A Clinical Study Of Atorvastatin Regulation On Lipid Levels In Patients With Different Apoe Genotypes In Coronary Heart Disease

Objectives:Cardiovascular heart disease has become one of the majorhealth-threatening diseases. Its incidence and mortality rate shows an increasingtrend year by year. Though the pathogenesis of it is still not entirely clear, it iswell acknowledged that the interaction of a variety of factors, among whichlipid metabolism is a leading independent risky factor, leads to the occurrenceof the disease. At present, a large number of basic and clinical studies haveshown that the polymorphism of ApoE gene has a close relevance to the diseaseand other related diseases. This study intends to reveal ApoE genotypes and theimpact of regulation on the expression of above-mentioned genotypes inpatients during the medication of Atorvastatin to the patients by employingPCR technology.Methods:116patients who were diagnosed with coronary heart disease (CHD) byselective coronary angiography in Cardiovascular Department of the AffiliatedHospital of Luzhou Medical College from January1,2013to December31,2013, were chosen as CHD group, including60males, aged from56to75years old, and56females, from58to74years, and the mean is60.5±8.4yearsold. All the cases had Luminal diameter stenosis≥50%in one or more vessels. 50volunteers from outpatient physical examination in the same period werechosen as comparison control group, including26males and24females, agedfrom55to69years, mean57.3±9.2years old. ApoE genotypes weredetermined by polymerase chain reaction-restriction fragment length(PCR-RFL), lipid levels were measured before Atorvastatin treatment and after12weeks of treatment CHD patients, and the relationship between genotypeand lipid-lowering efficacy was analyzed.Results:(1) Frequency of ApoE genotype and alleleIn CHD group, the frequency of ApoE genetype and allele was E3/3＞E3/4＞E2/3＞E4/4and ε3＞ε4＞ε2respectively. In the control group, theresults were E3/3＞E2/3＞E3/4＞E4/4andε3＞ε4=ε2. Among the coronaryheart disease patients, the figures of ApoE genetype (22.4%), E4/4genetype(5.2%) and ApoE ε4allele (16.4%) were significantly higher than those of thecontrol group (12%,2%and8%)(P <0.05). While the figures of E2/3(12.1%vs16%), E3/3(60.3%vs70%), ε2(6%vs8%) and ε3(77.6%vs84%) were lowerthan the control group and therefore without statistical significance (P＞0.05).(2) Comparison of lipid levels in different ApoE genotypesThe TC and LDL-C levels of ApoE ε4were significantly higher than theother groups (P<0.05), while TG and HDL-C level had no significantdifference among ApoE genotypes (P＞0.05). (3) Comparison of lipid levels in different ApoE genotypes before and afteratorvastatin administrationThe lipid levels demonstrated no significant difference among ApoEgenotypes ahead or after12weeks of atorvastatin administration (P<0.05).But compared ApoE E2/2+E3/2, E3/3with E4/3+E4/4, the level of TC,LDL-C and HDL-C in the patients’ plasma revealed significance after takingatorvastatin (P<0.05) but TG showed no statistical significance (P＞0.05).Conclusions:(1) In the coronary heart disease group, ApoE E3/4genotype (22.4%), E4/4genotype (5.2%) and ApoE ε4allele frequency (16.4%) were significantlyhigher than those (12%,2%,8%respectively) of control group (P<0.05), whichindicated that ApoE genotype E3/4, E4/4as well as ε4allele might play roles inthe starting and developing of coronary heart disease.(2) In the patients of coronary heart disease, ApoE ε4allele group had asignificant correlation with the increase of plasma TC and LDL-C, whichshowed the elevation of ε4allele frequency was an important genetic markerand a risky factor in the lipid metabolism disorder and formation of coronaryheart disease but imposed no significant impact on plasma TG and HDL-C.(3) TC, LDL-C and HDL-C plasma levels of coronary heart disease patientswere significantly lower than E4/3+E4/4group after the administration ofatorvastatin, which suggested atorvastatin achieved better effect in treating andlowering the blood lipid of the patients of ApoE E2/2+E3/2、E3/3allele group while achieved no tangible effect on the group of E4/3+E4/4allele.