Effect of apolipoprotein E polymorphism on serum lipid, lipoproteins, and atherosclerosis in hemodialysis patients

Atherosclerosis and cardiovascular disease are the main causes of death in hemodialysis patients. Possession of the apolipoprotein E4 (ApoE4) allele h as been associated with increased levels of serum lipids and with coronary and carotid artery atherosclerosis. We investigated the possible relationsh ip between ApoE polymorphism and atherosclerosis risk factors in hemodialys is patients. Two hundred sixty-nine hemodialysis patients (115 women, 154 m en) were included in our study. The mean patient age and mean hemodialysis duration were 45.8 +/- 15.3 years and 52.6 +/- 40.6 months, respectively. T esting was done on all patients to determine ApoE genotype and serum levels of total cholesterol (T-Cho), low-density lipoprotein (LDL-C), high-densit y cholesterol (HDL-C), triglyceride (TG), lipoprotein (a) (Lp[a]), intact p arathormone (iPTH), and fibrinogen. ApoE genotype was identified with the p olymerase chain reaction. Ultrasonographic measurement of carotid artery in tima media thickness (IMT) was used to diagnose atherosclerosis. We also an alyzed ApoE polymorphism and risk factors such as age, gender, duration of hemodialysis, smoking, and hypertension in relation to the presence of athe rosclerosis. Serum T-Cho and LDL-C levels were higher in patients with the ApoE4/3 phenotype than in those with ApoE3/3 and ApoE3/2 phenotypes (P < 0. 05). However, there was no statistically significant link between ApoE poly morphism and serum levels of TG, HDL-C, or Lp(a) (P > 0.05). Apart from a r elationship with age and duration of hemodialysis (P < 0.05), we found no s ignificant association between atherosclerosis and ApoE polymorphism or the other risk factors analyzed (P > 0.05). In conclusion, although ApoE polym orphism significantly affects serum levels of T-Cho and LDL-C in hemodialys is patients, this study indicates that ApoE polymorphism Is not associated with the presence of atherosclerosis in these individuals. The high inciden ce of atherosclerosis in these patients underlines the need for further res earch on other possible causative factors. (C) 2000 by the National Kidney Foundation, Inc.