 diabetes pathophysiology and inform strategies to reduce diabetes risk among individuals taking LDLc-lowering medications.