Analysis of the genetic component of coronary artery disease

Abstract

The genetic component of atherosclerotic disease has been increasingly investigated, and some genetic characteristics have been associated with that disease. The methodology and interpretation of the results of the genetic studies, however, have been frequently questioned. This review article discusses these points and suggests methods of analysis that may improve the understanding of the pathogenesis of coronary artery disease of atherosclerotic origin.General considerations -Coronary artery disease is the major cause of morbidity and mortality in the most developed regions of Brazil. Despite its high prevalence, the progressive reduction in mortality in the majority of Brazilian regions has been notable in recent years. The reasons are varied, but it is currently agreed that this reduction is primarily due to the increasing improvement in socioeconomic conditions, with special attention to the control of risk factors for cardiovascular diseases. Better understanding of the pathophysiology of coronary artery disease has also allowed advances in the pharmacological and surgical treatments for that entity and in the nonsurgical techniques of coronary reperfusion. Control of risk factors, however, continues to be the most effective management in regard to primary and secondary prevention of coronary artery disease.The major risk factors for coronary artery disease are: tobacco use, hypercholesterolemia, systemic hypertension, and diabetes mellitus. Other factors, such as high levels of lipoprotein(a), triglycerides, and fibrinogen, have been considered independent risk factors too 1 . The intensity of participation of these risk factors in the development of coronary artery disease depends on the environmental components and on the genetic characteristics of each individual or of one population.The presence of a family history is another important risk factor for coronary artery disease. Familial antecedents depend on genetic characteristics, as do other known factors, such as hypertension, dyslipidemia, and diabetes mellitus, which influence the development of coronary atherosclerosis. Currently, the genetic characteristics described and directly related to the atherogenic and thrombogenic processes are innumerable. Even though several genes influence both processes, some genes, such as those encoding the angiotensin-converting enzyme 2,3 , angiotensinogen 4,5 , AT1 angiotensin receptor 6 , and that of the apolipoproteins AI, B, and E 7-10 , apparently have a more prominent participation in the atherogenic process. On the other hand, prothrombin 11 , platelet glycoprotein IIb/IIIa 12 , and fibrinogen 13 polymorphisms are mainly involved in the thrombogenic process.Genetic component -The participation of the genetic component in the population with coronary artery disease is unknown. In clinical practice, investigation of the probable hereditary component influencing the development of atherosclerosis is basically performed through the verification of the presence of precocious coronary artery disease in parents, ...

The Roles of Genetic Polymorphisms and Human Immunodeficiency Virus Infection in Lipid Metabolism

“…The association between apo E polymorphisms and CAD has been studied with regard to cardiology, as apo E affects lipoprotein metabolism and cholesterol transport [80, 81, 91]. The apo Eε 4 allele is consistently associated with an increased risk of CAD, although its impact seems to vary according to other factors, such as gender, ethnic origin, and lifestyle [90, 92, 93].…”