Association of ApoE Gene Polymorphisms with the Risk of Coronary Heart Disease Combined with Essential Hypertension and the Regulation Effect of Statin on Lipid

ZHAO Qinqin; HE Xudong; CHEN Jianguo

doi:10.12102/j.issn.1672-1349.2025.08.016

Abstract：Objective: To investigate the relationship between apolipoprotein E (ApoE) gene polymorphism and the risk of hypertension complicated with coronary heart disease, as well as the lipid-lowering effect of statins. Methods: A total of 68 patients with primary hypertension complicated with coronary heart disease, 68 patients with simple coronary heart disease, 68 patients with simple primary hypertension, and 68 healthy individuals were selected from Wuhu No.1 People's Hospital between July 2021 and October 2023, and were divided into the combined group, coronary heart disease group, hypertension group, and control group, respectively. All subjects underwent ApoE gene polymorphism testing. The distribution of ApoE genotypes, allele frequencies, and phenotype distributions among the four groups were compared. Univariate and multivariate logistic regression analyses were used to analyze the relationship between genotype and the occurrence of hypertension complicated with coronary heart disease. The changes in four lipid indicators [total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)] before and after statin treatment in patients with hypertension complicated with coronary heart disease with different ApoE phenotypes were compared, as well as the safety of medication. Results: Among the 272 subjects, the ApoE genotypes ε2/2, ε2/3, ε3/3, ε2/4, ε4/3, and ε4/4 were detected, with detection rates of 0.74%, 15.44%, 68.75%, 2.57%, 12.50%, and 0%, respectively. According to the chi-square test, the distribution of ApoE gene polymorphism genotypes conformed to the Hardy-Weinberg equilibrium law (P > 0.05). The proportion of ApoE genotype ε4/3, the frequency of ε4 allele, and the proportion of E4 phenotype were higher in the combined group, coronary heart disease group, and hypertension group than in the control group (P < 0.05). The frequency of ε2 allele and the proportion of E2 phenotype were lower in the combined group than in the control group (P < 0.05). Multivariate logistic regression analysis showed that older age, a history of smoking, and ApoE phenotype E4 were risk factors for hypertension complicated with coronary heart disease, while higher HDL-C levels were protective factors (P < 0.05). Compared with before medication, the levels of TC, TG, HDL-C, and LDL-C in patients with different ApoE phenotypes improved after medication (P < 0.05). Compared with the E4 type, the TC level decreased in patients with E2 and E3 types after medication, with the lowest level in the E2 type (P < 0.05). The rate of change in the four lipid indicators before and after medication was higher in patients with E2 and E3 types compared with those with E4 type, with the highest rate in the E2 type (P < 0.05). There were no adverse reactions in patients with E2 type during statin treatment. The incidence of adverse reactions in E3 and E4 types was 4.26% and 7.14%, respectively. There was no statistically significant difference in the incidence of adverse reactions among patients with different ApoE phenotypes (P > 0.05). Conclusion: The ApoE E4 phenotype (ε4/3, ε4/4) is a high-risk factor for hypertension complicated with coronary heart disease. Patients with E2 phenotype (ε2/2, ε2/3) and E3 phenotype (ε3/3, ε2/4) have better lipid-lowering effects with statins, while patients with E4 phenotype have poorer lipid-lowering effects.