Objectives: Several factors, including abdominal obesity, insulin
resistance, diabetes mellitus and low levels of high-density lipoprotein cholesterol
have been implicated in the high prevalence and early onset of coronary heart disease
in Asian Indians. However, there are no reports regarding the role of apolipoprotein
E (apo E) gene polymorphisms in premature myocardial infarction (MI) in this
population. This study aimed to study the role of apo E gene polymorphisms in
premature MI patients and their relation to serum lipid levels.
Design and methods: Apo E gene polymorphisms were analysed in 35
patients with MI aged <40 years and in 45 age- and sex-matched controls using
polymerase chain reaction-restriction fragment length polymorphism. Levels of serum
lipids were measured in addition to the evaluation of conventional risk factors.
Results: Higher frequencies of the apo E4 allele (P<0·0001) and of
genotypes E3/E4 (P<0·005) and E4/E4 (P<0·005) were recorded in the premature MI
group compared with the controls. Multivariate regression analysis revealed that,
after adjusting for other covariates, individuals with the E4 allele were at ~46
times higher odds to develop premature MI compared with individuals without the E4
allele [adjusted odds ratio, OR (95% confidence interval, CI): 45·7 (4·9-421·3)].
Among conventional risk factors, higher risk was observed in those having
dyslipidaemia [OR (95% CI): 8·7 (0·9-86·6)] and those with a high waist : hip ratio
[OR (95% CI): 5·6 (1·4-21·2)].
Conclusion: Based on the robust association, the apo E4 allele should be
considered as an independent risk factor for premature MI in Asian Indians.
