Allelic polymorphism −491A/T in apo E gene modulates the lipid-lowering response in combined hyperlipidemia treatment

Background Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid‐lowering drugs are often necessary in its management. Some genetic loci have been associated with CHL expression, and some studies have shown modulation of drugs efficiency in t...

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Published inEuropean journal of clinical investigation Vol. 32; no. 6; pp. 421 - 428
Main Authors García-Otín, A.-L., Civeira, F., Aristegui, R., Díaz, C., Recalde, D., Sol, J. M., Masramon, X., Hernández, G., Pocoví, M.
Format Journal Article
LanguageEnglish
Published Oxford, UK Blackwell Science Ltd 01.06.2002
Blackwell Publishing Ltd
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Online AccessGet full text
ISSN0014-2972
1365-2362
DOI10.1046/j.1365-2362.2002.00996.x

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Abstract Background Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid‐lowering drugs are often necessary in its management. Some genetic loci have been associated with CHL expression, and some studies have shown modulation of drugs efficiency in the treatment of dyslipidemias by genetic polymorphisms. We have investigated whether common polymorphisms and mutations in the apolipoprotein (apo) E, lipoprotein lipase (LPL), and apo CIII genes influence atorvastatin or bezafibrate responses in patients with CHL. Design One hundred and sixteen subjects participating in the ATOMIX study (Atorvastatin in Mixed dyslipidemia) were randomized to treatment with either atorvastatin or bezafibrate. Apolipoprotein E genotype and common −491A/T and −219T/G polymorphisms in the apo E gene promoter region, Sst I polymorphism in the apo CIII gene (3238C/G), and D9N and N291S common mutations in the LPL gene were determined by polymerase chain reaction (PCR) and restriction enzyme digestion. Results Statistical analysis showed the influence of the −491A/T polymorphism in atorvastatin and bezafibrate treatments. Subjects carrying the −491T allele showed an increased LDL‐cholesterol‐lowering effect with atorvastatin compared with −491T allele noncarriers (−35% vs. −27%, P = 0·037). Subjects carrying the −491T allele, when on bezafibrate treatment, showed a lower triglyceride reduction compared with −491T allele noncarriers (−23% vs. −39%, P = 0·05). Conclusions In our study, the −491A/T polymorphism in the apo E gene promoter region modulated the lipid‐lowering efficiency of atorvastatin and bezafibrate in CHL patients. Such influence might explain some of the interindividual response variabilities observed for the two drugs, and could help in CHL management.
AbstractList Background Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid‐lowering drugs are often necessary in its management. Some genetic loci have been associated with CHL expression, and some studies have shown modulation of drugs efficiency in the treatment of dyslipidemias by genetic polymorphisms. We have investigated whether common polymorphisms and mutations in the apolipoprotein (apo) E, lipoprotein lipase (LPL), and apo CIII genes influence atorvastatin or bezafibrate responses in patients with CHL. Design One hundred and sixteen subjects participating in the ATOMIX study (Atorvastatin in Mixed dyslipidemia) were randomized to treatment with either atorvastatin or bezafibrate. Apolipoprotein E genotype and common −491A/T and −219T/G polymorphisms in the apo E gene promoter region, Sst I polymorphism in the apo CIII gene (3238C/G), and D9N and N291S common mutations in the LPL gene were determined by polymerase chain reaction (PCR) and restriction enzyme digestion. Results Statistical analysis showed the influence of the −491A/T polymorphism in atorvastatin and bezafibrate treatments. Subjects carrying the −491T allele showed an increased LDL‐cholesterol‐lowering effect with atorvastatin compared with −491T allele noncarriers (−35% vs. −27%, P  = 0·037). Subjects carrying the −491T allele, when on bezafibrate treatment, showed a lower triglyceride reduction compared with −491T allele noncarriers (−23% vs. −39%, P  = 0·05). Conclusions In our study, the −491A/T polymorphism in the apo E gene promoter region modulated the lipid‐lowering efficiency of atorvastatin and bezafibrate in CHL patients. Such influence might explain some of the interindividual response variabilities observed for the two drugs, and could help in CHL management.
Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid-lowering drugs are often necessary in its management. Some genetic loci have been associated with CHL expression, and some studies have shown modulation of drugs efficiency in the treatment of dyslipidemias by genetic polymorphisms. We have investigated whether common polymorphisms and mutations in the apolipoprotein (apo) E, lipoprotein lipase (LPL), and apo CIII genes influence atorvastatin or bezafibrate responses in patients with CHL. One hundred and sixteen subjects participating in the ATOMIX study (Atorvastatin in Mixed dyslipidemia) were randomized to treatment with either atorvastatin or bezafibrate. Apolipoprotein E genotype and common -491A/T and -219T/G polymorphisms in the apo E gene promoter region, Sst I polymorphism in the apo CIII gene (3238C/G), and D9N and N291S common mutations in the LPL gene were determined by polymerase chain reaction (PCR) and restriction enzyme digestion. Statistical analysis showed the influence of the -491A/T polymorphism in atorvastatin and bezafibrate treatments. Subjects carrying the -491T allele showed an increased LDL-cholesterol-lowering effect with atorvastatin compared with -491T allele noncarriers (-35% vs. -27%, P = 0.037). Subjects carrying the -491T allele, when on bezafibrate treatment, showed a lower triglyceride reduction compared with -491T allele noncarriers (-23% vs. -39%, P = 0.05). In our study, the -491A/T polymorphism in the apo E gene promoter region modulated the lipid-lowering efficiency of atorvastatin and bezafibrate in CHL patients. Such influence might explain some of the interindividual response variabilities observed for the two drugs, and could help in CHL management.
Background Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid‐lowering drugs are often necessary in its management. Some genetic loci have been associated with CHL expression, and some studies have shown modulation of drugs efficiency in the treatment of dyslipidemias by genetic polymorphisms. We have investigated whether common polymorphisms and mutations in the apolipoprotein (apo) E, lipoprotein lipase (LPL), and apo CIII genes influence atorvastatin or bezafibrate responses in patients with CHL. Design One hundred and sixteen subjects participating in the ATOMIX study (Atorvastatin in Mixed dyslipidemia) were randomized to treatment with either atorvastatin or bezafibrate. Apolipoprotein E genotype and common −491A/T and −219T/G polymorphisms in the apo E gene promoter region, Sst I polymorphism in the apo CIII gene (3238C/G), and D9N and N291S common mutations in the LPL gene were determined by polymerase chain reaction (PCR) and restriction enzyme digestion. Results Statistical analysis showed the influence of the −491A/T polymorphism in atorvastatin and bezafibrate treatments. Subjects carrying the −491T allele showed an increased LDL‐cholesterol‐lowering effect with atorvastatin compared with −491T allele noncarriers (−35% vs. −27%, P = 0·037). Subjects carrying the −491T allele, when on bezafibrate treatment, showed a lower triglyceride reduction compared with −491T allele noncarriers (−23% vs. −39%, P = 0·05). Conclusions In our study, the −491A/T polymorphism in the apo E gene promoter region modulated the lipid‐lowering efficiency of atorvastatin and bezafibrate in CHL patients. Such influence might explain some of the interindividual response variabilities observed for the two drugs, and could help in CHL management.
Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid-lowering drugs are often necessary in its management. Some genetic loci have been associated with CHL expression, and some studies have shown modulation of drugs efficiency in the treatment of dyslipidemias by genetic polymorphisms. We have investigated whether common polymorphisms and mutations in the apolipoprotein (apo) E, lipoprotein lipase (LPL), and apo CIII genes influence atorvastatin or bezafibrate responses in patients with CHL.BACKGROUNDCombined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid-lowering drugs are often necessary in its management. Some genetic loci have been associated with CHL expression, and some studies have shown modulation of drugs efficiency in the treatment of dyslipidemias by genetic polymorphisms. We have investigated whether common polymorphisms and mutations in the apolipoprotein (apo) E, lipoprotein lipase (LPL), and apo CIII genes influence atorvastatin or bezafibrate responses in patients with CHL.One hundred and sixteen subjects participating in the ATOMIX study (Atorvastatin in Mixed dyslipidemia) were randomized to treatment with either atorvastatin or bezafibrate. Apolipoprotein E genotype and common -491A/T and -219T/G polymorphisms in the apo E gene promoter region, Sst I polymorphism in the apo CIII gene (3238C/G), and D9N and N291S common mutations in the LPL gene were determined by polymerase chain reaction (PCR) and restriction enzyme digestion.DESIGNOne hundred and sixteen subjects participating in the ATOMIX study (Atorvastatin in Mixed dyslipidemia) were randomized to treatment with either atorvastatin or bezafibrate. Apolipoprotein E genotype and common -491A/T and -219T/G polymorphisms in the apo E gene promoter region, Sst I polymorphism in the apo CIII gene (3238C/G), and D9N and N291S common mutations in the LPL gene were determined by polymerase chain reaction (PCR) and restriction enzyme digestion.Statistical analysis showed the influence of the -491A/T polymorphism in atorvastatin and bezafibrate treatments. Subjects carrying the -491T allele showed an increased LDL-cholesterol-lowering effect with atorvastatin compared with -491T allele noncarriers (-35% vs. -27%, P = 0.037). Subjects carrying the -491T allele, when on bezafibrate treatment, showed a lower triglyceride reduction compared with -491T allele noncarriers (-23% vs. -39%, P = 0.05).RESULTSStatistical analysis showed the influence of the -491A/T polymorphism in atorvastatin and bezafibrate treatments. Subjects carrying the -491T allele showed an increased LDL-cholesterol-lowering effect with atorvastatin compared with -491T allele noncarriers (-35% vs. -27%, P = 0.037). Subjects carrying the -491T allele, when on bezafibrate treatment, showed a lower triglyceride reduction compared with -491T allele noncarriers (-23% vs. -39%, P = 0.05).In our study, the -491A/T polymorphism in the apo E gene promoter region modulated the lipid-lowering efficiency of atorvastatin and bezafibrate in CHL patients. Such influence might explain some of the interindividual response variabilities observed for the two drugs, and could help in CHL management.CONCLUSIONSIn our study, the -491A/T polymorphism in the apo E gene promoter region modulated the lipid-lowering efficiency of atorvastatin and bezafibrate in CHL patients. Such influence might explain some of the interindividual response variabilities observed for the two drugs, and could help in CHL management.
Author Civeira, F.
Pocoví, M.
Aristegui, R.
Díaz, C.
Recalde, D.
García-Otín, A.-L.
Sol, J. M.
Masramon, X.
Hernández, G.
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Departamento de Bioquímica y Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain (A.‐L. García‐Otín, D. Recalde, M. Pocoví); Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain (F. Civeira); Departamento de I + D de Pfizer, Barcelona, Spain (R. Aristegui, C. Díaz, J. M. Sol, X. Masramon, G. Hernández).
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Sanllehy C, Casals E, Rodriguez-Villar C, Zambon D, Ojuel J, Ballesta AM et al. Lack of interaction of apolipoprotein E phenotype with the lipoprotein response to lovastatin or gemfibrozil in patients with primary hypercholesterolemia. Metabolism 1998; 47:560-5.
Mahley RW. Apolipoprotein E. cholesterol transport protein with expanding role in cell biology. Science 1988; 240:622-30.
Ordovas JM, Lopez-Miranda J, Pérez-Jiménez F, Rodriguez C, Park JS, Cole T et al. Effect of apolipoprotein E and A-IV phenotypes on the low density lipoprotein response to HMG CoA reductase inhibitor therapy. Atherosclerosis 1995; 113:157-66.
Ordovas JM, Civeira F, Genest JJ Jr, Craig S, Robbins AH, Meade T et al. Restriction fragment length polymorphisms of the apolipoprotein A-I, C-III, A-IV gene locus. Relationships with lipids, apolipoproteins, and premature coronary artery disease. Atherosclerosis 1991; 87:75-86.
Ginsberg HN. Effects of statins on triglyceride metabolism. Am J Cardiol 1998; 81:32B-35B.
Hixson JE, Vernier DT. Restriction isotyping of human apolipoprotein E by gene amplification and cleavage with Hha I. J Lipid Res 1990; 31:545-8.
