GENETIC-POLYMORPHISM OF APOLIPOPROTEIN-E - A COMPARISON OF PATIENTS WITH CORONARY-ARTERY DISEASE AND HEALTHY CONTROLS

The development of coronary artery disease (CAD) is influenced by mult iple factors. Genetic predisposition accounts for approximately half o f the total coronary risk, but the responsible loci have not yet been identified in detail. Therefore, we examined apolipoprotein E (Apo E) phenotypes in patients with CAD and in healthy controls. Apo E phenoty pes, total, HDL, LDL cholesterol, triglycerides and lipoprotein(a) wer e determined in 167 patients with CAD (mean age: 58 +/- 8 years) and i n 102 healthy controls (mean age: 49 +/- 9 years). Total and LDL chole sterol (254 +/- 46 vs. 241 +/- 47 mg/dl; p < 0.05; respectively 181 +/ - 40 vs. 167 +/- 43 mg/dl; p < 0,01) were significantly higher in pati ents with CAD, as were triglycerides (178 +/- 84 vs. 140 +/- 73 mg/dl; p < 0.001) and lipoprotein(a) (36 +/- 37, median 23 mg/dl vs. 26 +/- 26, median 14 mg/dl: p < 0.05). HDL cholesterol (37 +/- 9 vs. 46 +/- 1 5 mg/dl: p < 0.001). in contrast, was significantly lower in patients with CAD. The percentage of patients with CAD was highest in the prese nce of the epsilon4 allele (69 %, while only 50 % of the carriers of t he epsilon2 allele had CAD (p < 0.08). LDL cholesterol was lowest in t he presence of the epsilon2 allele (162 +/- 55 mg/dl), and highest in homozygous carriers of the epsilon4 allele (193 +/- 15 mg/dl). In the CAD group, there was a significantly higher prevalence of risk factors such as smoking (p < 0.001 hypertension (p < 0.001) and diabetes (p < 0.05). The study shows that genetic markers such as the apo E polymor phism and the lipoprotein(a) concentration contribute significantly to the identification of patients at high risk for CAD. It also confirms the relationship between CAD and smoking, hypertension, impaired gluc ose tolerance, low HDL cholesterol, high triglycerides and LDL cholest erol.