Potentially inappropriate drug prescription in the elderly in France: a population-based study from the French National Insurance Healthcare system.

BACKGROUND: Inappropriate prescribing is a known risk factor for adverse drug event occurrence in the elderly. In various countries, several studies have used insurance healthcare databases to estimate the national prevalence of potentially inappropriate medications (PIM) in the elderly, as defined by explicit PIM lists. Recently, a representative sample of the French National Insurance Healthcare database, known as the "Echantillon Généraliste des Bénéficiaires" (EGB), was created, making it possible to assess the quality of drug prescription in France. Our objective was to evaluate the prevalence and the regional distribution of PIM prescription in the elderly aged 75 years and over in France, using the French PIM list and the EGB database. METHODS: The list of drugs reimbursed to patients aged 75 years and over from 1 March 2007 to 29 February 2008 was extracted from the EGB. Drugs were classified as inappropriate using the French PIM list. A PIM user was defined as a person receiving at least one PIM reimbursement during the study period. Interregion variability was estimated from logistic regression. RESULTS: In 53.6% (95% CI: 53.0-54.1) of the elderly aged 75 years and over, at least one PIM was given during the study period. The three main drug groups identified were cerebral vasodilators (19.4%), drugs with antimuscarinic properties (19.3%), and long half-life benzodiazepines (17.8%). There was an important disparity in PIM prescription among the French regions. In 14 out of 22 regions, the risk of PIM prescription was significantly elevated. This geographical variation differed for the different drug groups. CONCLUSION: PIM prescription in the elderly is a major and worrying problem in France. As in other countries, recent accessibility of the National Insurance Healthcare database makes it possible to create local indicators that the regional health agencies could use to manage public health policy in closer alignment to the needs of the patients within each French region.

New obesity body mass index threshold for self-reported data.

BACKGROUND: Since subjects included in population studies tend to underreport their weight and overestimate their height, obesity prevalence based on these data is often inaccurate. A reduced obesity threshold for self-reported height and weight was proposed and evaluated for its accuracy. METHODS: Self-reported heights and weights were compared with measured heights and weights in a Swiss city adult population representative sample. Participants were asked their height and weight and were invited to undergo a health examination, during which these data were measured. An optimal body mass index (BMI) value was assessed using receiver operating characteristic (ROC) curve analysis and its ability to correctly estimate obesity prevalence was tested on an external French population sample. RESULTS: The Swiss population sample consisted of 13 162 subjects (mean age 51.4). The comparison between self-reported and measured data showed that obesity prevalence calculated from declarations was underestimated: among obese subjects (according to measured BMI), 33.6% of men and 27.5% of women were considered to be non-obese according to their self-report. Considering measures as a reference, a lower BMI cut-off of 29.2 kg/m(2) was identified for both genders for the definition of obesity based on self-report. Respective misclassification was reduced to 17.9% in men and 16.9% in women. The validation procedure on a French population sample (n = 1858) yielded similar results. CONCLUSIONS: The reduced threshold based on self-report allowed a better estimation of obesity prevalence. Its use should be limited to population studies only.

New growth charts for Libyan preschool children.

To draw up new growth charts for Libyan children under 5 years of age, a cross-sectional survey was carried out in urban and rural areas in 2 regions of the Libyan Arab Jamahiriya from June 1999 to February 2000. Using WHO cluster sampling methodology, 1473 infants and children of both sexes aged between 0 and 59 months were selected from residential areas, maternal and child health centres, kindergartens and the delivery section of hospitals. Growth charts for weight-for-age, height-for-age and weight-for-height were plotted and smoothed, to provide reference curves for clinical, epidemiological and research purposes. In addition, mean Z-scores were analysed by sociodemographic variables collected from interviews with parents. Factors with a strong influence on childhood growth patterns were child's age, mother's education level and sex.

New growth charts for Libyan preschool children

To draw up new growth charts for Libyan children under 5 years of age, a cross-sectional survey was carried out in urban and rural areas in 2 regions of the Libyan Arab Jamahiriya from June 1999 to February 2000. Using WHO cluster sampling methodology, 1473 infants and children of both sexes aged between 0 and 59 months were selected from residential areas, maternal and child health centres, kindergartens and the delivery section of hospitals. Growth charts for weight-for-age, height for-age and weight-for-height were plotted and smoothed, to provide reference curves for clinical, epidemiological and research purposes. In addition, mean Z-scores were analysed by sociodemographic variables collected from interviews with parents. Factors with a strong influence on childhood growth patterns were child's age, mother's education level and sex

Determinants of arterial stiffness in an apparently healthy population over 60 years.