Mailly F, Tugrul Y, Reymer PWA, Bruin T, Seed M, Groenemeyer BF et al. A common variant in the gene for lipoprotein lipase (Asp9 - >Asn). Functional implications and prevalence in normal and hyperlipidemic subjects. Arterioscler Thromb Vasc Biol 1995; 15:468-78.
Juo SH, Beaty TH, Kwiterovich PO Jr. Etiologic heterogeneity of hyperapobetalipoproteinemia (hyperapoB). Results from segregation analysis in families with premature coronary artery disease. Arterioscler Thromb Vasc Biol 1997; 17:2729-36.
Sarkkinen E, Korhonen M, Erkkila A, Ebeling T, Uusitupa M. Effect of apolipoprotein E polymorphism on serum lipid response to the separate modification of dietary fat and dietary cholesterol. Am J Clin Nutr 1998; 68:1215-22.
Miller SA, Dykes DD, Polesky HF. A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res 1988; 16:1215.
Nestel P, Simons L, Barter P, Clifton P, Colquhoun D, Hamilton-Craig I et al. A comparative study of simvastatin and gemfibrozil in combined hyperlipoproteinemia: prediction response by baseline lipids, apo E genotype, lipoprotein (a) and insulin. Atherosclerosis 1997; 129:231-9.
Vega GL, Grundy SM. Effect of statins on metabolism of apo-B-containing lipoproteins in hypertriglyceridemic men. Am J Cardiol 1998; 81:36B-42B.
Lopez-Miranda J, Ordovas JM, Mata P, Lichtenstein AH, Clevidence B, Judd JT et al. Effect of apolipoprotein E phenotype on diet-induced lowering of plasma low density lipoprotein cholesterol. J Lipid Res 1994; 35:1965-75.
O'Malley JP, Illingwoth DR. The influence of apolipoprotein E phenotype on the response to lovastatin therapy in patients with heterozygous familial hypercholesterolemia. Metabolism 1990; 39:150-4.
Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Manttari M, Heinonen OP et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study Implications for Treatment. Circulation 1992; 85:37-45.
Clee SM, Zwinderman AH, Engert JC, Zwarts KY, Molhuizen HOF, Roomp K et al. Common genetic variation in ABCA1 is associated with altered lipoprotein levels and a modified risk for coronary artery disease. Circulation 2001; 103:1198-205.
Aouizerat BE, Allayee H, Bodnar J, Kras KL, Peltonen L, De Bruin TW et al. Novel genes for familial combined hyperlipidemia. Curr Opin Lipidol 1999; 10:113-22.
Babirak SP, Iverius PH, Fujimoto WY, Brunzell JD. Detection and characterization of the heterozygote state for lipoprotein lipase deficiency. Arteriosclerosis 1989; 9:326-34.
De Graaf J, Stalenhoef AFH. Defects of the lipoprotein metabolism in familial combined hyperlipidemia. Curr Opin Lipidol 1998; 9:189-96.
Genest JJ Jr, Martin-Munley SS, McNamara JR, Ordovas JM, Jenner J, Myers RH et al. Familial lipoprotein disorders in patients with premature coronary artery disease. Circulation 1992; 85:2025-33.
Wilson PW, Myers RH, Larson MG, Ordovas JM, Wolf PA, Schaefer EJ. Apolipoprotein E alleles, dyslipidemia, and coronary heart disease. JAMA 1994; 272:1666-71.
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344:1383-9.
Talmud PJ, Palmen J, Miller G, Humphries SE. Effect of microsomal triglyceride transfer protein gene variants (-493G> T, Q95H and H297Q) on plasma lipid levels in healthy middle-aged UK men. Ann Hum Genet 2000; 64:269-76.
Valveny N, Esteban E, Kandil M, Moral P. APO E polymorphism in Spanish and Moroccan populations. Clin Genet 1997; 51:354-6.
Gerdes C, Fisher RM, Nicaud V, Boer J, Humphries SE, Talmud PJ et al. Lipoprotein lipase variants D9N and N291S are associated with increased plasma triglyceride and lower high-density lipoprotein cholesterol concentrations: studies in the fasting and postprandial states: the European Atherosclerosis Research Studies. Circulation 1997; 96:733-40.
