title: Apolipoprotein e4 allele and the risk of CAD death in type 2 diabetes mellitus with ischaemia electrocardiographic change.
abstract: The presence of apolipoprotein (Apo) e4 allele is reported to be associated with the increased risk of coronary artery disease (CAD), as well as the impairment of endothelium-dependent arterial dilation in type 2 diabetes mellitus. Therefore, we hypothesized that Apo e4 allele increases the death risk from coronary artery disease in type 2 diabetes with ischaemia electrocardiographic change. From January 1993 to December 1999, 46 type 2 diabetic patients with e4/4 or e4/3, 96 with e3/3 and 45 with e2/2 or e3/2 genotypes were recruited. All subjects were unrelated elderly type 2 diabetic patients with ischaemia electrocardiographic change, aged 60-87 years, and their cardiac function were all the class I stage at their time of enrollment. A follow-up study of 3-10 years was undergone. The results are as follows: At baseline, serum total cholesterol and low-density lipoprotein (LDL) cholesterol concentrations were higher in subjects with e4/3 or e4/4 than in subjects with e2/2 or e3/2 (p<0.05). Lipoprotein(a) concentration was lower in subjects with e2/2 or e3/2 than in subjects with e3/3 and e4/3 or e4/4 (p < 0.05). During the 3-10 years follow-up period, a total of 55 patients who died from CAD were recorded in this sample. Compared with patients with e3/3 (p = 0.024) and patients with e2/2 or e2/3 genotypes (p = 0.002), the mortality rate of CAD in patients with e4/3 or e4/4 genotypes was the highest (47.8%). Stepwise discriminant analysis revealed that in the diabetic population studied Apo e4 allele was independently and significantly associated with CAD death (B = 0.65). However, the strength of the association decreased (B = 0.44) when total cholesterol, LDL-cholesterol and lipoprotein(a) were included in the model. Therefore, we concluded that Apo e4 allele increases the risk of CAD death in elderly type 2 diabetes mellitus with ischaemia electrocardiographic change.
authors.affiliation: Department of Endocrinology, Wuhan General Hospital of Guangzhou Command of PLA, Wuhan 430070, PR China. guangda64@163.net
authors.forename: Xiang
authors.initials: X
authors.lastname: Guang-da
authors.forename: Yang
authors.initials: Y
authors.lastname: Xiang-Jiu
authors.forename: Zhao
authors.initials: Z
authors.lastname: Lin-Shuang
authors.forename: Chen
authors.initials: C
authors.lastname: Zhi-Song
authors.forename: He
authors.initials: H
authors.lastname: Yu-Sheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000235:genetics*; D003324:Coronary Artery Disease / Q000235:genetics* / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000235:genetics*; D003925:Diabetic Angiopathies / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000503:physiopathology; D012306:Risk
chemical_list: D053327:Apolipoprotein E4; D001057:Apolipoproteins E