Arterial stiffness assessed by the pulse wave velocity (PWV), a non-invasive and reproducible method, predicts cardiovascular morbidity and mortality. The main determinants of arterial stiffness are well established in younger and middle-aged populations, but much less in the elderly. The aim of this study was to describe the determinants of arterial stiffness in elderly apparently healthy subjects. The study included 221 voluntary subjects born before 1944 (mean age 67.4+/-5.0 years), who had a standard health check-up at the 'Centre de Médecine Préventive' of Nancy. Arterial stiffness was evaluated by measuring the carotid-femoral PWV with the PulsePen automatic device. Clinical and biological parameters were evaluated at the same day. Measurements were valid and analysed in 207 subjects (94 women). Mean PWV was 9.39+/-2.64 m/s. Men showed higher PWV values than women (9.99+/-2.56 vs 8.66+/-2.56, P<0.001). In univariate analysis, PWV was correlated with age (r=0.26, P<0.001) and mean arterial pressure (MAP) (r=0.40, P<0.001), and these relationships were similar in men and women. Subjects with hypertension (P<0.001), diabetes mellitus (P<0.001) and obesity (P<0.01) had higher values of PWV. In multiple regression analysis, PWV correlated positively and independently with age, male gender, MAP and diabetes mellitus. In conclusion, in an apparently healthy elderly population, the main determinants of arterial stiffness are the age, MAP, diabetes and gender. Our study also shows that the gender-related differences in arterial stiffness observed in middle-aged subjects are maintained in the elderly.

[Epidemiological study of oral dental health of 4-year-old children in french nursery schools]. / Enquête épidémiologique sur la santé buccodentaire d'enfants âgés de 4 ans scolarisés en école maternelle.

UNLABELLED: The departmental service of maternal and infantile protection (PMI) of Moselle (Lorraine region), together with the Paediatric Dentistry Department from Nancy University, organized a study of the dental health of 4-year-old children. AIMS OF THE STUDY: To assess the children dental health; to evaluate parental knowledge of dental health; to identify the factors associated with caries amongst children. MATERIAL AND METHODS: The study was a cross sectional observation. A random sample of 4-year-old children was selected among 11 586 children in nursery schools. The study was based on a clinical examination performed by a dentist and a structured questionnaire completed by parents. RESULTS: The overall proportion of children affected by caries was 37.5%. The mean dmft score was 1.51 (sd = 2.82) and 11.6% of the children had caries which affected their upper incisors, a sign of early childhood caries. Only 6.2% had received dental treatment on at least 1 occasion. There was a clear disparity in dental health: 1 child out of 3 suffered from caries but 1 out of 2 children in priority education districts was affected, compared with only 1 out of 4 children coming from a rural area. The questionnaires completed by parents showed a lack of knowledge of dental health and inadequate use of current prevention facilities. The multivariate logistic regression analysis showed that the variables that were significantly associated with caries in 4 year-old children were the mother's education, the low social background, the level of consumption of drinks containing sugar by both children and parents, the consumption of fluoride, and the level of knowledge about fluoride. CONCLUSION: Preventive measures must be developed in close relationship between pediatricians and dentists. Initial training of health care professionals has to be reinforced. Health care professionals in paediatrics are far more likely to meet mothers and young children than are dentists.

[Blood pressure control by antihypertensive agents in people older than 60]. / Contrôle de la pression artérielle par le traitement antihypertenseur chez le sujet âgé de 60 ans et plus.

