(Stroke. 1997;28:2410-2416.)
© 1997 American Heart Association, Inc.
Articles |
Apolipoprotein E 
2 Allele and Risk of Stroke in the Older Population
From the Geriatric Department, "I Fraticini," National Research Institute (INRCA), Florence, Italy (L.F.); Epidemiology, Demography, and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Md (L.F., J.M.G., T.H., M.-C.C., R.J.H.); Department of Preventive Medicine, University of Tennessee, Memphis (M.P.); Neurology Service, Massachusetts General Hospital, Boston (B.T.H.); and Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City (R.B.W.).
Background and Purpose There is evidence for a role of
apolipoprotein E (apoE) in atherosclerosis.
Coronary heart disease morbidity is higher in persons carrying
an 4 allele and lower in those carrying an 2 allele, but
the effect on cerebrovascular disease is controversial. We estimated
the risk of stroke associated with different apoE genotypes in
older persons.
Methods At the sixth annual follow-up of the Iowa cohort of the
Established Populations for Epidemiologic Studies of the Elderly, 1664
persons aged 
71 years and free of stroke were genotyped for
apo E. Occurrence of ischemic strokes was prospectively
assessed from subsequent hospital discharge records and death
certificates.
Results One hundred fifty persons had an ischemic stroke
over the subsequent 5 years (21.2 per 1000 person-years). The presence
of 3 and 4 did not influence stroke risk. Among persons aged <80
years at the time of genotyping, 2 carriers had lower risk of
incident stroke, while no effect was detected in the older group.
Compared with 2 carriers aged 70 to 79 years (reference group),
those in the same age group and not carrying an 2 had 2.6-fold
higher risk of incident stroke, and those aged 80 years had even
higher risks of stroke but without any difference according to
presence/absence of 2 (relative risks 3.6 and 3.3). Results remained
substantially unchanged when adjusted for potential confounders and in
models estimating the effect of apoE polymorphism on the risk of
developing a stroke at ages between 70 and 79 years (56 events) and
separately at ages 80 years (94 events).
Conclusions The conditioning influence of age on the protection
conferred by the apoE 2 allele on stroke risk may account for
previous controversies. This hypothesis should be verified in a
population with a wider age range.
Key Words: aging • apolipoproteins • risk factors • stroke
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