The relation of apolipoprotein E polymorphism to multiple cardiovascular risk in children: the Bogalusa heart study

Apolipoprotein (apo) E is an important genetic determinant of serum lipoprotein concentrations and coronary artery disease risk. Multiple cardiovascular risk factors in addition to lipoproteins were examined by apoE phenotype in a random subsample (n = 746) of 8–17-year old children from a total community. The apoE2 group (n = 58) carrying E2/2 and E3/2 phenotypes showed lower age-, race- and sex-adjusted mean values of body mass index (BMI: weight/height2), percent body fat, fasting plasma insulin and LDL cholesterol, and a higher value of HDL cholesterol than the apoE3 group (n = 476) carrying the E3/3 phenotype (P < 0.01). In contrast, the apoE4 group (n = 212) carrying E4/4 and E3/4 phenotypes displayed higher values of total cholesterol and LDL cholesterol (P < 0.01). Both insulin and BMI, which correlated with each other, showed an association to triglycerides and systolic blood pressure in all three phenotype groups; whereas only BMI associated with LDL cholesterol, total cholesterol to HDL cholesterol ratio and diastolic blood pressure in all three phenotype groups (P < 0.05 to P < 0.0001). A marked increase in the prevalence of clustering of adverse (top tertile) total cholesterol to HDL cholesterol ratio with increased levels (top tertile) of one or two risk factors (BMI, insulin, and systolic blood pressure) occurred in the apoE3 and apoE4 groups, especially in the latter (P < 0.01 to P < 0.0001), but not in the apoE2 group. The prevalence of parental history of heart attack and diabetes mellitus among the three phenotype groups paralleled this trend. Thus, the risk status of apoE polymorphism may be associated with a constellation of cardiovascular risk factors in early life.