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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:211.)
© 2005 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Phenotype of Heterozygotes for Low-Density Lipoprotein Receptor Mutations Identified in Different Background Populations

Anne Tybjærg-Hansen; Henrik Kjærulf Jensen; Marianne Benn; Rolf Steffensen; Gorm Jensen; Børge G. Nordestgaard

From the Department of Clinical Biochemistry (A.T.-H., M.B.), Rigshospitalet, Copenhagen University Hospital, the Department of Cardiology (H.K.J.), Skejby University Hospital, the Department of Medicine B (R.S.), Hillerød Hospital, the The Copenhagen City Heart Study (A.T.-H., G.J., B.G.N.), Bispebjerg University Hospital, and the Department of Clinical Biochemistry (B.G.N.), Herlev University Hospital, Denmark.

Correspondence to Anne Tybjærg-Hansen, MD, DMSc, Chief Physician and Associate Professor, Department of Clinical Biochemistry KB 3011, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E-mail at-h{at}rh.dk

Background— The effect of mutations on phenotype is often overestimated because of ascertainment bias. We determined the effect of background population on cholesterol phenotype associated with specific mutations in the low-density lipoprotein (LDL) receptor and the relative importance of background population and type of mutation (LDL receptor [LDLR] or APOB R3500Q) for cholesterol phenotype.

Methods and Results— We studied 9255 individuals from the general population, 948 patients with ischemic heart disease (IHD), and 63 patients with clinical familial hypercholesterolemia (FH) for 3 common LDL receptor mutations. Average increase in cholesterol in LDL receptor heterozygotes identified in the general population or among patients with IHD or FH compared with noncarriers was 2.9 mmol/L, 4.1 mmol/L, and 4.9 mmol/L, respectively (P=0.02). Background population and type of mutation determined cholesterol phenotype; average increase in LDL cholesterol from carriers in the general population to carriers with clinical FH was 1.6 mmol/L (P=0.03). The average increase for carriers of LDLR mutations compared with carriers of APOB R3500Q was 1.2 mmol/L (P=0.05).

Conclusion— The phenotype associated with a given mutation should not be determined in patients, but rather in unselected individuals in the general population.

We determined the relative importance of background population and type of mutation for cholesterol phenotype in 10 262 individuals. The phenotype associated with a given mutation should not be determined in patients, but rather in unselected individuals in the general population.

Key Words: atherosclerosis • epidemiology • genetics • cardiovascular disease • hypercholesterolemia

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