Case Report: Hypertriglyceridemia and Premature Atherosclerosis in a Patient With Apolipoprotein E Gene ε 2 ε 1 Genotype

Abstract

We present a case of a 40-year-old male with premature atherosclerosis, with evidence of both eruptive and tendinous xanthomas, which could imply an increase in both low-density lipoprotein (LDL) and triglyceride (TG) levels. However, his LDL was 2.08 mmol/l, TG -11.8 mmol/l on rosuvastatin 20 mg. Genetic evaluation was performed using a custom panel consisting of 25 genes and 280 variants responsible for lipid metabolism. A rare ε2ε1 genotype of apolipoprotein E was detected. The combination of clinical manifestations and genetic factors in this patient leads to the diagnosis of familial dysbetalipoproteinemia. Implementation of genetic testing into routine clinical practice could not only improve disease diagnostics and management, but also help prevent their development.

Keywords: apolipoprotein E; familial dysbetalipoproteinemia; genetic testing; premature cardiovascular disease; triglyceride.

Figure 1

Eruptive xantomas on back, palms, knee, heel, elbows, before (A) and after treatment (B).

Figure 2

Coronary angiogram. (A) 80% occlusion of the proximal anterior descending artery, (B) 85% occlusion of the distal circumflex artery, (C) 100% occlusion of the proximal right coronary artery, (D) stent in anterior descending artery.