Abstract
Myocardial infarction (MI) is a serious result of coronary artery disease. Recent data from clinical trials have showed that the risk of MI was associated with high plasma apolipoprotein B (apoB) levels. Mutations in ApoB gene were also found to be associated with plasma lipid levels. The aim of this study is to evaluate the effect of ApoB polymorphisms on the risk of MI and plasma apoB levels in a Chinese population. Eight polymorphisms (rs676210, rs679899, rs3791980, rs2854725, rs11676704, rs512535, rs12720841 and rs2678379) in ApoB gene were genotyped in a case-control study in China, including 550 MI cases and 550 healthy controls. Carriers of GG genotype of rs676210 had significant increased risk of MI [odd ratio (OR) = 1.93, 95% confidence interval (CI): 1.23-3.03] compared to carriers of AA genotype. Haplotype analysis also showed that GTTGG (rs676210-rs2854725-rs11676704-rs3791980-rs2678379) haplotype had significant increased risk of MI (OR = 2.82, 95% CI: 1.49-5.33) compared with ATTGA haplotype. Furthermore, apoB rs676210 and rs2678379 polymorphisms were significantly associated with plasma levels of apoB in healthy controls (P = 0.01 and 0.02). Our findings indicated that ApoB mutations may be associated with the risk of MI and plasma ApoB levels in healthy controls in Chinese population.
Keywords: Myocardial infarction, ApoB, genetic mutation, haplotype, susceptibility
Introduction
Myocardial infarction (MI), a common presentation of ischemic heart disease, remains a leading cause of morbidity and mortality worldwide and affects approximately 7 million people a year according to statistics [1,2].
Although the exact etiology of MI has not been clearly explained, researches have proved that like other complex diseases, multiple environmental factors, genetic factors, and their interactions may responsible for the pathogenesis of MI [3]. Environmental risk factors contribute to MI including old age, tobacco smoking, diabetes, hypertension, obesity, high blood levels of high density lipoprotein cholesterol (HDL-C) and total cholesterol (TC), and low blood levels of low density lipoprotein cholesterol (LDL-C) [4-6]. Molecular epidemiological studies also identified a set of genetic mutations that can modify the risk of MI [7-11]. It is estimated that the overall genetic heritability of CAD/MI is around 40-60%, and this proportion includes mainly genes that regulate known risk factors (e.g., lipid metabolism), and also genes involved in as yet unknown metabolic pathways [12].
Apolipoprotein B (apoB), a key component of VLDL particles and microsomal triacylglycerol transfer protein (MTP), plays an important role in lipid metabolism [13]. Reduced secretion of apoB protein can result in reduced production of chylomicron and VLDL and then leading to malabsorption of fats and fat-soluble vitamins [14]. So, plasma apoB level is an important predictor of MI [15,16]. Twin studies also suggested that 50-60% of the variation in plasma levels of apoB in human is genetically determined [17,18]. Rare missense mutations in the ApoB gene may not only result in severe hypercholesterolemia and ischemic cardiovascular disease, but also in hypocholesterolemia [19,20]. But till now, studies on ApoB single nucleotide polymorphisms (SNP) and risk of MI were rare and have not been fully studied in Chinese population.
To help clarify whether mutations in ApoB gene are associated with risk of MI and plasma apoB levels in healthy controls, we examined eight SNPs in the ApoB gene (rs676210, rs679899, rs3791980, rs2854725, rs11676704, rs512535, rs12720841 and rs2678379) in a case-control study in Chinese population.
Materials and methods
Study subjects
Between March 2009 and February 2013, a total of 550 MI patients and 550 healthy controls were consecutively enrolled in the Gongren Hospital in Hebei, China. All patients were diagnosed according to the criteria of the WHO, including chest pain plus either electrocardiographic changes or elevated levels of cardiac enzymes [21]. Healthy control subjects, without MI, were selected in the same period and from the same hospital, and were frequency matched to the cases by age (5-year age groups) and gender. At enrollment, demographic characteristics, anthropometric measures, medical histories were collected from each subject by a trained interviewer using a structured questionnaire. Written informed consent was obtained from all enrolled participants. This study was approved by the Ethics Committee of the Gongren Hospital.
