Clinical Outcomes of an ApoE Genotype-Guided Lipid-Lowering Strategy in Acute Coronary Syndrome Patients Undergoing...

To evaluate the clinical efficacy of a statin therapy strategy guided by Apolipoprotein E (ApoE) gene polymorphism in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

In this retrospective study, 263 ACS patients post-PCI were included. The control group (n=120) received standard atorvastatin therapy. The study group (n=143) received a genotype-guided strategy: patients with ApoE E2/E3 genotypes received atorvastatin monotherapy, while those with the E4 genotype received atorvastatin combined with the PCSK9 inhibitor evolocumab. Clinical efficacy, cardiac function parameters, lipid profiles, and quality of life were compared between groups at 1 and 3 months post-treatment.

The total effective rate, defined as the combined proportion of patients rated "markedly effective" (complete symptom resolution with a ≥2-grade improvement in New York Heart Association [NYHA] functional class) and "effective" (notable symptom improvement with a 1-grade NYHA improvement), was significantly higher in the genotype-guided group than in the control group (92.3% vs 82.5%; P=0.025). At follow-up, the study group showed greater improvements in left ventricular ejection fraction (LVEF) and quality of life scores, and greater reductions in left ventricular dimensions and lipid parameters (including LDL-C) (all P<0.05). Multivariate logistic regression analysis identified the genotype-guided treatment strategy as an independent protective factor for clinical efficacy (P<0.05).

An ApoE genotype-guided lipid-lowering escalation strategy, in which E4 carriers-who typically respond suboptimally to statin monotherapy and carry a higher residual risk-received add-on PCSK9-inhibitor (evolocumab) therapy, was associated with improved clinical efficacy, cardiac function, and lipid control in ACS patients after PCI. Because the study group received more intensive lipid-lowering therapy, the observed benefits most plausibly reflect the greater treatment intensity achieved through genotype-directed escalation rather than the act of genotyping alone, and require confirmation in prospective randomized trials with longer follow-up.