Apolipoprotein E4 reduces risk of diabetic nephropathy in patients with NIDDM.
Hypercholesterolemia is a major determinant of the decline of renal function in patients with diabetes. Apolipoprotein E polymorphism may influence the metabolism of lipoprotein in diabetic patients. The purpose of this study was to investigate the association between genetic polymorphisms in apolipoprotein E and the progression of diabetic nephropathy in patients with non-insulin-dependent diabetes mellitus over a 10-year period (13 to 37 years; median, 20 years). Subjects with a stable renal function without overt proteinuria had a higher cholesterol level, lower incidences of hypertension and proliferative diabetic retinopathy, and a higher frequency of the E4 allele than subjects with a decline in renal function (end-stage renal failure requiring dialysis treatment). In the diabetic patients, the apolipoprotein E4 carriers had a higher cholesterol level than did the noncarriers. The survival rate from renal disease in the apolipoprotein E4 carriers was higher than in the noncarriers among the diabetic patients. Apolipoprotein E polymorphism and hypertension were identified as independent risk factors for the progression to renal failure. Results indicate that apolipoprotein E polymorphism is associated with the progression of diabetic nephropathy. Presence of the apolipoprotein E4 allele is a protective factor, and other alleles are risk factors.
Kimura
H
H
Department of Medicine (II), Nigata University School of Medicine, Japan. hkimura@fmsrsa.fukui-med.ac.jp
Suzuki
Y
Y
Gejyo
F
F
Karasawa
R
R
Miyazaki
R
R
Suzuki
S
S
Arakawa
M
M
D000328:Adult; D000368:Aged; D000483:Alleles; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000097:blood / Q000235:genetics*; D004247:DNA / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000235:genetics*; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology / Q000235:genetics*; D018450:Disease Progression; D005260:Female; D005838:Genotype; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000235:genetics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011110:Polymorphism, Genetic / Q000235:genetics; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors
D053327:Apolipoprotein E4; D001057:Apolipoproteins E; D004247:DNA