Laboratory tests
Blood samples were collected from all participants after a 12-hour overnight fast and then separated into plasma, red blood cells, and buffy coat. Plasma levels of TC (mmol/L), HDL-C (mmol/L), LDL-C (mmol/L) and apoB (g/L) were determined by commercial kits from the Nanjing Jiancheng Bio-company (Nanjing, China).
Genotyping
Genomic DNA was extracted from buffy coat using Promega DNA Extraction Kit (Promega, Madison, WI, USA). Genotyping was performed using the TaqMan assay on the ABI PRISM 7900HT Sequence Detection System (Applied Biosystems, Foster City, CA, USA), in a 384-well format, with VIC and FAM fluorescent reporter probes. The genotyping call rate was > 95%, and the completion rate was > 99%. The quality and potential misclassification of the genotyping were assessed by re-genotyping 10% of samples that were randomly selected from the whole population. The concordance rate for the quality control samples was 100%.
Statistical analysis
We used SAS 9.3 (SAS Institute, Inc.) for the statistical analyses. Chi-square test and the t test were used to evaluate the differences in the distribution of risk factors between cases and controls. The ORs and 95% CIs for the associations between the SNPs and MI risk were estimated by unconditional logistic regression model. Hardy-Weinberg equilibrium for genotypic distribution and linkage disequilibrium between loci were assessed by HaploView version 4.0 (Daly Lab at the Broad Institute, Cambridge, MA, USA) [22]. Associations between haplotypes (> 1% frequency) and risk of MI were evaluated by computing ORs and 95% CIs using HAPSTAT, assuming an additive model, using the most common haplotype as the referent category [23]. Both univariate ANOVA and multivariate ANCOVA analyses adjusting for age, smoking, diabetes, hypertension and BMI were performed to determine the effects of the ApoB polymorphisms on plasma ApoB levels. A two tailed P-value of 0.05 was considered statistically significant.
Results
Selected characteristics of the study population are shown in Table 1. Cases and controls were evenly matched by age and gender. Cases were more likely to smoke cigarettes (49.5% vs. 33.2%), have diabetes (34.4% vs. 13.6%), have hypertension (48.0% vs. 42.0%) and have higher BMI levels (24.34±2.61 vs. 23.83±2.51). Besides, cases have significant lower levels of plasma total cholesterol and HDL-C, but higher levels of LDL-C and ApoB than that in controls.
Table 1.
Characteristics of cases and controls
| Characteristics | Controls (n = 550) | Cases (n = 550) | P value |
|---|---|---|---|
| Age (year) | 57.68±8.65 | 57.88±8.53 | 0.72 |
| Sex (Male/Female) | 398/152 | 396/154 | 0.89 |
| Smoking (Yes/No) | 183/367 | 272/278 | < 0.001 |
| Diabetes (Yes/No) | 75/472 | 189/361 | < 0.001 |
| Hypertension (Yes/No) | 231/319 | 264/286 | 0.05 |
| BMI (kg/m2) | 23.83±2.51 | 24.34±2.61 | 0.001 |
| Total cholesterol (mmol/L) | 5.10±1.78 | 4.72±1.17 | < 0.001 |
| HDL-C (mmol/L) | 1.47±0.66 | 1.22±0.38 | < 0.001 |
| LDL-C (mmol/L) | 2.77±1.09 | 2.91±0.66 | 0.01 |
| ApoB (g/L) | 0.82±0.23 | 0.88±0.25 | < 0.001 |
The associations of ApoB polymorphisms with risk of MI are presented in Table 2. The genotype distributions of these eight variants showed no deviation from the expected Hardy-Weinberg equilibrium among controls (P > 0.05). Of these SNPs, carriers of the GG genotype of rs676210 had significant higher risk of MI [odds ratio (OR) = 1.93, 95% confidence interval (CI): 1.23-3.03] compared with carriers of the major genotype. This association remained statistically significant after further adjustment for age, smoking, hypertension, diabetes and BMI. None of the other SNPs examined was associated with MI.
