Original Article


, Volume 48, Issue 1, pp 51-61

First online:

High Serum Apolipoprotein E Determines Hypertriglyceridemic Dyslipidemias, Coronary Disease and ApoA-I Dysfunctionality

  • Altan OnatAffiliated withTurkish Society of CardiologyCerrahpaşa Medical Faculty, Istanbul University Email author 
  • , Günay CanAffiliated withCerrahpaşa Medical Faculty, Istanbul University
  • , Ender ÖrnekAffiliated withEtlik Ihtisas Education Hospital
  • , Erkan AyhanAffiliated withCardiology Department, Medical Faculty, Balıkesir University
  • , Nihan Erginel-ÜnaltunaAffiliated withDepartment of Genetics, Institute for Experimental Medical, Istanbul University
  • , Sani N. MuratAffiliated withEtlik Ihtisas Education Hospital

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The relevance of serum apolipoprotein E (apoE) levels to two hypertriglyceridemic dyslipidemias has not been clarified. We explored, in a cross-sectional (and short-term prospective) evaluation, the independent relationship of serum apoE to the atherogenic dyslipidemia, hypertriglyceridemia with elevated apoB (HtgB) and to apoA-I dysfunctionality, previously shown in Turkish adults to be independent of apoE genotype. Serum apoE concentrations were measured by immunonephelometry in 1,127 middle-aged adults. In multivariable regression analysis, apoE concentrations showed log-linear associations with apoB and apoA-I levels, waist circumference, independent of C-reactive protein (CRP), homeostatic model assessment (HOMA) index and other confounders. The likelihood of atherogenic dyslipidemia and of HtgB roughly tripled per 1-SD increment in apoE concentrations, additively to apoE genotype, HOMA, apoA-I, CRP concentrations and waist circumference; yet apoA-I, protective against atherogenic dyslipidemia, appeared to promote HtgB, a finding consistent with apoA-I dysfunctionality in this setting. Each 1-SD increment in the apoE level was moreover, associated in both genders with MetS (at OR 1.5), after adjustment for sex, age, apoB, apoA-I and CRP, or for apoE genotypes. Circulating apoE predicted in both genders age-adjusted prevalent and incident coronary heart disease (CHD), independent of apoE genotype and CRP (OR 1.32 [95 % CI 1.11; 1.58]). To conclude, in a general population prone to MetS, elevated apoE concentrations are strongly linked to HtgB and atherogenic dyslipidemia, irrespective of apoE genotype, are associated with MetS and CHD. Excess apoE reflects pro-inflammatory state and likely autoimmune activation.


Apolipoprotein A-I Apolipoprotein B Apolipoprotein E concentrations Atherogenic dyslipidemia Coronary heart disease Hypertriglyceridemia with elevated apoB