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(Stroke. 2004;35:1057.)
© 2004 American Heart Association, Inc.

Original Contributions

Interaction Between Hypertension, apoE, and Cerebral White Matter Lesions

Frank-Erik de Leeuw, MD; Florence Richard, MD; Jan Cees de Groot, MD; Cornelia M. van Duijn, PhD; Albert Hofman, MD; Jan van Gijn, FRCP Monique M.B. Breteler, MD

From Department of Epidemiology and Biostatistics (F.E.d.L., F.R., J.C.d.G., C.M.v.D., A.H., M.M.B.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Neurology (F.E.d.L., J.v.G.), University Medical Center, Utrecht, the Netherlands; Department of Neurology (F.E.d.L.), University Medical Center, Nijmegen, the Netherlands; INSERM Unit 508 (F.R.), Institut Pasteur de Lille, Lille, France; and Department of Radiology (J.C.d.G.), University Hospital, Groningen, the Netherlands.

Correspondence to M.M.B. Breteler, Department of Epidemiology and Biostatistics, Erasmus Medical Center, PO Box 1738, 3000DR Rotterdam, The Netherlands. E-mail m.breteler{at}erasmusmc.nl

Background and Purpose— Cerebral white matter lesions (WMLs) are frequently found on magnetic resonance imaging scans in both cognitively intact and demented elderly persons. Vascular risk factors, especially hypertension, are related to their presence. However, not every person with vascular risk factors has WMLs, which suggests interaction with other determinants, eg, genetic factors. The 4 allele of the apolipoprotein E gene (apoE) may be a candidate because this allele is associated with both the vascular risk factors and the consequences (cognitive impairment, dementia) of WMLs.

Methods— We investigated apoE genotype, blood pressure levels, and their interaction in relation to subcortical and periventricular WMLs in 971 participants in the Rotterdam Scan Study.

Results— ApoE 4 carriers had a significantly higher subcortical WML volume than did apoE 33 carriers (adjusted mean difference, 0.5; 95% confidence interval, 0.2 to 0.8), irrespective of hypertension. This was not found for periventricular WMLs. Participants with both hypertension and at least 1 apoE 4 allele had the highest degree of both types of WML; the interaction was statistically significant for subcortical WMLs (P=0.016).

Conclusions— apoE 4 carriers are at increased risk for WMLs if they suffer from hypertension as well. This may reflect a diminished capacity for neuronal repair in apoE 4 carriers.

Key Words: epidemiology • hypertension • cerebrovascular disease • MRI • other arteriosclerosis

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