Complex genetics of monogenic familial hypercholesterolemia

The etiology of cardiovascular disorders is complex and involves interaction of genetic, environmental, metabolic, and physiological factors. A small proportion of all cardiovascular cases results from rare single gene defects with strong effects on the phenotype. Biomedical research has been extremely successful in the genetic characterization of uncommon, monogenic cardiovascular disorders, thereby providing fundamental insights into the pathogenesis of cardiovascular disease (CVD). In 1985, Goldstein and Brown have been awarded the Nobel Prize for medicine for elucidating the molecular basis of familial hypercholesterolemia (FH)

A functional polymorphism in the glucocorticoid receptor gene and its relation to cardiovascular disease risk in familial hypercholesterolemia

Context: Individuals with the functional ER22/23EK variant in the glucocorticoid receptor gene are relatively resistant to the downstream consequences of glucocorticoids. Evidence suggests that carriers have a more favorable cardiovascular risk profile, but the relationship between this ER22/23EK variant and cardiovascular disease has not been hitherto assessed. Objective: We, therefore, determined whether carriership of the ER22/23EK improves cardiovascular disease risk in patients with severe hypercholesterolemia. Design, Setting, and Participants: In a multicenter cohort study, 2024 patients with heterozygous familial hypercholesterolemia, aged 18 yr and older, were genotyped for the ER22/23EK polymorphism. Patients were identified at lipid clinics throughout The Netherlands between 1989 and 2002. Main Outcome Measures: The primary outcome measure was cardiovascular disease. Results: Seventy-six (7.8%) of 977 men and 72 (6.9%) of 1047 women were carriers of the ER22/23EK variant. A total of 395 men and 247 women had a cardiovascular event. In contrast to expected results, we observed no significant association of the ER22/23EK variant with cardiovascular disease risk (men: relative risk, 0.75; 95% confidence interval, 0.50-1.14; P = 0.2; women: relative risk, 1.37;95%confidence interval, 0.82-2.28;P = 0.2). However, we found a significant interaction between gender and the polymorphism on cardiovascular disease (P = 0.02). Conclusions: In this large cohort of individuals with very high risk of cardiovascular disease, the association between the functional ER22/23EK polymorphism and cardiovascular risk was not significant overall, although it varied significantly by gender. Copyrigh