Cited by 125Lipoproteins and Cardiovascular HealthAlzheimer's disease research and treatmentsDementia and Cognitive Impairment Research

The DOI matches its Crossref record; 129 of the 129 references it cites were found in a registry or an index; 51 of the 139 sources its claims cite were checked for support.

Plasma levels of apolipoprotein E, APOE genotype and risk of dementia and ischemic heart disease: A review

Open access
Rasmussen, Katrine Laura·2016·Atherosclerosis

Abstract

Dementia is one of the major causes of disability in later life, and ischemic heart disease is a leading cause of morbidity and mortality. Apolipoprotein E (apoE) plays a pivotal role in lipoprotein metabolism in the brain and in the periphery, and is implicated in both dementia and ischemic heart disease. Peripherally, liver-derived apoE is the main source of plasma apoE. Approximately half of plasma apoE is associated with triglyceride-rich lipoproteins, where apoE serves as the main ligand for the low density lipoprotein (LDL) receptor and the LDL receptor Related Protein (LRP). In the brain, apoE is produced mainly by astrocytes. Astrocyte-derived apoE is pivotal for cerebral cholesterol metabolism and clearance of β-amyloid, a major pathological hallmark of Alzheimer disease. Plasma levels of apoE and other lipids and lipoproteins are under strong genetic influence by the APOE polymorphism, and the ε4 allele is a strong genetic risk factor for Alzheimer disease. The characteristics of the APOE polymorphism thus suggest the qualitative importance of apoE, whereas studies of familial absolute apoE deficiency suggest a quantitative importance of plasma apoE levels in lipid metabolism. Whether plasma levels of apoE are associated with increased risk of dementia and ischemic heart disease, and whether these associations are independent of the APOE polymorphism and of lipids and lipoproteins has only recently been established. The aim of this review is to summarize and discuss the current epidemiological and biological evidence for an association of plasma levels of apoE with risk of dementia and ischemic heart disease.

Overview

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TL;DR

This review summarizes evidence that plasma apolipoprotein E (apoE) levels and APOE genotype are linked to dementia and ischemic heart disease, with low apoE associated with future dementia and high apoE with ischemic heart disease. It argues for the qualitative importance of the APOE polymorphism and an emerging quantitative importance of plasma apoE, though associations differ by disease and are partly mediated by lipids and triglyceride-rich lipoproteins.

Key findings

  • Plasma apoE levels are strongly influenced by APOE genotype, with stepwise decreases from ε22 to ε32 to ε42 to ε33 to ε43 to ε44; the APOE polymorphism accounts for roughly 15–25% of variability in plasma apoE. In the Copenhagen General Population Study and Copenhagen City Heart Study, genotype frequencies were 0.7%, 12.4%, 2.9%, 55.8%, 25.4%, and 2.9% for ε22, ε32, ε42, ε33, ε43, and ε44, respectively.
  • The ε4 allele is a major genetic risk factor for late-onset Alzheimer disease: one copy is associated with a two- to three-times increased risk, and two copies with roughly an eight- to ten-times increased risk; ε2 is associated with decreased risk. Low plasma apoE levels were epidemiologically associated with increased risk of future dementia in the general population, independent of APOE genotype.
  • For ischemic heart disease, high plasma apoE was associated with increased risk in men but not women in a prospective general population cohort of ~91,000 participants; the association was not attenuated by adjustment for APOE genotype but was attenuated after adjustment for triglycerides. In a population-based study of 546 elderly individuals, high plasma apoE was associated with increased cardiovascular mortality in both genders, independently of APOE genotype and plasma triglycerides, LDL cholesterol, and HDL cholesterol.
  • Mechanistically, liver-derived apoE is the main source of plasma apoE, and approximately half of plasma apoE is associated with triglyceride-rich lipoproteins, where it serves as the main ligand for the LDL receptor and LRP. In the brain, astrocyte-derived apoE is pivotal for cerebral cholesterol metabolism and amyloid-β clearance, and both decreased apoE levels and APOE genotype may contribute to dementia via impaired amyloid-β clearance.

Methods

  • Narrative review summarizing epidemiological and biological evidence on plasma apoE levels, APOE genotype, and risk of dementia and ischemic heart disease.
  • Draws on population studies including the Copenhagen General Population Study and Copenhagen City Heart Study, the ApoEurope project, the Rotterdam Study, and a prospective general population cohort of ~91,000 participants, as well as animal and in vitro studies.
  • No new primary data collection or meta-analysis is reported; the paper synthesizes prior findings and presents combined CGPS/CCHS data in figures.

Limitations

  • Stated: word and reference limits required prioritization of the literature; human studies of plasma or cerebrospinal fluid apoE in Alzheimer disease are conflicting, possibly reflecting different disease stages; immunoassay results may be biased by isoform-dependent epitope masking and lipid complexation; animal model results differ and complicate translation to humans.
  • Stated: whether blood apoE levels reflect cerebral apoE levels has been debated, although cerebrospinal fluid apoE shows a genotype-dependent pattern similar to plasma.
  • Evident from the text: this is a narrative rather than systematic review, so literature selection and synthesis may be selective; observational associations cannot establish causality; and the contrasting directions of apoE associations with dementia versus ischemic heart disease indicate different disease mechanisms that remain incompletely understood.

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Crossref · 10.1016/j.atherosclerosis.2016.10.037

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    Whether plasma levels of apoE are associated with increased risk of dementia and ischemic heart disease, and whether these associations are independent of the APOE polymorphism and of lipids and lipoproteins, has only recently been established.

    “Whether plasma levels of apoE are associated with increased risk of dementia and ischemic heart disease, and whether these associations are independent of the APOE polymorphism and of lipids and lipoproteins has only recently been established.”
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Metadata

Authors
Rasmussen, K. L.
Affiliations
Herlev Hospital (DK)
Corresponding author
Rasmussen, Katrine Laura
Venue
Atherosclerosis
Publisher
Elsevier BV
Published
2016-12
Volume
255
Pages
145-155
ISSN
0021-9150 (ISSN-L)
OpenAlex
W2538539323
Cited by
125
References
129
Citations by year
2026: 14 · 2025: 17 · 2024: 9 · 2023: 14 · 2022: 17 · 2021: 21 · 2020: 11 · 2019: 13 · 2018: 7 · 2017: 2
FWCI
1.45
Type
journal article
Language
en
Open access
Locations
  • Atherosclerosis (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
apolipoprotein E, APOE polymorphism, APOE ε4, dementia, ischemic heart disease, Alzheimer's disease, LDL receptor, LDL receptor-related protein, triglyceride-rich lipoproteins, lipoprotein metabolism, amyloid-beta clearance, genetic risk factors
MeSH terms
Adult, Aged, Aged, 80 and over, Animals, Apolipoproteins E, Brain, Dementia, Female, Humans, Liver, Male, Middle Aged, Phenotype, Polymorphism, Genetic, Protein Conformation, Risk Factors, Structure-Activity Relationship, Biomarkers, Myocardial Ischemia, Risk Assessment, Genetic Predisposition to Disease, Young Adult

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