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Meta-Analysis: Apolipoprotein E Genotypes and Risk for Coronary Heart Disease
Abstract
BACKGROUND: Apolipoprotein E (apoE) genotypes play critical roles in lipid metabolism and are believed to influence risk for coronary heart disease (CHD). Despite many population studies, however, the impact of apoE polymorphism on risk for CHD remains uncertain. PURPOSE: To qualitatively and quantitatively assess the evidence regarding the relation of apoE polymorphism to CHD risk. DATA SOURCES: All relevant reports and references from original and review papers published from 1966 to January 2004. STUDY SELECTION: Predefined criteria were used to identify 48 relevant studies. DATA EXTRACTION: A summary database that contained variables of study design, study sample and ethnicity, sex, apoE genotypes, CHD end points, plasma lipid levels, and other CHD risk factors was developed. DATA SYNTHESIS: The authors qualitatively evaluated many potential sources of heterogeneity. To quantify the extent of heterogeneity and assess the consistency of apoE-CHD associations, stratified analyses were conducted using the classic random-effects model. To further incorporate uncertainty due to between-study variation, the pooled odds ratios (ORs) and 95% credible intervals (CrIs) were estimated by using a Bayesian hierarchical model. Finally, the robustness of the pooled estimates was tested in multiple sensitivity analyses. Compared with individuals with the epsilon3/3 genotype, carriers of the apoE epsilon4 allele had a 42% higher risk for CHD (OR, 1.42 [95% CrI, 1.26 to 1.61]). The epsilon2 allele had no significant association with CHD risk (OR, 0.98 [CrI, 0.66 to 1.46]). LIMITATIONS: This meta-analysis did not include unpublished data or studies published in languages other than English. CONCLUSIONS: Inadequate statistical power, differences in geographic and ethnic background, allele frequency, sex, CHD phenotypes, study design, and potential gene-environment interactions may have contributed to the conflicting results of previous studies. The apoE epsilon4 allele is a significant risk factor for CHD.
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“Diastolic blood pressure was elevated for male APOE4 carriers relative to non-carriers, consistent with a documented susceptibility of APOE4 carriers to cardiovascular risk factors [54], including higher diastolic blood pressure observed in some cohorts [55–57].”
From Effects of APOE2 and APOE4 on brain microstructure in older adults: modification by age, sex, and cognitive status (2024) · cites this paper as [54]
In the citing paper
“The apoE4 isoform has been linked with increased levels of LDL and has been demonstrated to be a risk factor for cardiovascular disease (Song et al., 2004; Wilson et al., 1994).”
From The role of apolipoprotein E in Alzheimer's disease (2009) · cites this paper as Song et al., 2004
In the citing paper
“APOE genotypes were in Hardy-Weinberg equilibrium in both cases and controls; their frequencies (Table 4) were similar to previous reports for the relevant age groups (44;47;48).”
From Association of ALS with head injury, cigarette smoking and APOE genotypes (2010) · cites this paper as [48]
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Sorted by citations
The role of apolipoprotein E in Alzheimer's disease
Kim, J., Basak, J. M., & Holtzman, D. M. (2009) · Neuron · doi:10.1016/j.neuron.2009.06.026 · Cited by 1,661
Association Between Midlife Vascular Risk Factors and Estimated Brain Amyloid Deposition
Gottesman, R. F., Schneider, A. L. C., Zhou, Y., Coresh, J., Green, E., Gupta, N., Knopman, D. S., Mintz, A., Rahmim, A., Sharrett, A. R., et al. (2017) · JAMA · doi:10.1001/jama.2017.3090 · Cited by 650
Risk Factors for β-Amyloid Deposition in Healthy Aging: Vascular and Genetic Effects
Rodrigue, K. M., Rieck, J. R., Kennedy, K. M., Devous, M. D., Diaz-Arrastia, R., & Park, D. C. (2013) · JAMA Neurology · doi:10.1001/jamaneurol.2013.1342 · Cited by 249
Eisenberg, D. T. A., Kuzawa, C. W., & Hayes, M. G. (2010) · American Journal of Physical Anthropology · doi:10.1002/ajpa.21298 · Cited by 231
Rasmussen, K. L. (2016) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2016.10.037 · Cited by 125
Metadata
- Authors
- Song, Y., Stampfer, M. J., & Liu, S.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2004-07-20
- Volume
- 141
- Issue
- 2
- Pages
- 137-147
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2128519424
- Cited by
- 528
- References
- 94
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 14 · 2023: 10 · 2022: 14 · 2021: 15 · 2020: 13 · 2019: 23 · 2018: 14 · 2017: 15 · 2016: 23 · 2015: 27 · 2014: 38 · 2013: 22 · 2012: 38
- FWCI
- 6.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL 26490)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK 62290)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
- Keywords
- apolipoprotein E, APOE polymorphism, coronary artery disease, APOE ε4, APOE ε2 allele, genetic risk factors, plasma lipids, lipid metabolism, gene-environment interaction
- MeSH terms
- Apolipoproteins E, Bayes Theorem, Coronary Disease, Genotype, Humans, Risk Factors, Sensitivity and Specificity, Genetic Heterogeneity, Lipid Metabolism
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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