Carmena R, Roederer G, Mailloux H, Lussier-Cacan S, Davignon. J. The response to lovastatin treatment in patients with heterozygous familial hypercholesterolemia is modulated by apolipoprotein E polymorphism. Metabolism 1993; 42:895-901.
De Knijff P, Stalenhoef AF, Mol MJ, Gevers Leuven JA, Smit J, Erkelens DW et al. Influence of apo E polymorphism on the response to simvastatin treatment in patients with heterozygous familial hypercholesterolemia. Atherosclerosis 1990; 83:89-97.
Farnier M and the Cerivastatin Study Group. Cerivastatin in the treatment of mixed hyperlipidemia: the Right Study. Am J Cardiol 1998; 82:47J-51J.
Talmud P, Humphries SE. Apolipoprotein C-III gene variation and dyslipidaemia. J Lipid Res 1997; 8:154-8.
Staels B, Dallongeville J, Auwerx J, Schoonjans K, Leitersdorf E, Fruchart JC. Mechanism of fibrates on lipid and lipoprotein metabolism. Circulation 1998; 98:2088-93.
Lambert J-C, Brousseau T, Defosse V, Evans A, Arveiler D, Ruidavets J-B et al. Independent association of an apo E gene promoter polymorphism with increased risk of myocardial infarction and decreased apo E plasma concentrations-the ECTIM Study. Hum Mol Genet 2000; 9:57-61.
East C. Combined hyperlipidemia as a risk factor for premature atherosclerosis disease. Am J Med 1999; 107:46S-47S.
Artiga MJ, Bullido MJ, Sastre I, Recuero M, Garcia MA, Aldudo J et al. Allelic polymorphisms in the transcriptional regulatory region of the apolipoprotein E gene. FEBS Lett 1998; 421:105-8.
Bullido MJ, Artiga MJ, Recuero M, Sastre I, García MA, Aldudo J et al. A polymorphism in the regulatory region of apoE associated with risk for Alzheimer's dementia. Nat Genet 1998; 18:69-71.
Kakko S, Tamminen M, Paivansalo M, Kauma H, Rantala AO, Lilja M et al. Variation at the cholesterol ester transfer protein gene in relation to plasma high density lipoproteins cholesterol levels and carotid intima-media thickness. Eur J Clin Invest 2001; 31:593-602.
1990; 31
1995; 15
1990; 39
2000; 9
1988; 16
1993; 42
1989; 9
1995; 10
1994; 272
2000; 64
1995; 113
1998; 81
1967; 276
1988; 240
1998; 82
1999; 107
2001; 103
1998; 47
1997; 8
1998; 68
1990; 83
1994; 344
1993; 13
1998; 18
1997; 51
1997; 129
1991; 87
1997; 96
1997; 17
1999; 10
1994; 35
1998; 421
1998; 98
1992; 2
1998; 9
2001; 31
1992; 85
e_1_2_6_31_2
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Talmud P (e_1_2_6_25_2) 1997; 8
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Scandinavian Simvastatin Survival Study Group. (e_1_2_6_9_2) 1994; 344
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International Task Force of Coronary Heart Disease. (e_1_2_6_11_2) 1992; 2
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East C (e_1_2_6_2_2) 1999; 107
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Wilson PW (e_1_2_6_24_2) 1994; 272
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References_xml – reference: Juo SH, Beaty TH, Kwiterovich PO Jr. Etiologic heterogeneity of hyperapobetalipoproteinemia (hyperapoB). Results from segregation analysis in families with premature coronary artery disease. Arterioscler Thromb Vasc Biol 1997; 17:2729-36.
– reference: Babirak SP, Iverius PH, Fujimoto WY, Brunzell JD. Detection and characterization of the heterozygote state for lipoprotein lipase deficiency. Arteriosclerosis 1989; 9:326-34.
– reference: Talmud PJ, Palmen J, Miller G, Humphries SE. Effect of microsomal triglyceride transfer protein gene variants (-493G> T, Q95H and H297Q) on plasma lipid levels in healthy middle-aged UK men. Ann Hum Genet 2000; 64:269-76.