Table 2.
Association of genetic variants in ApoB gene with risk of MI
| SNP | Controls, n (%) | Cases, n (%) | OR (95% CI)† | OR (95% CI)‡ | P value |
|---|---|---|---|---|---|
| rs676210 | |||||
| AA | 280 (50.9) | 245 (44.5) | 1.00 | 1.00 | |
| AG | 235 (42.7) | 246 (44.7) | 1.20 (0.93-1.53) | 1.19 (0.92-1.54) | 0.16 |
| GG | 35 (6.4) | 59 (10.7) | 1.93 (1.23-3.03) | 1.89 (1.18-3.03) | 0.005 |
| AG+GG | 270 (49.1) | 305 (55.5) | 1.29 (1.02-1.64) | 1.28 (1.00-1.64) | 0.04 |
| rs679899 | |||||
| AA | 385 (70.0) | 380 (69.1) | 1.00 | 1.00 | |
| AG | 153 (27.8) | 154 (28.0) | 1.02 (0.78-1.33) | 0.99 (0.75-1.31) | 0.89 |
| GG | 12 (2.2) | 16 (2.9) | 1.34 (0.63-2.88) | 1.65 (0.75-3.65) | 0.45 |
| AG+GG | 165 (30.0) | 170 (30.9) | 1.04 (0.81-1.35) | 1.04 (0.79-1.36) | 0.75 |
| rs2854725 | |||||
| TT | 404 (73.5) | 388 (70.5) | 1.00 | 1.00 | |
| TG | 139 (25.3) | 147 (26.7) | 1.10 (0.84-1.44) | 1.09 (0.82-1.45) | 0.49 |
| GG | 7 (1.3) | 15 (2.7) | 2.23 (0.90-5.53) | 2.11 (0.82-5.40) | 0.08 |
| TG+GG | 146 (26.6) | 162 (29.4) | 1.16 (0.89-1.50) | 1.15 (0.87-1.51) | 0.28 |
| rs11676704 | |||||
| TT | 284 (51.6) | 281 (51.1) | 1.00 | 1.00 | |
| TG | 215 (39.1) | 216 (39.3) | 1.01 (0.79-1.30) | 1.02 (0.79-1.33) | 0.91 |
| GG | 51 (9.3) | 53 (9.6) | 1.05 (0.69-1.59) | 1.13 (0.73-1.74) | 0.83 |
| TG+GG | 266 (48.4) | 269 (48.9) | 1.02 (0.81-1.29) | 1.04 (0.81-1.34) | 0.86 |
| rs3791980 | |||||
| GG | 304 (55.3) | 302 (54.9) | 1.00 | 1.00 | |
| GT | 205 (37.3) | 206 (37.5) | 1.01 (0.79-1.30) | 1.00 (0.77-1.30) | 0.92 |
| TT | 41 (7.5) | 42 (7.6) | 1.03 (0.65-1.63) | 0.97 (0.60-1.57) | 0.90 |
| GT+TT | 246 (44.7) | 248 (45.1) | 1.02 (0.80-1.29) | 1.00 (0.78-1.28) | 0.90 |
| rs512535 | |||||
| CC | 396 (72.0) | 392 (71.3) | 1.00 | 1.00 | |
| CT | 144 (26.2) | 147 (26.7) | 1.03 (0.79-1.35) | 1.04 (0.78-1.38) | 0.81 |
| TT | 10 (1.8) | 11 (2.0) | 1.11 (0.47-2.64) | 1.03 (0.41-2.61) | 0.81 |
| CT+TT | 154 (28.0) | 158 (28.7) | 1.04 (0.80-1.35) | 1.04 (0.79-1.37) | 0.78 |
| rs12720841 | |||||
| TT | 486 (88.4) | 470 (85.5) | 1.00 | 1.00 | |
| TC | 64 (11.6) | 80 (14.6) | 1.29 (0.91-1.84) | 1.36 (0.94-1.97) | 0.15 |
| CC | - (-) | - (-) | - | - | - |
| rs2678379 | |||||
| AA | 293 (53.3) | 270 (49.1) | 1.00 | 1.00 | |
| AG | 216 (39.3) | 226 (41.1) | 1.13 (0.88-1.46) | 1.14 (0.88-1.48) | 0.32 |
| GG | 41 (7.5) | 54 (9.8) | 1.43 (0.92-2.21) | 1.40 (0.88-2.22) | 0.11 |
| AG+GG | 257 (46.7) | 280 (50.9) | 1.18 (0.93-1.50) | 1.18 (0.92-1.52) | 0.17 |
Adjusted for age.