PURPOSE: The prevalence or hypertension increases with aging, reaching more than 50% in people aged 60 years and older. The increase of systolic blood pressure is a major risk of cardiovascular event. METHODS: With the aim of assessing risk factors in old people "in apparent good health", we analysed blood pressure and treatments in people aged 60 years and older who had a periodic check-up that was adapted to older people. RESULTS: This check-up concerned, between April and December 2003, 1638 people with a mean age of 68 years (SD 5.7): 815 men and 823 women. Fourty percent had a systolic blood pressure (SBP) >or=140 mmHg (44% of men, 36% of women); 6% (8% of men, 4% of women) had a diastolic blood pressure (DBP) >or=90 mmHg. A treatment for hypertension was followed by 473 people: 31% of men and 26% of women. Fifty percent were controlled for the SBP and the DBP. Fourty-two percent were not controlled for the SBP, but were controlled for the DBP. Seven percent were not controlled for the SBP nor the DBP. Only 3 subjects (<1%) were not controlled for the DBP, whereas they were controlled for SBP. CONCLUSION: These results, combined with data of literature on the predominant role of SBP in cardio-vascular risk, as compared with DBP, underline the need for a better treatment of systolic hypertension in older people.

[Comparison of the individual deprivation index of the French Health Examination Centres and the administrative definition of deprivation]. / Comparaison du score individuel de précarité des centres d'examens de santé, EPICES, à la définition socio- administrative de la précarité.

In French Health Examination Centres, populations in deprived situation were usually defined by administrative criteria The aim of the study was to investigate whether EPICES, a new individual index of deprivation, was more strongly related to health status than an administrative classification. The EPICES score was calculated on the basis of 11 weighted questions related to material and social deprivation. Participants were 197, 389 men and women, aged over 18, encountered in 2002 in French Health Examination Centres. Relationships between health status, health-related behaviours, access to health care, EPICES and the administrative classification of deprivation were analyzed by logistic regression. The associations between EPICES and the study variables were stronger than those observed for the administrative definition. The comparison also showed socially disadvantaged people with poor health identified by the EPICES score who were not by the administrative classification. These results showed that the EPICES score can be a useful tool to improve the identification of deprived people having health problems associated to deprivation.

[Determination of glucose, proteins, blood and leucocytes in urines: evaluation of automated analyzer Aution Max AX 4280]. / Détermination urinaire du glucose, des protéines, du sang et des leucocytes avec l'analyseur automatique Aution Max AX-4280.

The aim of this study was to evaluate the automated urine test strip analyzer Aution Max AX 4280 which uses strips able to measure 12 urinary parameters. For precision study, we considered glucose, protein, blood, leukocytes, nitrite, and pH and the four first were compared with usual methods: chemical measurement or microscopic examination. Reproducibility of the semi quantitative results was determined as the proportion of results falling into the same concentration range. Within-run reproducibility assessed using urine specimens were between 83% and 96%. Between day on quality controlled materials, it was higher (96%), and leukocytes were shared between two classes 250 and 500 cells/microL. For glucose and proteins, linearity was good and comparison with quantitative methods yielded high correlation. The false negative fraction was low and there was no false positive results. For blood, fraction of false positive was 7.5% for 0.3 mg/L of hemoglobin compared with microscopic analysis and false negative fraction was 1.3%. For leukocytes, false positive fraction was 4%, false negative one was 7.8%. These results, values for sensitivity, specificity, predictive positive value, predictive negative value permitted to determine the cut-off values to realize second levels analysis: proteins are measured from 0.30 g/L, glucose from 2.8 mmol/L, microscopic urinalysis was performed from hemoglobin more than 0.3 mg/L and leukocytes more than 25 cells/microL.

[Reference limits for urine sediments performed on Sysmex UF-50]. / Etablissement de limites de référence des sédiments urinaires mesurés sur UF-50 Sysmex.

The Sysmex UF-50 is an automated flow cytometer for urine sediments analysis. Interpretation of the results needs establishment of reference limits for the different constituents measured. First of all, we checked precision of measurements and stability of urines during transportation. Then, urine samples from 4 to 95 year old subjects were examined with the UF-50, by visual microscopy and test strips. Distributions of results for erythrocytes, leukocytes, epithelial cells, casts, bacteria and conductivity were described in a sample of 680 subjects (364 men and 316 women), with creatininemia below 140 micromol/L, consuming no drugs and for women without intra uterine device and apart from menstruation period. Then, the results were compared with those obtained in groups selected on microscopic analysis and test strip results. UF-50 sensitivity and specificity were 77.5% and 88% for 15 erythrocytes/microL in reference to microscopic urinalysis, they were 91.3% and 87.3% for 15 leucocytes/microL. The reference sample was defined with negative microscopic results. The upper reference limits (centile 97.5) were 16 red blood cells/microL for men 14.5 for women, 13.5 and 33 leucocytes/microL, 8 and 19 epithelial cells/microL, 1,3 and 0,4 casts/microL, 5 500 et 7 700 bacteria/microL, 36,2 et 34,6 conductivity mS/cm. The Sysmex UF-50 is a suitable analyser for urinary sediments. Reference limits may be different from usual reference limits due to variability in performances of other methods.