– reference: Hixson JE, Vernier DT. Restriction isotyping of human apolipoprotein E by gene amplification and cleavage with Hha I. J Lipid Res 1990; 31:545-8.
– reference: De Graaf J, Stalenhoef AFH. Defects of the lipoprotein metabolism in familial combined hyperlipidemia. Curr Opin Lipidol 1998; 9:189-96.
– reference: Venkatesan S, Cullen P, Pacy P, Halliday D, Scott. J. Stable isotopes show a direct relation between VLDL apoB overproduction and serum triglyceride levels and indicate a metabolically and biochemically coherent basis for familial combined hyperlipidemia. Arterioscler Thromb 1993; 13:1110-8.
– reference: Ordovas JM, Lopez-Miranda J, Pérez-Jiménez F, Rodriguez C, Park JS, Cole T et al. Effect of apolipoprotein E and A-IV phenotypes on the low density lipoprotein response to HMG CoA reductase inhibitor therapy. Atherosclerosis 1995; 113:157-66.
– reference: Genest JJ Jr, Martin-Munley SS, McNamara JR, Ordovas JM, Jenner J, Myers RH et al. Familial lipoprotein disorders in patients with premature coronary artery disease. Circulation 1992; 85:2025-33.
– reference: Lambert J-C, Brousseau T, Defosse V, Evans A, Arveiler D, Ruidavets J-B et al. Independent association of an apo E gene promoter polymorphism with increased risk of myocardial infarction and decreased apo E plasma concentrations-the ECTIM Study. Hum Mol Genet 2000; 9:57-61.
– reference: Wilson PW, Myers RH, Larson MG, Ordovas JM, Wolf PA, Schaefer EJ. Apolipoprotein E alleles, dyslipidemia, and coronary heart disease. JAMA 1994; 272:1666-71.
– reference: Farnier M and the Cerivastatin Study Group. Cerivastatin in the treatment of mixed hyperlipidemia: the Right Study. Am J Cardiol 1998; 82:47J-51J.
– reference: Artiga MJ, Bullido MJ, Sastre I, Recuero M, Garcia MA, Aldudo J et al. Allelic polymorphisms in the transcriptional regulatory region of the apolipoprotein E gene. FEBS Lett 1998; 421:105-8.
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– reference: Talmud P, Humphries SE. Apolipoprotein C-III gene variation and dyslipidaemia. J Lipid Res 1997; 8:154-8.
– reference: Staels B, Dallongeville J, Auwerx J, Schoonjans K, Leitersdorf E, Fruchart JC. Mechanism of fibrates on lipid and lipoprotein metabolism. Circulation 1998; 98:2088-93.
– reference: Miller SA, Dykes DD, Polesky HF. A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res 1988; 16:1215.
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– reference: Valveny N, Esteban E, Kandil M, Moral P. APO E polymorphism in Spanish and Moroccan populations. Clin Genet 1997; 51:354-6.
– reference: East C. Combined hyperlipidemia as a risk factor for premature atherosclerosis disease. Am J Med 1999; 107:46S-47S.
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Snippet Background Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid‐lowering drugs are often necessary...
Background Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid‐lowering drugs are often necessary...
Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid-lowering drugs are often necessary in its...
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SubjectTerms Adult
Anticholesteremic Agents - therapeutic use
ApoE
Apolipoproteins E - genetics
Apolipoproteins E - metabolism
Atorvastatin
bezafibrate
Bezafibrate - therapeutic use
Cholesterol - blood
DNA - analysis
Double-Blind Method
Female
Heptanoic Acids - therapeutic use
Humans
Hyperlipidemia, Familial Combined - drug therapy
Hyperlipidemia, Familial Combined - genetics
Hypolipidemic Agents - therapeutic use
lipid-lowering drugs
Male
Middle Aged
Polymorphism, Genetic
promoter
Promoter Regions, Genetic
Pyrroles - therapeutic use
transcription
Triglycerides - blood
Title Allelic polymorphism −491A/T in apo E gene modulates the lipid-lowering response in combined hyperlipidemia treatment
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