Adjusted for age, smoking, diabetes, hypertension and BMI.
Five SNPs in the ApoB gene (rs676210-rs2854725-rs11676704-rs3791980-rs2678379) were in linkage disequilibrium with D’ ranging from 0.79 to 1.00 and r2 ranging from 0.06 to 0.87. We found that GTTGG haplotype was significantly associated with increased risk of MI (OR = 2.82, 95% CI: 1.49-5.33) compared with the referent haplotype ATTGA (Table 3).
Table 3.
Association of haplotypes in the ApoB gene with risk of MI
| Haplotype* | Controls, % | Cases, % | OR (95% CI)† | OR (95% CI)‡ | P value |
|---|---|---|---|---|---|
| ATTGA | 43.9 | 38.0 | 1.00 | 1.00 | |
| ATGGA | 27.0 | 28.4 | 1.11 (0.90-1.37) | 1.13 (0.91-1.42) | 0.32 |
| GGTTG | 11.9 | 13.1 | 1.27 (0.97-1.68) | 1.25 (0.93-1.67) | 0.09 |
| GTTTG | 12.8 | 11.7 | 1.05 (0.80-1.38) | 1.04 (0.78-1.40) | 0.73 |
| GTTGG | 1.0 | 3.3 | 2.82 (1.49-5.33) | 3.06 (1.57-5.95) | 0.002 |
In the order of rs676210, rs2854725, rs11676704, rs3791980 and rs2678379.
Adjusted for age.
Adjusted for age, smoking, diabetes, hypertension and BMI.
Finally, we investigated the associations between the eight SNPs and plasma apoB levels in 550 healthy controls. In univariate analyses, ApoB rs676210 and rs2678379 were significantly associated with plasma level of apoB (P = 0.01 and 0.02). Specifically, carriers of the mutant allele of rs676210 (A/G: 0.85±0.27 g/L; G/G: 0.86±0.21 g/L) had significantly increased plasma apoB levels compared with subjects with AA genotype (0.79±0.18 g/L). A/G (0.85±0.27 g/L) and G/G (0.83±0.21 g/L) genotypes of rs2678379 also conferred elevated level of apoB compared with A/A genotype (0.80±0.18 g/L). When ANCOVA model was applied, the significance remained. None of the other studied SNP was associated with plasma apoB level (Table 4).
Table 4.
Association between ApoB polymorphisms and plasma apoB levels in healthy controls
| SNP | M/m | ApoB (g/L) | P value | ||
|---|---|---|---|---|---|
|
|
|||||
| MM | Mm | mm | |||
| rs676210 | A/G | 0.79±0.18 | 0.85±0.27 | 0.86±0.21 | 0.01 |
| rs679899 | A/G | 0.81±0.21 | 0.85±0.25 | 0.84±0.30 | 0.13 |
| rs2854725 | T/G | 0.82±0.17 | 0.84±0.25 | 0.82±0.22 | 0.70 |
| rs11676704 | T/G | 0.81±0.22 | 0.80±0.21 | 0.84±0.24 | 0.13 |
| rs3791980 | G/T | 0.81±0.20 | 0.84±0.26 | 0.83±0.21 | 0.20 |
| rs512535 | C/T | 0.81±0.22 | 0.85±0.23 | 0.73±0.21 | 0.09 |
| rs12720841 | T/C | 0.82±0.23 | 0.84±0.24 | - | 0.48 |
| rs2678379 | A/G | 0.80±0.18 | 0.85±0.27 | 0.83±0.21 | 0.02 |
M indicates major allele; m: indicates minor allele.
