RT Journal Article SR Electronic T1 Chr15q25 genetic variant (rs16969968) independently confers risk of lung cancer, COPD and smoking intensity in a prospective study of high-risk smokers JF Thorax JO Thorax FD BMJ Publishing Group Ltd and British Thoracic Society SP 272 OP 280 DO 10.1136/thoraxjnl-2020-214839 VO 76 IS 3 A1 Raewyn J Hopkins A1 Fenghai Duan A1 Greg D Gamble A1 Caroline Chiles A1 Alana Cavadino A1 Paul Billings A1 Denise Aberle A1 Robert P Young YR 2021 UL http://thorax.bmj.com/content/76/3/272.abstract AB Importance While cholinergic receptor nicotinic alpha 5 (CHRNA5) variants have been linked to lung cancer, chronic obstructive pulmonary disease (COPD) and smoking addiction in case–controls studies, their corelationship is not well understood and requires retesting in a cohort study.Objective To re-examine the association between the CHRNA5 variant (rs16969968 AA genotype) and the development of lung cancer, relative to its association with COPD and smoking.Methods In 9270 Non-Hispanic white subjects from the National Lung Screening Trial, a substudy of high-risk smokers were followed for an average of 6.4 years. We compared CHRNA5 genotype according to baseline smoking exposure, lung function and COPD status. We also compared the lung cancer incidence rate, and used multiple logistic regression and mediation analysis to examine the role of the AA genotype of the CHRNA5 variant in smoking exposure, COPD and lung cancer.Results As previously reported, we found the AA high-risk genotype was associated with lower lung function (p=0.005), greater smoking intensity (p<0.001), the presence of COPD (OR 1.28 (95% CI 1.10 to 1.49) p=0.0015) and the development of lung cancer (HR 1.41, (95% CI 1.03 to 1.93) p=0.03). In a mediation analyses, the AA genotype was independently associated with smoking intensity (OR 1.42 (95% CI 1.25 to 1.60, p<0.0001), COPD (OR 1.25, (95% CI 1.66 to 2.53), p=0.0015) and developing lung cancer (OR 1.37, (95% CI 1.03 to 1.82) p=0.03).Conclusion In this large-prospective study, we found the CHRNA5 rs 16 969 968 AA genotype to be independently associated with smoking exposure, COPD and lung cancer (triple whammy effect).All data relevant to the study are included in the article or uploaded as online supplemental information. All clinical data is deidentified. The genetic data are reported in the manuscript.