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Background  Hypertriglyceridemia has emerged as a critical coronary artery disease (CAD) risk factor. Rare loss-of-function (LoF) variants in apolipoprotein C-III have been reported to reduce triglycerides (TG) and are cardioprotective in American Indians and Europeans. However, there is a lack of data in other Europeans and non-Europeans. Also, whether genetically increased plasma TG due to ApoC-III is causally associated with increased CAD risk is still unclear and inconsistent. The objectives of this study were to verify the cardioprotective role of earlier reported six LoF variants of  APOC3  in South Asians and other multi-ethnic cohorts and to evaluate the causal association of TG raising common variants for increasing CAD risk.    Methods  We performed gene-centric and Mendelian randomization analyses and evaluated the role of genetic variation encompassing  APOC3  for affecting circulating TG and the risk for developing CAD.    Results  One rare LoF variant (rs138326449) with a 37% reduction in TG was associated with lowered risk for CAD in Europeans ( p  = 0.007), but we could not confirm this association in Asian Indians ( p  = 0.641). Our data could not validate the cardioprotective role of other five LoF variants analysed. A common variant rs5128 in the  APOC3  was strongly associated with elevated TG levels showing a  p -value 2.8 × 10 − 424 . Measures of plasma ApoC-III in a small subset of Sikhs revealed a 37% increase in ApoC-III concentrations among homozygous mutant carriers than the wild-type carriers of rs5128. A genetically instrumented per 1SD increment of plasma TG level of 15 mg/dL would cause a mild increase (3%) in the risk for CAD ( p  = 0.042).    Conclusions  Our results highlight the challenges of inclusion of rare variant information in clinical risk assessment and the generalizability of implementation of ApoC-III inhibition for treating atherosclerotic disease. More studies would be needed to confirm whether genetically raised TG and ApoC-III concentrations would increase CAD risk.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12944-021-01531-8

APOC3 genetic variation, serum triglycerides, and risk of coronary artery disease in Asian Indians, Europeans, and other ethnic groups