Transcriptome- and proteome-wide Mendelian randomization to prioritize therapeutic targets for coronary heart disease

Abstract Despite widespread use of drugs targeting traditional cardiovascular risk factors such as lipids and blood pressure, a high burden of coronary heart disease (CHD) remains, hence novel therapeutics are needed for people who harbor residual risk. Using transcriptomic and proteomic data to instrument 15,527 genes or proteins, we conducted systematic cis- Mendelian randomization (MR) and conditional colocalization analyses with a genetic meta-analysis involving nearly 300,000 CHD cases. We identified 567 targets with putative causal relevance to CHD, of which 69 were not identified in previous genetic discovery or MR studies and were the sole causal signal in that genomic region. To aid translation of our findings, we annotated results with up-to-date information on drugs acting on these targets. Our results revealed opportunities for drug repurposing and development prioritization. For example, we provide evidence that cilostazol, a drug that targets PDE3A and is currently used for claudication, could be repurposed for prevention of CHD.