Robust association of the APOE ε4 allele with premature myocardial infarction especially in patients without hypercholesterolaemia: The Aachen study

Background: Genetic influence on the manifestation of coronary artery disease (CAD) and myocardial infarction (MI) has been shown previously. From many candidate genes the APOE (apolipoprotein E) with the major alleles ε2/ε3/ε4 is in the focus of interest. Materials and methods: In 1817 patients admitted for their first left heart catheterization at a premature age (males < 55 and females < 65) the association of APOE alleles with MI was analysed. Genotyping was done by 5′ exonuclease assay (TaqMan ^(M)). Results: APOE was significantly associated with hypercholesterolaemia (ε4 72% vs. ε3 66% vs. ε2 51%; P < 0·0001), and premature MI (ε4 57% vs. ε3 50% vs. ε2 41%; P < 0·0001; hazard ratio 1·41, 95%CI 1·14-1·75). In patients without hypercholesterolaemia, the APOE allele ε4 was highly predictive for the presence of premature MI (ε4 55% vs. ε3 45% vs. ε2 28%; P < 0·0001; hazard ratio 1·75, 95%CI 1·19-2·57). Conclusion: The APOE ε4 allele shows a robust association with premature MI independent of hypercholesterolaemia.