The Role of a Common Variant of the Cholesteryl Ester Transfer Protein Gene in the Progression of Coronary Atherosclerosis
Jan Albert Kuivenhoven, Ph.D., J. Wouter Jukema, M.D., Aeilko H. Zwinderman, Ph.D., Peter de Knijff, Ph.D., Ruth McPherson, M.D., Ph.D., Albert V.G. Bruschke, M.D., Kong I. Lie, M.D., John J.P. Kastelein, M.D., for The Regression Growth Evaluation Statin Study Group
Background The high-density lipoprotein (HDL) cholesterol concentrationis inversely related to the risk of coronary artery disease.The cholesteryl ester transfer protein (CETP) has a centralrole in the metabolism of this lipoprotein and may thereforealter the susceptibility to atherosclerosis.
Methods The DNA of 807 men with angiographically documentedcoronary atherosclerosis was analyzed for the presence of apolymorphism in the gene coding for CETP. The presence of thisDNA variation was referred to as B1, and its absence as B2.All patients participated in a cholesterol-lowering trial designedto induce the regression of coronary atherosclerosis and wererandomly assigned to treatment with either pravastatin or placebofor two years.
Results The B1 variant of the CETP gene was associated withboth higher plasma CETP concentrations (mean [±SD], 2.29±0.62µg per milliliter for the B1B1 genotype vs. 1.76±0.51µg per milliliter for the B2B2 genotype) and lower HDLcholesterol concentrations (34±8 vs. 39±10 mgper deciliter). In addition, we observed a significant dose-dependentassociation between this marker and the progression of coronaryatherosclerosis in the placebo group (decrease in mean luminaldiameter: 0.14±0.21 mm for the B1B1 genotype, 0.10±0.20mm for the B1B2 genotype, and 0.05±0.22 mm for the B2B2genotype). This association was abolished by pravastatin. Pravastatintherapy slowed the progression of coronary atherosclerosis inB1B1 carriers but not in B2B2 carriers (representing 16 percentof the patients taking pravastatin).
Conclusions There is a significant relation between variationat the CETP gene locus and the progression of coronary atherosclerosisthat is independent of plasma HDL cholesterol levels and theactivities of lipolytic plasma enzymes. This common DNA variantappears to predict whether men with coronary artery diseasewill benefit from treatment with pravastatin to delay the progressionof coronary atherosclerosis.
Source Information
From the Departments of Vascular Medicine (J.A.K., J.J.P.K.) and Cardiology (K.I.L.), Academic Medical Center, Amsterdam, the Netherlands; the Departments of Cardiology (J.W.J., A.V.G.B.), Biostatistics (A.H.Z.), and Human Genetics (P. de K.), Leiden University, Leiden, the Netherlands; the Lipoproteins and Atherosclerosis Group, Ottawa Heart Institute, Ottawa, Ont., Canada (R.M.); and the Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (A.V.G.B.).
Address reprint requests to Dr. Kastelein at the Academic Medical Center, Department of Vascular Medicine (Rm. G1-123), Meibergdreef 9, P.O. Box 22.700, 1105 AZ Amsterdam, the Netherlands.
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