Related Experiment Video
Updated: Aug 16, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Apolipoprotein E polymorphism is not a predictor for repeated coronary artery bypass surgery
Pekka Kuukasjärvi1, Matti Tarkka, Ari Mennander
1Heart Center, Tampere University Hospital and Medical School, University of Tampere, Finland. pekka.kuukasjarvi@uta.fi
Insights
Genetic factors strongly predispose younger patients to repeated coronary artery bypass grafting (CABG). Older patients undergoing repeat CABG show links to hypercholesterolemia, influenced by apoE genotype.
Area of Science:
- Cardiovascular Genetics
- Coronary Artery Disease Research
- Surgical Outcomes
Background:
- Coronary graft occlusion has diverse causes, potentially including inherited factors.
- Understanding genetic predispositions is crucial for managing coronary artery disease (CAD).
Purpose of the Study:
- To investigate the genetic predisposition for repeated coronary artery bypass grafting (CABG).
- To specifically assess the role of the apolipoprotein E (apoE) epsilon4 allele as a risk factor for redo CABG.
Main Methods:
- A case-control study involving 137 matched pairs of patients who underwent repeated CABG versus first-time CABG.
- DNA analysis for apoE genotype and assessment of family history and hypercholesterolemia.
- Patients were stratified by age relative to the median age of 62 years.
Main Results:
- In patients younger than 62, a positive family history was the sole significant predictor of repeated CABG (OR=3.4).
- In older patients, hypercholesterolemia predicted repeated CABG (OR=2.1), modified by apoE genotype.
- Family history was not a significant predictor in the older age group.
Conclusions:
- Medium-term survivors of redo CABG exhibit a strong genetic predisposition for severe CAD at an earlier age, independent of hypercholesterolemia or apoE genotype.
- In older patients, redo CABG is linked to hypercholesterolemia, with potential contributions from genetic or acquired factors beyond the apoE genotype.
Objectives:
Factors leading to the occlusion of coronary grafts are diverse and may at least partially be inherited. We aimed to study the possible genetic predisposition and especially the role of apoE epsilon4 allele as a risk factor for repeated coronary artery bypass grafting (CABG) in a case-control setting.
Design:
All patients (n=184) who underwent repeated CABG between 1990 and 1998 were identified in the computed registry of the Department of Cardiothoracic Surgery in Tampere University Hospital. Age, sex and operation date matched controls with first time CABG were selected from the same registry. DNA samples were collected by sample stick sent via the mail for buccal smear. The final analysis included 137 surviving matched pairs.
Results:
In patients <62 years of age (median age), family history emerged as the only significant (OR=3.4; 95% CI=1.5-7.8, p=0.004) predictor for repeated surgery. Among older patients, repeated CABG was no longer predicted by family history but by hypercholesterolemia (OR=2.1; 95% CI=1.1-4.0, p=0.027), modified by apoE genotype.
Conclusions:
Our results suggest that medium-term survivors after redo CABG have a strong genetic predisposition unrelated to hypercholesterolemia or apoE genotype, leading to more severe coronary artery disease at earlier age. In the older age group, redo coronary artery bypass surgery is associated with hypercholesterolemia, which, although modified by apoE genotype, may mainly be due to other genetic or acquired factors.
Related Concept Videos
01:11Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase
01:30Coronary Artery Disease I: Introduction