From the Departments of Neuropathology (M.O.M., J.A.R.N.) and Neurology
(K.W.M., I.B.), Institute of Neurological Sciences, Southern General Hospital;
and Acute Stroke Unit, Department of Medicine and Therapeutics, Gardiner
Institute, Western Infirmary (C.J.W., A.G.D., K.R.L.), Glasgow, Scotland.
Correspondence to Dr James A.R. Nicoll, Department of Neuropathology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, UK. E-mail JARN1H{at}clinmed.gla.ac.uk
Background and
Purpose—Polymorphism of the apolipoprotein E gene
(APOE) may influence outcome after traumatic brain
injury and intracerebral hemorrhage, with the
Methods—APOE genotypes were determined in
714 stroke patients: 640 ischemic stroke and 74
intracerebral hemorrhage patients. The survival
effect of the
Results—Allele distribution matched the general population
with no difference between the ischemic and hemorrhagic groups.
Survival in the entire cohort was unaffected by
Conclusions—The APOE
© 1998 American Heart Association, Inc.
Original Contributions
The Apolipoprotein E
4 Allele and Outcome in Cerebrovascular Disease
4 allele being associated with poorer prognosis. We investigated
APOE allele distribution in acute stroke and the
effect of the 4 allele on outcome. 4 allele was assessed with the use of a stratified
log-rank test. A Cox proportional hazards regression model was used to
estimate the independent effect of 4 dose (0, 1, or 2) on survival,
and logistic regression was used to determine the effect on 3-month
outcome (good if alive at home, poor if in care or dead). 4 dose. Improved
survival with increasing 4 dose was found in the ischemic
group (relative hazard=0.76 per allele; P=0.04). If
transient ischemic attacks were excluded, a trend for improved
survival persisted (P=0.06). With
intracerebral hemorrhage, a trend was seen
toward reduced survival with 4 (P=0.07, log-rank
test). Three-month outcome in the ischemic group was unaffected
by 4 dose, and a trend toward poorer outcome with 4 was seen for
intracerebral hemorrhage
(P=0.10). 4 allele had divergent
effects on survival and outcome in ischemic and hemorrhagic
strokes in this population. The reported adverse effect on patients
with intracerebral hemorrhage was supported.
The favorable survival effect on ischemic stroke patients
requires further study.
Key Words: apolipoproteins • stroke outcome
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