Apolipoprotein E polymorphism and atherosclerosis.
Abstract
The apo E locus contributes to determining the variation in plasma cholesterol levels of healthy and diseased populations. It also influences the expression of hyperlipidemia and appears to modulate the susceptibility to atherosclerosis in a complex multifactorial interaction. There is evidence that the presence of apo E2 is protective, whereas that of apo E4 predisposes to coronary artery disease. The burden of proof, however, lies on future, well-designed clinical trials and prospective studies. The study of the biological significance of the apo E polymorphism in humans has emphasized the importance of gene-gene and gene-environment interactions in the pathogenesis of hyperlipidemia and atherosclerosis. The apo E polymorphism involves the coding region of the apo E gene and results in alterations of the gene product which, in turn, either directly or secondarily affect the metabolic fate of the lipoprotein particles. Rapid advances in knowledge over the last decade have provided a metabolic explanation for the observation of the opposite effects of the epsilon 4 and the epsilon 2 alleles on lipoprotein levels. Apo E2 has lower receptor binding affinity which results in delayed clearance of apo E2-bearing lipoprotein particles from plasma. Apo E4 is distributed differently from apo E3 between VLDL and HDL, is degraded more rapidly than apo E3, and may enhance the catabolism of E4-bearing particles, leading to other alterations in lipoprotein metabolism which result in elevated levels of LDL. In view of the significant opposite impacts of the epsilon 4 and the epsilon 2 alleles on plasma LDL cholesterol concentrations, it is evident that determination of the apo E phenotype will become a useful adjunct to the assessment of the cardiovascular risk profile of an individual. In addition, the relationship between the epsilon 2 allele and type III hyperlipoproteinemia provides a valuable model for the study of complex genetic interactions in the pathogenesis of hyperlipidemia. The further study of apo E and its interactions shows great promise for a deeper comprehension of the pathogenesis of atherosclerosis.
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APOE2 homozygosity can lead to Hyperlipoproteinemia type III (HLP), characterized by mixed hypercholesterolemia and hypertriglyceridemia.
“The critical role of APOE in lipid metabolism is underscored by evidence showing that APOE2 homozygosity can lead to Hyperlipoproteinemia type III (HLP), characterized by mixed hypercholesterolemia and hypertriglyceridemia [35–39].”
APOE2hAβ rats are characterized as a model for type III HLP.
“This observation, coupled with evident mixed hypercholesterolemia and hypertriglyceridemia, supports the characterization of APOE2hAβ rats as a model for type III HLP”
Both the ε2 and the ε4 alleles are associated with unfavorable lipid profiles.
“Both the ε2 and the ε4 alleles are associated with unfavorable lipid profiles [8][9][10][11][12][13].”
From APOE and vascular disease: Sequencing and genotyping in general population cohorts (2023) · cites this paper as [13]
Less than one in 20 individuals with the ε22 genotype will have overt type III hyperlipoproteinemia.
“It is estimated that less than one in 20 individuals with the ε22 genotype will have overt type III hyperlipoproteinemia [24].”
From Plasma levels of apolipoprotein E, APOE genotype and risk of dementia and ischemic heart disease: A review (2016) · cites this paper as [24]
At the level of an individual, the effect of the APOE polymorphism on plasma lipid levels is moderate, but because the polymorphism is common, it contributes substantially to total phenotypic variability in plasma lipid levels in the general population.
“At the level of an individual the effect of the APOE polymorphism on plasma lipid levels is moderate, however since the APOE polymorphism is common, it contributes substantially to the total phenotypic variability in plasma lipid levels in the general population [21,24,58].”
From Plasma levels of apolipoprotein E, APOE genotype and risk of dementia and ischemic heart disease: A review (2016) · cites this paper as [24]
The pattern of associations between the six common APOE genotypes and plasma lipid levels is similar across populations, although the magnitude differs between populations and subgroups, suggesting both context-dependent and invariant associations.
“The pattern of associations between the six common APOE genotypes and plasma lipid levels is similar across populations, although the magnitude of the associations differs between populations and subgroups within populations; thus both context-dependent and invariant associations could be suggested [9,24,30].”
From Plasma levels of apolipoprotein E, APOE genotype and risk of dementia and ischemic heart disease: A review (2016) · cites this paper as [24]
Both APOE ε2 and ε4 alleles are associated with unfavourable lipid profiles.
“Both ɛ2 and ɛ4 alleles are associated with unfavourable lipid profiles,12–19”
The e2 allele is associated with a decreased risk of coronary artery disease, unless it is associated with type III hyperlipoproteinemia.
“a decreased risk of coronary artery disease (unless it is associated with type III hyperlipoproteinemia), 42,43”
From Preclinical Evidence of Alzheimer's Disease in Persons Homozygous for the ε4 Allele for Apolipoprotein E (1996) · cites this paper as [42]
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- Authors
- Davignon, J., Gregg, R. E., & Sing, C. F.
- Affiliations
- Montreal Clinical Research Institute (CA)
- Venue
- Arteriosclerosis: An Official Journal of the American Heart Association, Inc.
- Published
- 1988-01
- Volume
- 8
- Issue
- 1
- Pages
- 1-21
- ISSN
- 0276-5047 (ISSN-L)
- OpenAlex
- W2066644955
- Cited by
- 1,981
- References
- 98
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 17 · 2023: 10 · 2022: 9 · 2021: 21 · 2020: 21 · 2019: 21 · 2018: 27 · 2017: 28 · 2016: 23 · 2015: 33 · 2014: 31 · 2013: 40 · 2012: 49
- FWCI
- 83.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arteriosclerosis An Official Journal of the American Heart Association Inc (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL24489, HL-39107)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Keywords
- APOE polymorphism, atherosclerosis, coronary artery disease, hyperlipidemia, LDL cholesterol, lipoprotein metabolism, gene-environment interaction, type III hyperlipoproteinemia, cardiovascular risk assessment, genetic susceptibility
- MeSH terms
- Alleles, Apolipoproteins, Apolipoproteins E, Arteriosclerosis, Coronary Disease, Humans, Lipids, Lipoproteins, Phenotype, Polymorphism, Genetic, Radiography, Risk Factors
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