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Published on: October 12, 2017
Paradoxical Long-Term Impact Between Serum Apolipoprotein E and High-Density Lipoprotein Cholesterol in Patients
Tatsuya Fukase1, Tomotaka Dohi1, Ryota Nishio1
1Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.
Insights
Serum Apolipoprotein E (ApoE) levels show a paradoxical impact on cardiovascular risk in coronary artery disease (CAD) patients, depending on high-density lipoprotein cholesterol (HDL-C) levels. This finding is crucial for understanding CAD progression and risk stratification.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Atherosclerosis Research
Background:
- Apolipoprotein E (ApoE) influences arteriosclerosis, with potential atheroprotective effects when combined with high-density lipoprotein cholesterol (HDL-C).
- The interplay between serum ApoE and HDL-C levels in coronary artery disease (CAD) patients requires further elucidation.
Purpose of the Study:
- To investigate the quantitative relationship between serum ApoE and HDL-C levels.
- To evaluate the impact of this relationship on major adverse cardiac and cerebrovascular events (MACCE) in CAD patients.
Main Methods:
- Inclusion of 3632 consecutive patients undergoing first intervention (2000-2016).
- Categorization into normal and abnormal HDL-C groups, further subdivided by ApoE levels (high/low).
- Evaluation of MACCE incidence (cardiovascular death, myocardial infarction, stroke, all-cause death) over a 6.4-year follow-up.
Main Results:
- A statistically significant interaction between ApoE levels and HDL-C status was observed for MACCE and all-cause death.
- In the normal HDL-C group, elevated ApoE correlated with higher MACCE incidence.
- Conversely, in the abnormal HDL-C group, reduced ApoE correlated with higher MACCE incidence.
Conclusions:
- Serum ApoE levels exhibit a paradoxical association with cardiovascular risk in CAD patients.
- The impact of ApoE on future cardiovascular risk is contingent upon the patient's HDL-C status.
Aim:
Apolipoprotein E (ApoE) strongly affects arteriosclerosis but has atheroprotective effects in combination with high-density lipoprotein cholesterol (HDL-C). The impact of the quantitative relationship between serum ApoE and HDL-C levels in patients with coronary artery disease (CAD) remains unclear.
Methods:
A total of 3632 consecutive patients who underwent their first intervention between 2000 and 2016 were included. They were categorized into normal and abnormal HDL-C groups based on the normal HDL-C value, and each group was subdivided into high and low ApoE subgroups based on the group-specific median ApoE value. We evaluated the incidence of major adverse cardiac and cerebrovascular events (MACCE), including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and all-cause deathResults: During a 6.4-year follow-up, 419 patients developed MACCE and 570 patients died. The interaction term between ApoE levels and HDL-C status in MACCE and all-cause death proved to be statistically significant. Kaplan-Meier analysis revealed that the cumulative incidence of MACCE was significantly higher for elevated pre-procedural ApoE levels than for reduced preprocedural ApoE levels in the normal HDL-C group. Conversely, the cumulative incidence of MACCE was significantly higher for reduced pre-procedural ApoE levels than for elevated pre-procedural ApoE levels in the abnormal HDL-C group. After adjustment for important covariates, multivariable Cox hazard analysis revealed that the serum ApoE level was a strongly independent predictor of MACCE; this was inversely related in both groups.
Conclusions:
Serum ApoE levels may have a paradoxical impact on the future cardiovascular risk depending on the HDL-C status in patients with CAD.
