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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17:2630-2637.)
© 1997 American Heart Association, Inc.

Articles

Prevalence of Double Pre-Beta Lipoproteinemia in Hyperlipidemic Patients Is Influenced by Gender, Menopausal Status, and ApoE Phenotype

Jeffrey S. Cohn; Louise-Marie Giroux; Louis-Jacques Fortin; ; Jean Davignon

From the Hyperlipidemia and Atherosclerosis Research Group, Clinical Research Institute of Montreal, Montreal, Quebec, Canada.

Correspondence to Dr J.S. Cohn, Hyperlipidemia and Atherosclerosis Research Group, Clinical Research Institute of Montreal, 110 Pine Ave W, Quebec, Canada, H2W 1R7.

Abstract Double pre-beta lipoproteinemia (DPBL) is a plasma lipoprotein phenotype characterized by the presence of two agarose gel electrophoretic populations of very low density lipoproteins (VLDLs, d<1.006 g/mL), ie, normal pre–ß-migrating VLDL and slow pre–ß VLDL. Slow pre–ß VLDL represents remnant lipoproteins derived from the hydrolysis of triglyceride (TG)-rich lipoproteins (TRLs), and thus DPBL is a characteristic of plasma remnant lipoprotein accumulation. To determine the prevalence of DPBL in our lipid clinic population, patients (n=2501) were selected who (1) had an unambiguous VLDL electrophoretic phenotype and could be classified as having either DPBL (DPBL+), ß-migrating VLDL (ß-VLDL+), or an absence of both (DPBL/ß-VLDL -/-) and (2) had hypercholesterolemia (HC: plasma cholesterol 6.2 mmol/L, n=1017), hypertriglyceridemia (HTG: plasma TG 2.3 mmol/L but <15 mmol/L, n=554) or combined hyperlipidemia (HC+HTG, n=930). Patients with TG <2.3 mmol/L and cholesterol <5.2 mmol/L acted as control subjects (n=343). Using a commercially available agarose gel electrophoresis system, we identified 220 hyperlipidemic patients (8.8%) with DPBL (versus <1% of control). The prevalence of DPBL was higher in (1) male than in female patients (10.7% versus 6.7%), (2) postmenopausal than in premenopausal females (7.3% versus 4.1%), and (3) patients with HC+HTG than in those with HTG or HC alone (15.8% versus 8.3% versus 2.7%, respectively). Patients with an 2 allele had a higher prevalence of DPBL; ie, 26.9% of apoE 3/2 and 26.2% of apoE 4/2 patients had DPBL compared with 6.5%, 6.8%, and 7.4% of apoE 3/3, 4/3, and 4/4 patients, respectively. DPBL patients consistently had increased levels of VLDL-C and (LDL+HDL)-TG and decreased levels of LDL-C, and their plasma lipid profiles were intermediate between those of ß-VLDL+ and DPBL/ß-VLDL-/- patients. These results demonstrate that male sex, postmenopausal status in women, and the presence of an apoE 3/2 or apoE 4/2 phenotype are associated with an increased incidence of DPBL in hyperlipidemic patients.

Key Words: triglyceride-rich remnant lipoproteins • double pre-beta lipoproteinemia • agarose gel electrophoresis

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