Discussion
Considering the crucial role of apoB in lipid metabolism, we investigated the association of eight SNPs in this gene and the risk of MI in a Chinese population. Our results showed that rs676210 mutation may increase the risk of MI and plasma apoB levels in healthy controls, and mutant allele of rs2678379 may confer elevated plasma apoB level in our control population.
The human ApoB gene is located on chromosome 2p24-p23. There are two main protein products of ApoB gene, a short version called apolipoprotein B-48 and a longer version known as apolipoprotein B-100, both of which play central roles in human lipoprotein metabolism. So far, certain mutations in the ApoB gene have been found to have relation with obesity [24], familial hypobetalipoproteinemia (FHBL) [25], coronary heart disease [26], gallstone and gallbladder cancer [27], and etc. Rare mutations in ApoB also have profound influence on plasma apoB and LDL-C levels [28].
ApoB rs676210 is a missense mutation involving A to G substitution that results in the conversion of leucine to proline. Studies on rs676210 and risk of lipid metabolic disorders are relatively rare. In an earlier study, rs676210 was found to be strongly associated with plasma VLDL-related fractions, triglycerides, and mean VLDL/LDL size [29]. Chasman et al. [30] also found that the A allele of rs676210 was associated with lower triglyceride, total cholesterol, and LDL cholesterol levels and higher HDL cholesterol levels in comparison with G allele. Recently, a Genome-Wide Association Study (GWAS) showed that rs676210 is an important factor for regulating oxidized low-density lipoprotein (oxLDL) levels, which increases the atherogenic potential of LDL and is regarded as a key event in the development of fatty streaks and the early atherosclerotic lesions [31]. Besides, rs676210 mutation may modify the response of hypertriglyceridemia patients to fenofibrate (a commonly used drug to treat hypertriglyceridemia), as individuals with the TT genotype of rs676210 had greater TG lowering than those with the CC genotype (additive model, P = 0.0017) [32]. In our study, we found that carriers of G allele of rs676210 conferred increased risk of MI and elevated plasma level of apoB, which was in accordance with previous studies. We also found the same trend of association when analyzed the rs676210 mutation in relation with serum LDL-C levels in healthy controls, although it did not reach statistically significance (P = 0.14).
We found another genetic mutation, rs2678379, in ApoB gene was also associated with plasma apoB levels in our population. Rs2678379 was once reported to have an interaction with dietary plasma cholesterol levels by influencing the absorption and transport of dietary cholesterol in Carotid Lesion Epidemiology and Risk (CLEAR) cohort in USA [33]. In our study, rs2678379 is in high linkage disequilibrium with rs676210 (D’ = 0.87), and rs2678379 GG genotype showed a non-significant increased risk of MI (OR = 1.43, 95% CI: 0.92-2.21).
The limitations of our study including the hospital-based study design that may not avoid selection bias and recall bias completely; the relatively small sample size may reduce the statistical power of our study; and the results should be confirmed in other prospective cohort studies. Although the exact pathological mechanisms of MI are still unclear, the linkage between ApoB polymorphisms and MI risk and plasma apoB level may provide a possible mechanism that merits further investigation.
In summary, the present study demonstrating that the G allele of the rs676210 may confer increased risk of MI, and rs676210 and rs2678379 may exert effect on plasma apoB levels in Chinese population. Future studies in prospective cohorts as well as functional studies are needed to confirm our findings.
Disclosure of conflict of interest
None.
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