on April 1, 2004
Published online before print April 1, 2004, doi: 10.1161/01.STR.0000125859.71051.83
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Submitted on November 3, 2003
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. * To whom correspondence should be addressed. 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 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 Conclusions--apoE
Revised on January 16, 2004
Accepted on January 29, 2004
Interaction Between Hypertension, apoE, and Cerebral White Matter Lesions
Frank-Erik de Leeuw MD;
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.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).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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