Associação dos polimorfismos dos genes das apolipoproteínas A1 e B e o risco cardiovascular em pacientes com COVID-19 em atendimento ambulatorial

Abstract

COVID-19 is a respiratory infection with the involvement of multiple organ systems, most of which are due to the high inflammatory component involved, such as cardiovascular risk (CVR), in which lesions ranging from endothelial lesions to the occurrence of Acute Myocardial Infarction are observed. (IAM). The dosage of Apolipoproteins (Apo) A1 and B as well as the Apo B/Apo A1 ratio are good markers of the balance between pro and antiatherogenic particles, acting in the stratification of the risk of AMI. In these Apo genes, the single nucleotide polymorphisms (SNP) rs670 and rs693 of Apo A1 and B, respectively, can quantitatively and qualitatively compromise translation. In the Apo A1 gene, there is the PMN for the exchange of Cytosine (wild allele) by Thymine (polymorphic allele); in the Apo B gene there is a polymorphism by the substitution of guanine (wild) by Cytosine (polymorphic). The objective of this study was to evaluate CVR in patients with COVID-19 in outpatient diagnostic care and to verify associations with genetic polymorphisms of Apolipoproteins. Descriptive, cross-sectional and observational study with patients treated at the COVID-19 emergency sentinel units of the Fortaleza Municipal Health Department during the second wave of Covid-19 cases in the state. The study had 98 participants (18- 60 years old), with a positive molecular biology test for the SARS-CoV-2 virus. The healthy control group consisted of 156 young students without COVID-19. Anthropometric parameters were recorded; in addition, biological samples were obtained for genotyping using Taqman probes, in addition to the determination of traditional parameters of lipid metabolism and serum levels of Apo A1 and B. For statistical analysis, p < 0.05 was considered. The Covid-19 group showed higher values of Total Cholesterol (TC), Triglycerides (TG), Cholesterol associated with LDL (LDL-c), Non-HDL Cholesterol (CNHDL) and TG/HDL-c Ratio. The individuals were stratified based on the reference interval of each test, with the Covid-19 group having a higher frequency of values outside the reference interval. As for the presence of polymorphisms, it was observed that, for rs670 there was no difference between the groups while for rs693, the Covid-19 group showed a high frequency of the polymorphous allele (A) mainly with heterozygous genotype (GA) compared to the control group which has a higher frequency of the wild-type allele (G). We evaluated whether the presence of polymorphic alleles alone exerted influence on serum lipid parameters; it can be seen that the polymorphic allele T (thymine) of the rs670 indicates lower TG values and, consequently, the TG/HDL-c ratio in the group with COVID-19. As for rs693, the control group had higher HDL-c and Apo A values in the absence of Allele A. As for the concomitant presence of the two polymorphic alleles, the doubly polymorphic individuals in the Covid-19 group had higher HDL-c values and lower TG values. The Apo B/Apo A ratio correlated with changes in serum lipids. Individuals with high CT/HDL-c values are 23.2 times more likely to be classified as moderate to high risk. The simultaneous presence of the polymorphic alleles of Apo A and Apo B decreases to 0.011 times these chances.