Patient Test Information

_em_APOE__em_ Genotyping, Cardiovascular Disease

Also known as:

APOE Cardiac Risk

Formal name:

Apolipoprotein E Genotyping

Related tests:

Cardiac Risk Assessment; HDL Cholesterol; LDL Cholesterol; Lipid Profile; Triglycerides

Were you looking instead for APOE genotyping ordered to evaluate for Alzheimer disease? If so, see APOE Genotyping, Alzheimer Disease.

Why Get Tested?

APOE genotype tests are most often done as part of research protocols to help understand the role of genetic factors in cardiovascular disease. However, the testing is sometimes used in clinical settings to help confirm a diagnosis of type III hyperlipoproteinemia (also known as familial dysbetalipoproteinemia).

When to Get Tested?

When your health care provider suspects that you have an inherited component to your high cholesterol and triglyceride levels or if you have yellowish lesions called xanthomas on your skin

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

How is it used?

While APOE genotyping is mostly done in research settings, it can be used clinically to help in diagnosis and treatment of elevated lipid levels.

APOE testing may be used to help diagnose type III hyperlipoproteinemia (HPL III or familial dysbetalipoproteinemia) in a person with symptoms that suggest the disorder and to evaluate the potential for the condition in other family members. This is a rare inherited disorder that causes fatty, yellowish deposits on the skin called xanthomas, a high level of triglycerides in the blood, and atherosclerosis that develops at an early age.

APOE genotyping has potential to help guide lipid treatment. In cases of high cholesterol and triglyceride levels, statins are usually considered the treatment of choice to decrease the risk of developing cardiovascular disease (CVD). However, there is a wide variability in the response to these lipid-lowering drugs that is in part influenced by the APOE genotype. At present, the clinical utility of this type of information is yet to be totally understood.

When is it ordered?

As a test to evaluate lipid metabolism or cardiovascular risk, APOE genotyping is ordered when someone has:

  • Significantly elevated cholesterol and triglyceride levels that do not respond to dietary and exercise lifestyle changes
  • Family members who have APOE e2/e2 and a health practitioner wants to see if the person might be at a higher risk for early heart disease
  • Yellowish skin lesions called xanthomas and the health practitioner suspects type III hyperlipoproteinemia

What does the test result mean?

APOE e3/e3 is the most common genotype. APOE e3 is associated with "normal" lipid metabolism, thus may not have any genetic impact on risk of developing cardiovascular disease.

APOE e4 (genotype e4/e4 or e4/e3) is found in 25% of the population and is associated with an increased risk of atherosclerosis. People with these genotypes could be predisposed to significantly elevated levels of LDL-C ("bad cholesterol") and triglycerides when their diet is high in saturated fat.

People with the APOE e2/e2 alleles tend to have lower LDL-C levels but elevated triglycerides. APOE e2 is also associated with type III hyperlipoproteinemia/hyperlipidemia. People with APOE e2/e2 alleles are at a higher risk of premature vascular disease, but they may never develop disease. APOE genotyping adds additional information and, if symptoms are present, e2/e2 can help confirm type III hyperlipoproteinemia.

Is there anything else I should know?

APOE genotyping is not available in every laboratory. If a health practitioner recommends this test, the specimen will likely be sent to a reference laboratory and results may take longer to return than they would from a local laboratory.

Alterations in lipid concentrations do not lead directly to vascular disease or atherosclerosis. Other factors, such as obesity, diabetes, and hypothyroidism, also play a role in whether a person actually develops disease.

What is being tested?

Apolipoprotein E (Apo E) is a protein that helps transport lipids (fats and cholesterol) in the blood. It is recognized by specific cell surface receptors that allow it to deliver lipids to cells for use or storage and to deliver excess lipid to the liver for excretion.

The ApoE protein has three genetic forms that have slightly different compositions. They are called ApoE2, ApoE3, and ApoE 4. ApoE2 is poorly recognized by cell surface receptors whereas ApoE3 and ApoE4 bind tightly to those receptors. Therefore, people with ApoE2 tend to have higher blood lipids since delivery from blood to cells is impaired by poor binding of ApoE2 to receptors.

Three different genes (termed alleles) are designated as e2, e3, and e4 and code respectively for ApoE2, ApoE3, and ApoE4. Each person inherits one allele from each parent. A person who has the same allele from each parent is termed homozygous: e2/e2 or e3/e3 or e4/e4. One who has different alleles is termed heterozygous: e2/e3 or e2/e4 or e3/e4.

The APOE genotype test evaluates a person's DNA to determine what APOE forms (alleles) are present.

APOE e3/e3 is the most common genotype (seen in about 63% of the population) and is considered "neutral." Risks of disease are made relative to the e3/e3 population.

APOE e4 (as e4/e4 and e4/e3) is found in 25% of the population and is associated with an increased risk of atherosclerosis. People with these genotypes could be predisposed to a significantly elevated level of LDL-C ("bad cholesterol") and triglycerides when their diet is high in saturated fat.

People with the APOE e2 allele tend to have lower LDL-C levels but elevated triglycerides. APOE e2 is also associated with type III hyperlipoproteinemia/hyperlipidemia (HPL III or familial dysbetalipoproteinemia), a rare inherited disorder that causes fatty yellowish deposits on the skin called xanthomas, increased triglycerides in the blood, and atherosclerosis that develops at an early age. However, only about 2% of people with the e2/e2 genotype develop type III hyperlipoproteinemia/hyperlipidemia.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

  1. Should everyone have their APOE genotype tested?

    No, the test is not intended to be used to screen the general population. It is intended to be used in very specific situations to give a health practitioner additional information about a possible genetic cause for observed lipid abnormalities.

  2. Is there a reason to test for APOE genotype more than once?

    No. A person inherits one copy of the gene from each parent and genotype does not change.