© 1998 Oxford University Press
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Regional serum cholesterol differences in Belgium: do genetically determined cardiovascular risk factors contribute?
aDepartment of Clinical Chemistry, CKCL. L 139. Dijkzigt Hospital Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
bDepartment of Epidemiology and Biostatistics, Erasmus University Rotterdam, The Netherlands
BACKGROUND: Differences in serum lipid distribution and mortality from ischaemic heart disease have repeatedly been reported between Belgian northerners and southerners. We investigated whether serum lipoprotein(a) (Lp(a)) and apolipoprotein (apo) F polymorphism were involved.
METHODS: Fasting serum lipids, apo A-I and B, and Lp(a) levels were examined in randomly selected, 20–39 year old Belgian males and females from the north (Flanders) and the south (Wallonia) of Belgium (N = 900). Apo E phenotype distribution was investigated in random subsamples from either region (N = 249).
RESULTS: Mean serum cholesterol, low density lipoprotein cholesterol (LDL-c), apo B and triglyceride levels were higher in Walloons compared to Flemings within each gender, the difference being significant in 30–39 year old males. Average high density lipoprotein cholesterol and apo A-I levels were significantly lower in 30–39 year old male southerners, compared to their northern counterparts. Median Lp(a) was 67 mg/I in northerners and 75 mg/l in southerners (NS). The apo E phenotype distribution was similar in both regions (x2 = 7.213; d.f. = 5; P = 0.2053), whereas the average effects of the apo E alleles differed between the regions. In southerners the 
4 effect upon adjusted apo B and LDL-c levels was 
+12% and the 2 effect was –15% in northerners the 4 and 2 effects were +5% and –25%, respectively. The apo F polymorphism did not affect serum Lp(a) levels.
CONCLUSIONS: Regional cholesterol differences between Flemings and Walloons cannot be explained by differences in serum Lp(a) or apo E phenotype distribution. The less favourable 2 and 4 effects in southerners compared to northerners reflect modulation of the apo E gene by particular environments.
Keywords Lipoprotein(a) levels, apolipoprotein E polymorphism, Flemings, Walloons, Belgium, cardiovascular risk factors
Accepted 21 November 1997
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