Universidad de los Andes, School of Medicine, Bogotá, Colombia.
J Am Heart Assoc. 2013 May 14;2(3):e000130. doi: 10.1161/JAHA.113.000130.
Low-density lipoprotein (LDL) with apolipoprotein C-III (apoC-III) is the lipoprotein species that most strongly predicts initial and recurring coronary heart disease (CHD) events in several cohorts. Thus, a large portion of the CHD risk conferred by LDL may be attributable to LDL that contains apoC-III. Very-low-density lipoprotein (VLDL) and LDL with apoC-III have varying amounts of apoE. We hypothesized that a high content of apoE lessens the adverse influence of apoC-III on the risk of CHD because it promotes the clearance of VLDL and LDL from plasma.
We studied 2 independent cohorts, the Nurses' Health Study, composed of women, and the Health Professionals Follow-up Study, composed of men. These cohorts contributed to this study 322 women and 418 men initially free of CVD who developed a fatal or nonfatal myocardial infarction during 10 to 14 years of follow-up and matched controls who remained free of CHD. The apoE content of LDL with apoC-III was inversely associated with CHD after multivariable adjustment (relative risk for top versus bottom quintile 0.53, 95% CI 0.35 to 0.80). The apoE content of VLDL with apoC-III had a similar inverse association with CHD. The highest risks were associated with a high apoB concentration and a low apoE content of LDL with apoC-III or of VLDL+LDL with apoC-III. The observed associations were in both male and female cohorts and independent of traditional CHD risk factors and of C-reactive protein.
An increased apoE content in VLDL and LDL with apoC-III was associated with a lower risk of CHD. Strategies to enrich VLDL and LDL in apoE are worth exploring for the prevention of CHD.
载脂蛋白 C-III（apoC-III）的低密度脂蛋白（LDL）是在多个队列中预测首发和复发性冠心病（CHD）事件最强的脂蛋白种类。因此，LDL 所带来的 CHD 风险的很大一部分可能归因于含有 apoC-III 的 LDL。极低密度脂蛋白（VLDL）和载有 apoC-III 的 LDL 含有不同量的 apoE。我们假设 apoE 含量高会减轻 apoC-III 对 CHD 风险的不利影响，因为它可以促进 VLDL 和 LDL 从血浆中清除。
我们研究了两个独立的队列，女性的护士健康研究和男性的健康专业人员随访研究。这些队列为这项研究贡献了 322 名最初无 CVD 的女性和 418 名无 CHD 的男性对照者，他们在 10 至 14 年的随访期间发生了致命或非致命性心肌梗死。在多变量调整后，载有 apoC-III 的 LDL 的 apoE 含量与 CHD 呈负相关（最高五分位与最低五分位的相对风险为 0.53，95%CI 为 0.35 至 0.80）。载有 apoC-III 的 VLDL 的 apoE 含量与 CHD 也呈类似的负相关。与 LDL 载 apoC-III 或 VLDL+LDL 载 apoC-III 的 apoB 浓度高、apoE 含量低相关的风险最高。观察到的相关性在男性和女性队列中均存在，并且独立于传统的 CHD 危险因素和 C 反应蛋白。
载有 apoC-III 的 VLDL 和 LDL 中 apoE 含量增加与 CHD 风险降低相关。富含 apoE 的 VLDL 和 LDL 的策略值得探索用于 CHD 的预防。
