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Apolipoprotein E4 and coronary heart disease in middle-aged men who smoke: a prospective study.
- Source :
-
Lancet (London, England) [Lancet] 2001 Jul 14; Vol. 358 (9276), pp. 115-9. - Publication Year :
- 2001
-
Abstract
- Background: The common isoforms of apolipoprotein E (apoE), E2, E3, and E4, are important determinants of plasma lipid concentrations, and the epsilon4 allele is associated with raised risk of coronary heart disease. We investigated whether the effect of smoking on coronary heart disease risk is affected by APOE genotype.<br />Methods: We enrolled 3052 middle-aged men who were free of coronary heart disease for prospective cardiovascular surveillance in the second Northwick Park Heart Study (NPHSII). Smoking habit was ascertained at baseline and yearly by questionnaire. APOE genotype was identified by PCR and restriction enzyme digestion. Endpoints were fatal coronary heart disease, non-fatal myocardial infarction, and coronary artery surgery and silent myocardial infarction at follow-up.<br />Findings: During 18836 person years of surveillance, 96 men had an acute myocardial infarction, 26 needed coronary artery surgery, and 14 had silent myocardial infarctions. Compared with never-smokers, risk of coronary heart disease in ex-smokers was 1.34 (95% CI 0.86-2.08) and in smokers it was 1.94 (1.25-3.01). This risk was independent of other classic risk factors. In never-smokers, risk was closely similar in men with different genotypes. Risk in men homozygous for the epsilon3 allele was 1.74 (1.10-2.77) in ex-smokers and 1.68 (1.01-2.83) in smokers, whereas in men carrying the epsilon4 allele risk was 0.84 (0.40-1.75) and 3.17 (1.82-5.50), respectively, with no significant differences in risk in the epsilon2 carriers. For the epsilon3 group, the genotype effect on risk was no longer significant after adjustment for classic risk factors (including plasma lipids). However, even after adjustment, smokers who were carriers of the epsilon4 allele, showed significantly raised risk of coronary heart disease compared with the non-smoking group (2.79, 1.59-4.91, epsilon4-smoking interaction p=0.007).<br />Interpretation: Smoking increases the risk of coronary heart disease in men of all genotypes but particularly in men carrying the epsilon4 allele.
- Subjects :
- Apolipoprotein E4
Coronary Disease epidemiology
Gene Frequency genetics
Genetic Carrier Screening
Genotype
Homozygote
Humans
Male
Middle Aged
Polymerase Chain Reaction
Proportional Hazards Models
Prospective Studies
Risk Factors
Surveys and Questionnaires
Survival Analysis
United Kingdom epidemiology
Apolipoproteins E genetics
Coronary Disease etiology
Coronary Disease genetics
Smoking adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 0140-6736
- Volume :
- 358
- Issue :
- 9276
- Database :
- MEDLINE
- Journal :
- Lancet (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 11463413
- Full Text :
- https://doi.org/10.1016/S0140-6736(01)05330-2