Apolipoprotein E4 Phenotype Is Not an Important Risk Factor for Coronary Heart Disease or Stroke in Elderly Subjects

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Abstract
Abstract The allele e4 (apo e4) of apolipoprotein E (apo E) has been associated with an increased risk for coronary heart disease (CHD) in cross-sectional studies in middle-aged subjects. We investigated the risk of CHD and stroke with respect to the number of apo e4 alleles in a prospective study of a Finnish nondiabetic cohort including 1067 subjects 65 to 74 years old at baseline. During the 3.5-year follow-up, CHD mortality was 2.8%, total CHD incidence 6.9%, and the cumulative occurrence of CHD (prevalence at baseline and the 3.5-year incidence combined) 17.0%. The incidence of stroke was 3.4%, and the cumulative occurrence of stroke was 6.0%. The CHD mortality was 3.4% in subjects with no apo e4 allele (n=734), 1.7% in those with one apo e4 allele (n=296), and 0% in subjects with two apo e4 alleles (n=37) ( P =NS between the three groups). The incidence of CHD according to the number of apo e4 alleles was 6.9% (no apo e4 alleles), 7.4% (one apo e4 allele), and 2.7% (two apo e4 alleles), and the cumulative occurrence of CHD was 16.5%, 18.6%, and 13.5%, respectively ( P =NS). The incidence of stroke was 3.8% in subjects with no apo e4 allele, 2.7% in those with one apo e4 allele, and 0% in those with two apo e4 alleles ( P =NS). The cumulative occurrence of stroke was 6.0%, 6.4%, and 2.7%, respectively ( P =NS). In conclusion, in contrast to middle-aged subjects, the risk of cardiovascular disease in elderly subjects with apo e4 is not increased. Consequently, the allele e4 of apo E cannot be regarded as an important risk factor for CHD or stroke in the elderly.