Impact of the ApoE Genotype on Coronary Artery Disease and the Incidence of Myocardial Infarction: A Clinical Observational Study

Background: This study aimed to investigate the relationships between the expression of apolipoprotein E (APOE) and gene polymorphisms of solute carrier organic anion transporter family member 1B1 (SLCO1B1) with the blood lipid profile and coronary artery disease severity in Han Chinese individuals living in eastern China. Methods: This study enrolled 91 patients hospitalized at the Second Affiliated Hospital of Anhui Medical University from June 2024 to December 2024. The serum lipid profiles, including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and lipoprotein(a) [LP(a)], were measured via the Olympus AU5400 system. The genotypes of the APOE and SLCO1B1 genes were determined by Sanger sequencing. The participantswere stratified into three groups on the basis of their Gensini scores. Differences in blood lipid levels and APOE/SLCO1B1 genotype distributions among these groups were statistically analyzed. The Gensini score model and myocardial infarction risk model were subsequently constructed via APOE genotyping, LDL-C levels, and other differential biomarkers identified from the analysis. Results: Patients with the ApoE ε4 genotype had higher LDL-C and Lp(a) levels and higher Gensini scores (F=11.591, P<0.001), indicating more severe coronary artery lesions than the other groups did. Multiple linear regression analysis revealed both LDL-C levels and ApoE genotypes as independent predictors of the severity of coronary artery lesions, whereas SLCO1B1 genotype had a minor effect on lipid levels and coronary artery lesion severity. Notably, this study specifically analyzed the impact of ApoE polymorphisms on the incidence of myocardial infarction and reported a statistically significant difference in the incidence of myocardial infarction among different ApoE genotypes (χ²=6.49, P=0.039). The prediction model showed excellent predictive performance (area under the curve (AUC): 0.793 in the Gensini score prediction model and AUC: 0.855 in the myocardial infarction prediction model). Conclusion: APOE genotype is associated with the concentrations of LDL-C and Lp(a) as well as the severity of coronary artery lesions and the occurrence of myocardial infarction.