Sriprasert I, et al. - Given that metabolic profile and ApoE4 genotype impact coronary heart disease, researchers studied the interaction between these factors on subclinical atherosclerosis among 497 postmenopausal women from the Early versus Late Intervention Trial with Estradiol. Using nine metabolic biomarkers (fasting blood glucose, insulin sensitivity, ketones, triglycerides, HDL, LDL, HbA1c, and blood pressure), K-means clustering classified women into the phenotypes healthy, high blood pressure, and poor metabolic. ApoE4+ women with poor metabolic phenotype had the highest CIMT vs all other groups in cross-sectional analysis. CIMT was significantly lower among ApoE4- women classified as healthy vs the high blood pressure phenotype. Among ApoE4+ women, compared to healthy and high blood pressure phenotypes, CIMT was significantly higher in those with poor metabolic phenotype. These findings show that metabolic phenotype among females with ApoE4+ (but not ApoE4-) had an adverse impact on CIMT. Compared to ApoE4+ women without poor metabolic profile and ApoE4- women, ApoE4+ women are more likely to have higher levels of subclinical atherosclerosis if their metabolic phenotype is poor.