Family resemblance in breakfast energy intake: the Stanislas Family Study.

BACKGROUND: There seems to be a consensus that family influences on dietary habits are important. However, no data relative to breakfast have been published yet. OBJECTIVE: To investigate whether and how breakfast energy intake aggregates within French families. DESIGN: A total of 398 families of the Stanislas Family Study who filled in a 3 day food consumption diary were selected. Absolute and relative breakfast energy intakes (BEI in kcal/day and RBEI in percentage of daily intake, respectively) were both studied. RESULTS: By using a variance component analysis, no genetic influence was shown in family aggregation of both BEI and RBEI. Intra-generation common environmental contribution to total phenotypic variance of BEI and RBEI was higher than inter-generation; both were increased with frequency of sharing breakfast. Furthermore frequency of sharing breakfast contributed to increase family resemblance in breakfast energy intake, particularly in offspring for BEI and RBEI, and in spouses for RBEI. Smoking habits, alcohol consumption, BMI or physical activity were related to family resemblance, but after adjustment on each factor degrees of resemblance were almost unchanged. CONCLUSION: General findings of this study were that family aggregation in breakfast absolute and relative energy intakes was significant within Stanislas families. Family resemblance depended on inter- and intra-generation components and was modified by the number of shared breakfasts. Our study confirmed that familial habits act on family resemblance in both absolute and relative breakfast energy intakes, so that family should be a favorite unit for health and diet promotion programs. SPONSORSHIP: Kellogg's PA, France.

Genetic influences on lipid metabolism trait variability within the Stanislas Cohort.

The contribution of 17 polymorphisms within 13 candidate genes on lipid trait variability was investigated by a multiplex assay in 772 men and 780 women coming for a health checkup examination. The studied genes were APOE, APOB, APOC3, CETP, LPL, PON, MTHFR, FGB, GpIIIa, SELE, ACE, and AGT. We found that APOB-Thr71Ile, APOE-(112/158), APOC3-1100C/T, and SELE-98G/T polymorphisms had a significant effect on lipid traits (P < or = 0.001 to P < or = 0.01). Genetic effects accounted for 3.5-5.7% of variation in apolipoprotein B (apoB)-related traits among men, and for 5.7-9.0% among women. The contribution of APOE polymorphism on apoB-related traits variability was two to three times more important in women than in men. We found suggestive evidence for interactive effects between genetics and age, smoking status, and oral contraceptives. Increase of LDL-cholesterol and apoB concentrations with age was stronger among the epsilon4 carriers in women, and apolipoprotein A-I (apoA-I) concentration decreased with age in epsilon4 male carriers. The effect of epsilon2 allele on LDL-cholesterol was more important in the oral contraceptive users. In nonsmokers only, the APOC3-1100C allele in women was related to lower apoB-related traits concentrations, and in men to higher apoA-I and HDL-cholesterol concentrations. In conclusion, this work, in addition to the reinforcement of the already known associations between APOB, APOE, and APOC3 genes and lipids, leads to new perspectives in the complex relationships among genes and environmental factors. The newly observed relationships between E-selectine gene and lipid concentrations support the hypotheses of multiple metabolic pathways contributing to the complexity of lipids variability.

Determination of serum cystatin C: biological variation and reference values.

Human cystatin C is a low molecular weight protein which has been proposed as a better marker of glomerular filtration rate than creatinine. To be able to interpret results obtained in different patient populations it is necessary to define cystatin C reference values. We measured serum concentration of cystatin C in 1223 subjects using a particle-enhanced nephelometric assay. Subjects were aged 4 to 79 years and were selected among apparently healthy individuals who came to the Centre for Preventive Medicine in Vandoeuvre-Lès-Nancy, France. We observed a Gaussian distribution of cystatin C concentration in serum. We did not find any effect of age or gender in children, hormonal status in women (puberty, menopause, oral contraceptives or hormone replacement therapy) or alcohol intake. Cystatin C concentration was slightly lower in female than in male adults below the age of 60 years. Cystatin C levels significantly increased above the age of 60 in both males and females, probably due to physiological aging of renal function. No other significant differences were observed between males and females. Using multiple regression analysis, moderate correlations were observed between body mass index and cystatin C, and between smoking and cystatin C, but these were not biologically significant. According to the literature, only methylprednisolone and cyclosporin A increased and decreased cystatin C levels, respectively. The reference values for cystatin C obtained in a carefully selected population were 0.75+/-0.089 mg/l for children aged 4-19 years, 0.74+/-0.100 mg/l for males and 0.65+/-0.085 mg/l for females (aged 20-59 years), and 0.83+/-0.103 mg/l for older individuals (> or =60 years).

