Association Between Apoe Gene Polymorphism And Coronary Artery Disease In Patients With Coronary Heart Disease

Objective:To investigate the relationship of Apolipoprotein E（Apo E）gene polymorphism with the severity and prognosis of coronary artery disease in patients with coronary artery disease（CAD）.Methods:The objects of study were 355 inpatients with CAD in our hospital from January 2019 to August 2019.The diagnoses of enrolled patients were confirmed based on the results of coronary angiography.During angiography,the number,location and degree of stenosis of diseased coronary artery were recorded,associated with the calculation of Gensini score.On the basis of completing routine examination items,venous blood was collected from all patients and Apo E gene was then detected by polymerase chain reaction（PCR）.Furthermore,patients were followed up for one and halfa year after angiography,and the major adverse cardiac events（MACE）were recorded during the follow-up period.Subjects were then divided into MACE group and non-MACE group.The two groups were compared in the aspects of baseline data,blood lipid indexes and the distribution of Apo E gene polymorphism.According to the imaging data of coronary angiography,patients were further divided into single-vessel,double-vessel,three-vessel lesion groups,as well as low Gensini score(GS_low),middle Gensini score(GS_mid),high Gensini score groups(GS_high)according to the involved vessels and Gensini score.The distribution of Apo E alleles was compared in the above two types of groups.Meanwhile,according to the different Apo E alleles,these patients were divided into three groups ofε2,ε3 andε4 alleles to compare the difference in blood lipids among groups.Logistic regression analysis was performed to evaluate the correlation between Apo E gene polymorphism and MACE.In addition,the predictive value of Apo E allele for MACE was analyzed by receiver operating characteristic（ROC）curve and the area under the curve.Results:1.Through one and a half-year follow-up,50 patients developed MACE,305 patients showed stable condition,and there was no difference in baseline data between groups（P>0.05）.Patients in MACE group had significantly higher levels of TG,LDL-C and TC than those in non-MACE group（P<0.05）.2.There was no difference in the distribution ofε2 allele between groups（P>0.05）.Meanwhile,there were 6 cases（12.0%）who carriedε3allele in MACE group,and the proportion was obviously lower than that in non-MACE group（76.7%）（P<0.05）;while there were 39 carriers withε4 allele in MACE group（78.0%）,which was evidently higher than that in non-MACE group（P<0.05）.3.Of the enrolled subjects,there were 187 cases of single-vessel lesion,98 cases of double-vessel lesion,and 70 cases of three-vessel lesion.Among them,41 patients in single vessel group were detected to beε2allele carriers,and corresponding proportion was significantly higher than that in double-vessel group and three-vessel group（71.9%vs.17.5%vs.10.5%,respectively）（P<0.05）.In addition,there were 34 patients withε4 allele in three-vessel group,and the proportion was much higher than that in single-vessel group and double-vessel group（58.6%vs.13.8%vs.27.6%,respectively）（P<0.05）.4.There were 148 cases in GS_low group,112 cases in GS_mid group,and 95 cases GS_high group.In GS_low group,36 patients were detected to beε2 allele carriers,and the proportion of patients withε2 allele was higher than that in GS_midgroup and GS_highgroup（24.3%vs.11.6%vs.8.4%）（P<0.05）.Besides,47 patients were found withε4 allele in GS_high group,and corresponding proportion was remarkably higher than that in GS_low group and GS_midgroup（49.5%vs.4.3%vs.4.5%）（P<0.05）.5.There were significant correlations of serum TG,TC and LDL-C levels with among patients with three different allele distributions of Apo E（P<0.05）,yet with no correlation in terms of the level of HDL-C（P>0.05）.Among them,the serum LDL-C,TG and TC levels of patients withε2 allele were obviously lower than those of the patients withε4 allele（P<0.05）.6.According to the results of Logistic regression analysis,Apo E gene polymorphism was associated with the occurrence of MACE,in whichε3 allele was a protective factor andε4 allele was a risk factor.7.The ROC curve of Apo E gene polymorphism and MACE indicated a strong predictive value of Apo E alleles for the occurrence of MACE（the area under the curve>0.5）.Conclusion:Apo E gene polymorphism may be an influential factor for predicting the degree of coronary artery disease and long-term prognosis of patients with CAD.Apo Eε4 allele carriers have more severe coronary artery disease and higher incidence of MACE.Additionally,Apo Eε4 allele may be a risk factor for the occurrence of MACE.