(Stroke. 1997;28:951-956.)
© 1997 American Heart Association, Inc.
Articles |
Apolipoprotein E Polymorphism and Silent Microangiopathy-Related Cerebral Damage
Results of the Austrian Stroke Prevention Study
From the Departments of Neurology (R.S., F.F., K.N., P.K.) and Internal Medicine (M.S., V.W.), the Institute of Medical Biochemistry (H.S., G.M.K.), and the MRI Center (R.S., F.F., P.K.), Karl-Franzens University Graz, Austria.
Correspondence to Reinhold Schmidt, MD, Department of Neurology, Karl-Franzens University Graz, Auenbruggerplatz 22, A-8036 Graz, Austria. E-mail reinhold.schmidt{at}kfunigraz.ac.at
Background and Purpose Microangiopathy-related cerebral damage (MARCD) includes white matter abnormalities and lacunar infarctions and represents a common MRI observation in subjects above 50 years of age. The risk factors of such brain abnormalities are not fully determined. The goal of this study was to determine whether the genetic heterogeneity of apolipoprotein E (apoE) contributes to the occurrence of MARCD.
Methods Brain MRI (1.5 T) was performed in 280 individuals (ages 50 to 75 years) without neuropsychiatric disease randomly selected from the official register of residents of the city of Graz, Austria. All study participants underwent apoE genotyping, carotid Doppler sonography, electrocardiography, echocardiography, and a complete blood chemistry panel. MARCD was defined as evidence of early confluent and confluent white matter hyperintensities or lacunes. Carotid atherosclerosis was graded on a five-point scale ranging from not present (0) to complete occlusion (5).
Results MARCD occurred in 61 individuals (21%). The
distribution of apoE genotypes differed significantly between
subjects with and without MARCD (P=.036). Subjects with such
findings more commonly had the 
2/3 genotype (24.6%
versus 10%) at similar frequencies of genotypes containing the
4 allele. The 2/3 genotype was associated with
lower levels of total cholesterol (P=.0009), LDL
cholesterol (P=.00001), and apolipoprotein B
(P=.00001). Also, there was a nonsignificant trend toward
less cardiac disease. Other major vascular risk factors and carotid
abnormalities were similar among the various genotypes.
Multiple logistic regression analysis created a model of
significant MARCD predictors, including age (odds ratio [OR], 1.1 per
year), hypertension (OR, 3.4), and the apoE 2/3 genotype
(OR, 3.0).
Conclusions These data suggest an association between the
apoE 2/3 genotype and MARCD despite favorable effects on
the lipid profile and cardiac disease.
Key Words: apolipoproteins • lacunar infarction • magnetic resonance imaging • stroke prevention • white matter
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