Wine, beer, and mortality in middle-aged men from eastern France.

OBJECTIVE: To evaluate prospectively the health risk of wine and beer drinking in middle-aged men in the area of Nancy, France. DESIGN: Prospective cohort study. SUBJECTS: A total of 36 250 healthy men who underwent comprehensive health appraisals in a center of preventive medicine between January 1, 1978, and December 31, 1983. MAIN OUTCOME MEASURES: Education, professional and leisure activities, and smoking and drinking habits were evaluated using a questionnaire. Blood pressure and mean corpuscular volume and gamma-glutamyltransferase, glucose, and serum cholesterol levels were routinely measured, and electrocardiography was routinely performed. We recorded mortality from all causes and specific causes during a 12- to 18-year follow-up across categories of baseline alcohol consumption. RESULTS: Of the subjects, 28% drank beer, 61% drank wine but no beer, and 11% were abstainers; there was not much difference between social classes. During the follow-up, 3617 subjects died. The relative risk of death was estimated by the Cox proportional hazards model using nondrinkers as the reference and adjusting for 4 or 5 covariables. Moderate intake of both wine and beer was associated with lower relative risk for cardiovascular diseases; the risk was more significant with the intake of wine. For all-cause mortality, only daily wine intake (22-32 g of alcohol) was associated with a lower risk (0.67; 95% confidence interval, 0.58-0.77; P<.001) due to a lower incidence of cardiovascular diseases, cancers, violent deaths, and other causes. CONCLUSION: In eastern France, moderately drinking only wine was associated with a lower all-cause mortality, although drinking both wine and beer reduced the risk of cardiovascular death.

Genetics strongly determines the wall thickness of the left and right carotid arteries.

In 76 supposedly healthy families, we investigated the familial resemblance of left and right carotid intima-media thickness (IMT) measured by B-mode ultrasonography and the impact of the common apolipoprotein E (apo E) polymorphism and the insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE). Genetic factors accounted for about 30% of IMT variation. The insertion/deletion ACE polymorphism did not influence carotid IMT, whereas apoE polymorphism explained about 1.5% of only right carotid IMT variability independently of cholesterol levels. The apo epsilon2 and apo epsilon4 alleles were associated with lower right carotid IMT than was the apo epsilon3 allele. We conclude that genetic factors strongly contribute to IMT variability in healthy people and that the apo E polymorphism may be one of these factors.

Objectives, design and recruitment of a familial and longitudinal cohort for studying gene-environment interactions in the field of cardiovascular risk: the Stanislas cohort.

The main objective of the Stanislas cohort is to study the role and the contribution of genetic and environmental factors to cardiovascular status. We plan: a) to describe the degree of association of a large number of cardiovascular risk indicators with cardiovascular endpoints, b) to evaluate the contribution of genetic and that of environmental factors to this association, c) to follow the evolution of these risk indicators during a period of at least ten years, d) to search for the determinants influencing this evolution. The principal variables studied are: a) blood pressure, cardiac mass, and wall thickness of carotid and femoral arteries, b) obesity and fat mass, c) indicators of lipid metabolism, d) genetic polymorphisms of several cardiovascular risk candidate genes, e) food, tobacco and alcohol consumption, f) consumption of drugs and anti-oxidant vitamins. Between September 1993 and August 1995, 1006 families consisting of the two biological parents with at least two children were recruited totalling 4295 individuals. This cohort will be followed up until 2004. There will be two health examinations five and ten years after the initial examination. A bank of blood samples (serum and plasma) in liquid nitrogen and DNA (-80 degrees C) has been established.

Biological variations and genetic reference values for apolipoprotein E serum concentrations: results from the STANISLAS cohort study.

