International Journal of Epidemiology, Vol 18, S183-S195, Copyright © 1989 by International Epidemiological Association
CF Sing and PP Moll
Many genetic and environmental factors act in combination to determine
inter-individual variability in risk factor traits for coronary artery
disease (CAD). Geneticists have focused on the study of continuously
distributed biological traits such as total plasma cholesterol. In every
population, plasma cholesterol has been implicated as a risk factor for
CAD. Every biometrical study of the distribution of cholesterol in families
has established a significant role of genetic variability in determining
inter-individual differences in the population at large. While a few genes
have been identified that have rare alleles with large effects on this
trait, variability among individuals in most families is influenced by
allelic variation in many genes as well as various environmental exposures.
Therefore, in most families, one does not expect CAD to cosegregate with
allelic variation at a single gene, and one does not expect each family to
be segregating for the same subset of genes that influence variability in
risk among individuals in the population at large. Strategies have been
developed to address questions about the role of genes with common alleles
in studies of intra- and interpopulation differences in risk for CAD. These
strategies are illustrated here by a review of studies of the association
between common allelic variations in the structure of the apolipoprotein
(apo) E molecule and levels of total plasma cholesterol. This polymorphic
gene may explain as much as 6% of the variation in risk for CAD in a North
American population. In international comparisons, populations with a
higher relative frequency of the E4 allele at this gene locus have higher
cholesterol levels and higher rates of CAD deaths. Other candidate genes,
in addition to apo E, need to be studied before individuals, families and
populations at high risk for CAD can be identified more accurately.
ARTICLES
Genetics of variability of CHD risk
Department of Human Genetics, University of Michigan Medical School, Ann Arbor 48109.
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