title: Diversity of apolipoprotein E genetic polymorphism significance on cardiovascular risk is determined by the presence of metabolic syndrome among hypertensive patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Nephrology Division, Universidade Federal de São Paulo, R, Pedro de Toledo, 781 14o, andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032, Brazil. andreialkmim@uol.com.br.
authors.forename: Andrei Alkmim
authors.initials: AA
authors.lastname: Teixeira
authors.forename: Mauro Sergio
authors.initials: MS
authors.lastname: Marrocos
authors.forename: Beata Marie Redublo
authors.initials: BM
authors.lastname: Quinto
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Dalboni
authors.forename: Cassio Jose de Oliveira
authors.initials: CJ
authors.lastname: Rodrigues
authors.forename: Silmara de Melo
authors.initials: Sde M
authors.lastname: Carmona
authors.forename: Mariana
authors.initials: M
authors.lastname: Kuniyoshi
authors.forename: Marcelo Costa
authors.initials: MC
authors.lastname: Batista
mesh_terms: D000368:Aged; D001057:Apolipoproteins E / Q000235:genetics*; D005260:Female; D005787:Gene Frequency; D056726:Genetic Association Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D006973:Hypertension / Q000235:genetics*; D008297:Male; D024821:Metabolic Syndrome / Q000235:genetics*; D008875:Middle Aged; D020641:Polymorphism, Single Nucleotide; D012306:Risk
chemical_list: D001057:Apolipoproteins E