Serum apolipoprotein (apo) E concentrations were determined by immunoturbidimetry in 4284 subjects from 4 to 71 years of age and belonging to 1003 nuclear families recruited for the STANISLAS cohort study between January 1994 and August 1995. Values for apo E ranged from 16 to 169 mg/L, with a geometric mean +/- SD values of 46.6 +/- 13.8 mg/L in the overall sample. The interindividual variability varied from 24.6% to 32.0% among family members. Females exhibited higher apo E values than males until the age of 17-26 years. Conversely, after the age of 26 years, serum apo E concentrations were higher in men than in women. Biological factors affecting serum apo E concentrations were described in fathers, mothers, sons, and daughters and explained up to 32.0% of the apo E variability in daughters and 19.0% in fathers. The main biological factors affecting apo E concentrations were the following: apo E polymorphism, waist-to-hip ratio, oral contraceptive intake, puberty, body mass index, age, and gender. Given the importance of apo E polymorphism in the regulation of apo E concentrations, we recommend the use of genetic-based reference values for the clinical interpretation of serum apo E concentrations.

Alcohol and mortality in middle-aged men from eastern France.

To evaluate prospectively the effect on mortality of wine drinking in Eastern France, we conducted an analysis on 34,014 consecutive middle-aged men coming for a comprehensive health appraisal between 1978 and 1983. We evaluated education, physical activity, smoking, and drinking habits by a questionnaire. Electrocardiogram, blood pressure, serum total cholesterol, and gamma-glutamyltransferase level were routinely measured. Seventy-seven per cent of the subjects drank wine; there was little difference between social classes in this proportion. We evaluated mortality over 10-15 years of follow-up. We estimated the relative risk (RR) of death by Cox proportional hazard models using nondrinkers as the reference and adjusting for six covariables. For an intake of 22-32 and 33-54 gm of alcohol per day, the RR of all-cause death was 0.70 [95% confidence interval (CI) = 0.59-0.82] and 0.76 (95% CI = 0.66-0.87), respectively. The lower mortality resulted from fewer deaths from cardiovascular disease and cancer. Above 128 gm per day of alcohol consumption, the RR was 1.37 (95% CI = 1.16-1.61). A moderate intake of wine (2-5 glasses per day) was associated with a 24-31% reduction in all-cause mortality, a proportion that was similar for smokers, ex-smokers, and nonsmokers.

The French paradox and wine drinking.

Despite a high level of risk factors such as cholesterol, diabetes, hypertension and a high intake of saturated fat, French males display the lowest mortality rate from ischaemic heart disease and cardiovascular diseases in Western industrialized nations (36% lower than the USA and 39% lower than the UK). By contrast, mortality from all causes is only 8% lower than in the USA and 6% than in the UK, owing to a high level of cancer and violent deaths. In a recent study of 34,000 middle-aged men from Eastern France with a follow-up of 12 years we have observed that for 48 g of alcohol (mostly wine) per day as the mean intake, mortality from cardiovascular diseases was lower by 30%, all-cause mortality was reduced by 20%, but mortality by cancer and violent death was increased compared with abstainers. Thus the so-called 'French Paradox' (a low mortality rate specifically from cardiovascular diseases) may be due mainly to the regular consumption of wine.

Combined effects of lipoprotein lipase and apolipoprotein E polymorphisms on lipid and lipoprotein levels in the Stanislas cohort.

We have genotyped 1101 supposedly healthy subjects from the Stanislas cohort for the lipoprotein lipase (LPL) gene Ser417(C)-->stop (G) polymorphism and/or for the apolipoprotein (apo)E common polymorphism. Genotypic effects of the two polymorphisms on fasting serum triglycerides (TG), total cholesterol (Tchol), high density lipoprotein-cholesterol (HDLc), low density lipoprotein-cholesterol (LDLc), apoB, apoA-I, and apoE levels were studied separately for each polymorphism and in conjunction. epsilon 4 allele and high apoE levels were associated with high levels of LDLc, Tchol, apoB, and TG. The G allele of LPL was significantly associated with low TG levels. We found a clear interaction between the LPL/apoE polymorphisms and apoE levels on serum TG variation. Total variability of TG levels in women and men of 42.31% and 53.62% respectively, were mainly explained by apoE concentration and these two polymorphisms. ApoE and LPL genes simultaneously modulated TG levels.