Teixeira Andrei Alkmim, Marrocos Mauro Sergio, Quinto Beata Marie Redublo, Dalboni Maria Aparecida, Rodrigues Cassio Jose de Oliveira, Carmona Silmara de Melo, Kuniyoshi Mariana, Batista Marcelo Costa
Nephrology Division, Universidade Federal de São Paulo, R, Pedro de Toledo, 781 14o, andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032, Brazil.
Lipids Health Dis. 2014 Nov 20;13:174. doi: 10.1186/1476-511X-13-174.
Hypertension has a significant relevance as a cardiovascular risk factor. A consistent increase on world's Metabolic Syndrome (MetS) incidence has been associated with an epidemic cardiovascular risk in different populations. Dislipidemia plays a major role determining the epidemic CV burden attributed to MetS. Apolipoprotein E (ApoE) is involved on cholesterol and triglycerides metabolism regulation. Once ApoE polymorphism may influence lipid metabolism, it is possible that it brings on individual susceptibility consequences for the development of MetS and cardiovascular risk. The objective of the study is to measure the discriminatory power of ApoE polymorphism in determining cardiovascular risk stratification based on the presence MetS in a cohort of hypertensive patients.
It was enrolled 383 patients, divided in two groups, classified by MetS presence (IDF criteria): Group 1: 266 patients with MetS (MetS +) and Group 2: 117 patients without Mets (MetS -). Patient's data were collected by clinical evaluation, physical exam, file reviews and laboratory testing. Polymorphic ApoE analysis was performed by PCR amplification. Groups were compared on clinical and laboratory characteristics as well as allele and genotype distribution towards ApoE polymorphism. Mets CVD prevalence was analysed according to E4 allele prevalence.
The results evidenced 184 men (48%), 63,7% whites, 45,1% diabetics and 11,7% of patients were smokers. Mean age was 64,0 ± 12,0 years. When genotypic distribution was analyzed, E3/3 genotype and E3 allele frequencies were more prevalent. Among patients with MetS, we observed an independent association between CVD prevalence and E4 allele frequency (OR 2.42 (1.17- 5.0, p < 0,05)). On the opposite direction, in those without MetS, there was lesser CVD burden in E4 allele carriers (OR 0,14 (0,02-0,75)). These associations remained significant even after confounding factor corrections.
The results presented demonstrate that the association between ApoE gene and CVD may be modulated by the presence of MetS, with an increased CV burden observed among E4 allele carriers with the syndrome. On the opposite way, E4 allele carriers without visceral obesity had lesser prevalence of CVD.
高血压作为一种心血管危险因素具有重要意义。全球代谢综合征（MetS）发病率的持续上升与不同人群中流行的心血管风险相关。血脂异常在决定归因于MetS的流行心血管负担方面起主要作用。载脂蛋白E（ApoE）参与胆固醇和甘油三酯代谢的调节。由于ApoE基因多态性可能影响脂质代谢，因此它可能导致个体对MetS发展和心血管风险的易感性后果。本研究的目的是在一组高血压患者中，基于MetS的存在情况，测量ApoE基因多态性在确定心血管风险分层方面的鉴别能力。
纳入383例患者，分为两组，根据MetS的存在情况（国际糖尿病联盟标准）进行分类：第1组：266例患有MetS的患者（MetS +）和第2组：117例未患有MetS的患者（MetS -）。通过临床评估、体格检查、病历审查和实验室检测收集患者数据。通过PCR扩增进行ApoE基因多态性分析。比较两组在临床和实验室特征以及ApoE基因多态性的等位基因和基因型分布方面的差异。根据E4等位基因患病率分析MetS合并心血管疾病（CVD）的患病率。
结果显示有184名男性（48%），63.7%为白人，45.1%为糖尿病患者，11.7%的患者吸烟。平均年龄为64.0±12.0岁。在分析基因型分布时，E3/3基因型和E3等位基因频率更为普遍。在患有MetS的患者中，我们观察到CVD患病率与E4等位基因频率之间存在独立关联（比值比2.42（1.17 - 5.0，p < 0.05））。相反，在没有MetS的患者中，E4等位基因携带者的CVD负担较轻（比值比0.14（0.02 - 0.75））。即使在校正混杂因素后，这些关联仍然显著。
所呈现的结果表明，ApoE基因与CVD之间的关联可能受到MetS存在的调节，在患有该综合征的E4等位基因携带者中观察到心血管负担增加。相反，没有内脏肥胖的E4等位基因携带者的CVD患病率较低。
