Objectives: To investigate the arachidonate 5-lipoxygenase-activating protein (ALOX5AP) gene as a potential modifier gene for coronary heart disease (CHD) in patients with familial hypercholesterolemia (FH). Background: The ALOX5AP gene is required for the synthesis of leukotrienes, a protein family involved in inflammatory responses. Recently, genetic variation in this gene was shown to be associated with myocardial infarction in an Icelandic and British population. Since FH is characterized by severely increased levels of plasma low-density lipoprotein (LDL) cholesterol levels, chronic inflammation of the arterial wall, and subsequent premature CHD, the ALOX5AP gene could be an important modifier gene for CHD in FH. Methods: In a cohort of 1817 FH patients, we reconstructed two four-marker haplotypes, previously defined in Icelandic (HapA) and British (HapB) individuals. The haplotypes were inferred with PHASE and the associations between the haplotypes and CHD were analyzed with a Cox proportional hazards model, adjusted for year of birth, sex, and smoking. Results: HapB had a frequency of 6.9% and 8.2% in the group without and with CHD, respectively, conferring a hazard ratio of 1.48 (95% CI 1.17-1.89, p = 0.001). This association was predominantly found in patients with LDL cholesterol levels above the median (HR 1.82, 95% CI 1.20-2.76, p = 0.005). HapA was not associated with CHD. Conclusion: We conclude that genetic variation in the ALOX5AP gene contributes to CHD risk in patients with FH. Our findings emphasize the important role of inflammation in the pathogenesis of early CHD in this disorder, particularly in patients with more severely raised LDL cholesterol levels.

ALOX5AP, Coronary heart disease, DNA modification, FLAP, Familial hypercholesterolemia, Genetics, Iceland, Lipoxygenase, United Kingdom, adult, arachidonate 5 lipoxygenase activating protein, artery wall, article, birth, cardiovascular risk, chronic inflammation, cigarette smoking, clinical trial, cohort analysis, disease severity, familial hypercholesterolemia, female, gene, genetic association, genetic variability, haplotype, heart infarction, human, ischemic heart disease, leukotriene, low density lipoprotein cholesterol, major clinical study, male, multicenter study, priority journal, protein synthesis, sex difference
dx.doi.org/10.1016/j.atherosclerosis.2008.07.025, hdl.handle.net/1765/18000
Erasmus MC: University Medical Center Rotterdam

van der Net, J.B, Versmissen, J, Oosterveer, D.M, Defesche, J.C, Yazdanpanah, M, Aouizerat, B.E, … Sijbrands, E.J.G. (2009). Arachidonate 5-lipoxygenase-activating protein (ALOX5AP) gene and coronary heart disease risk in familial hypercholesterolemia. Atherosclerosis, 203(2), 472–478. doi:10.1016/j.atherosclerosis.2008.07.025