<![CDATA[Apolipoprotein A-5 (APOA5) is a hepatic regulator of triglyceride-rich lipoprotein metabolism, and the promoter polymorphism rs662799 is its most extensively investigated variant. This narrative review synthesises current evidence on the molecular consequences of rs662799 and its relationship with lipid profile, central obesity, and metabolic syndrome, with particular attention to its relevance for Asian and Indonesian populations. Literature published between 2011 and 2026 was retrieved from PubMed, ScienceDirect, SpringerLink, Google Scholar, and Garuda, and thirty-nine sources met the selection criteria. The minor allele reduces promoter transcriptional activity, lowers APOA5 concentration, and impairs lipoprotein lipase-mediated triglyceride clearance, resulting in higher plasma triglyceride and lower high-density lipoprotein cholesterol. Meta-analyses report a 1.3- to 1.5-fold increase in metabolic syndrome risk among minor allele carriers, whereas associations with central obesity are inconsistent and frequently conditional on energy intake, sex, or degree of adiposity. Minor allele frequency is substantially higher in East Asian than in European populations, indicating population-specific clinical implications. Evidence relating this variant to lipid-lowering pharmacotherapy response remains scarce and warrants investigation, particularly in Indonesia where population data are still limited.]]>
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