Apolipoprotein E genetic variation, atherogenic index and cardiovascular disease risk assessment in an African population: An analysis of HIV and malaria patients in Ghana
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Date
2023
Authors
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Journal ISSN
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Publisher
PLOS ONE
Abstract
Background
Apolipoprotein E is involved in lipid transport and clearance of lipoprotein through low-density lipoprotein receptors (LDLR). ApoE variation has been linked to cardiovascular disease
(CVD) risk. There are 3 isoforms of ApoE which originate from two non-synonymous single
nucleotide polymorphisms denoted as ε2, ε3 and ε4. The ε2 isoform is implicated in higher
levels of atherogenic lipoprotein with the ε4 isoform causing LDLR downregulation. This
leads to variable effects and differential CVD risk. Malaria and HIV are life-threatening diseases affecting several countries globally especially in sub-Saharan Africa. Parasite and
viral activities have been implicated in lipid dysregulation leading to dyslipidaemia. This
study examined ApoE variation and CVD risk assessment in malaria and HIV patients.
Methods
We compared 76 malaria-only, 33 malaria-HIV coinfected, 21-HIV-only and 31 controls
from a tertiary health facility in Ghana. Fasting venous blood samples were taken for ApoE
genotyping and lipid measurements. Clinical and laboratory data were collected with ApoE
genotyping performed using Iplex Gold microarray and PCR-RFLP. Cardiovascular disease
risk was calculated using the Framingham BMI and cholesterol risk and Qrisk3 tools.
Results
The frequency of C/C genotype for rs429358 was 9.32%, whiles T/T genotype for rs7412
was found in 2.48% of all participants. ε3/ε3 was the most distributed ApoE genotype accounting for 51.55% of the total participants whiles ε2/ε2 was found in 2.48% of partici pants, with 1 in malaria-only and 3 in HIV-only patients. There was a significant association
between ε4+ and high TG (OR = 0.20, CI; 0.05–0.73; p = 0.015), whiles ε2+ was significantly
associated with higher BMI (OR; 0.24, CI; 0.06–0.87; p = 0.030) and higher Castelli Risk
Index II in females (OR = 11.26, CI; 1.37–92.30; p = 0.024). A higher proportion of malaria only participants had a moderate to high 10-year CVD risk.
Conclusion
Overall malaria patients seem to have a higher CVD risk though the means through which
this occurs may be poorly understood. ε2/ε2 genotypes was observed in our population at a
lower frequency. Further studies are vital to determine CVD risk in malaria and how this
occurs.
Description
Research Article
Keywords
Apolipoprotein E, genetic variation, cardiovascular disease (CVD)
Citation
Citation: Thomford NE, Anyanful A, Ateko RO, Blackhurst D, Biney RP, Boadi D, et al. (2023) Apolipoprotein E genetic variation, atherogenic index and cardiovascular disease risk assessment in an African population: An analysis of HIV and malaria patients in Ghana. PLoS ONE 18(5): e0284697. https://doi.org/10.1371/journal. pone.0284697