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European Heart Journal 2004 25(11):943-951; doi:10.1016/j.ehj.2004.03.020
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Single nucleotide polymorphism in the low-density lipoprotein receptor is associated with a threefold risk of stroke

A case-control and prospective study

Ruth Frikke-Schmidta, Børge G. Nordestgaardb,c, Peter Schnohrc and Anne Tybjærg-Hansena,c,*

a Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
b Department of Clinical Biochemistry, Herlev University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark
c The Copenhagen City Heart Study, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark

* Corresponding author. Tel.: +45-3545-4159; fax: +45-3545-4160
E-mail address: at-h{at}rh.dk

Received 3 September 2003; revised 7 March 2004; accepted 12 March 2004

Abstract

Background More than 600 different, but rare, mutations in the low-density lipoprotein (LDL) receptor have been identified as the cause of familial hypercholesterolaemia. In contrast, only a single common amino acid-changing polymorphism (A370T) has been reported in this gene. The association of this polymorphism with variations in lipid levels is at present unclear.

Methods We obtained genotypes for 9238 individuals from The Copenhagen City Heart Study, of which 465 had stroke and 1019 had ischaemic heart disease.

Results In this cohort from the Danish general population, 90.2% (), 9.5% (), and 0.3% () were 370A homozygotes, A370T heterozygotes, and 370T homozygotes, respectively. The incidences of stroke in 370A homozygotes, A370T heterozygotes, and 370T homozygotes were 28, 26, and 100 per 10,000 person–years, respectively (370T homozygotes vs. 370A homozygotes: log-rank, ). The relative risk and odds ratio for stroke in 370T homozygotes vs. 370A homozygotes were 3.6 (95% confidence interval, 1.5–8.8) and 3.6 (95% confidence interval, 1.3–9.8) in prospective and cross-sectional studies, respectively. Furthermore, average age at onset of stroke in 370T homozygotes tended to be lower than in heterozygotes and 370A homozygotes combined (59 vs. 66 years, ). In contrast, neither levels of cholesterol, LDL cholesterol, apolipoprotein B, or triglycerides, nor risk of ischaemic heart disease was associated with genotype.

Conclusion This is the first prospective study to suggest an association between a polymorphism in the LDL receptor and stroke. Because this association is independent of lipid levels, our results point toward a hitherto unknown function of this receptor in the brain.

Key Words: Low-density lipoprotein receptor • Stroke • Single nucleotide polymorphism


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