Apo E Genotyping and Cardiovascular Risk Re-Classification of Subjects, A Single Center Experience 2008-2022

• Published in: Journal of clinical lipidology Vol. 18; no. 4; pp. e485 - e486
• Main Authors: Shaish, Aviv, Cohen, Hofit
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.07.2024
• ISSN: 1933-2874; 1876-4789
• DOI: 10.1016/j.jacl.2024.04.004

Apolipoprotein E (apo E) is a glycoprotein, associated with the metabolism of the remnants of triglyceride-rich lipoproteins and their clearance in the liver. Apo E exists in three isoforms: Apo E2, apo E3 (most common), and apo E4. Apo E2 is considered favorable and apo E4 is least favorable for cardiovascular and neurological health. Genotyping of apo E may have a role in personalized medicine and individualized cardiovascular risk-assessment. To evaluate whether apo E genotyping as a part of cardiovascular risk stratification, influences the clinical decision making in regard of cardiovascular risk assessment. Cardiovascular risk assessment and apo E genotyoing were performed in adult patients, at the outpatient clinic of the Strassburger Lipid Center, Sheba Medical Center, Tel-Hashomer, Israel. From January 2008 till January 2022, 435 tests were done. Two participants had apo E of 2/2 (0.5 %), seven had apo E of 2/3 (1.6 %), four had apo E of 2/4 (1%), 314 participants had apo E of 3/3 (72%), 99 participant had apo E of 3/4 (23%) and nine had apo E of 4/4 (2 %). Cardiovascular risk assessment was done by the ACC/AHA cardiovascular risk calculator. Among the 112 carriers of apo E4 isoforms: 36 (32%) were females, mean age at the test was 52.8 ±16.4 years, range 11-88 years. Out of the 99 apo E 3/4 carriers, 80% of patients were in primary prevention and 20% in secondary prevention for atherosclerotic cardiovascular disease (ASCVD). Re-classification of risk with lower low-density lipoprotein cholesterol therapeutic targets, was found in 62 patients, out of 112 apo E4 carriers patients (55%). Apo E gene polymorphisms is associated with cardiovascular morbidity and affect the lipid profile. In our experience, apo E genotyping was a valuable tool that assisted in the identification of certain patients at higher cardiovascular risk. Further studies are needed to elucidate the question whether earlier and more aggressive intervention will result in reduced ASCVD mortality and morbidity.