A single genetic polymorphism may account for a fifth of infarctions

Paraoxonase is an antioxidative enzyme in high density lipoproteins, which protect against coronary disease. Its activity is increased in people with a mutation at position 54 of the paraoxonase gene, where methionine is substituted by leucine (Met54Leu). Salonen et al followed a cohort of 1137 men free of coronary disease for a mean of 8.5 years and determined the paraoxonase genotype in the 55 who developed a myocardial infarction and in 110 matched controls (p 487). Those homozygous for the M allele (MM)a low paraoxonase activityhad an over threefold risk of infarction compared with men without the M allele. Overall 24% of the cases and 10% of the controls had an MM genotype. The authors conclude that paraxonase may protect against coronary disease.

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Polymorphism in high density lipoprotein paraoxonase gene and risk of acute myocardial infarction in men: prospective nested case-control study • Commentary: Causalitythe Achilles' heel of observational studies • Commentary: How high density lipoprotein protects against heart disease

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