Apolipoprotein E genotype predicts hematoma expansion in lobar intracerebral hemorrhage.

Stroke
Authors
Keywords
Abstract

BACKGROUND AND PURPOSE: Hematoma volume is the most potent predictor of outcome in spontaneous intracerebral hemorrhage (ICH), and hematoma expansion after hospital presentation occurs in up to 40% of individuals. Among patients with lobar ICH, the apolipoprotein E (APOE) ε2 allele predicts larger hematoma volumes at presentation. We investigated whether the ε2 allele also identifies individuals at increased risk of hematoma expansion.

METHODS: We analyzed 510 patients with primary ICH and genetic data available from an ongoing prospective cohort study. Baseline and follow-up CT scans were assessed for ICH location and volume using computer-assisted volumetric methods.

RESULTS: Individuals with lobar ICH who possessed APOE ε2 were at increased risk for hematoma expansion (OR, 2.72; 95% CI, 1.19-6.23; P=0.009). The highest odds of expansion were in patients who qualified for the diagnosis of cerebral amyloid angiopathy-related ICH and carried the APOE ε2 allele (OR, 6.02; 95% CI, 1.60-22.58; P=0.008). There was no effect of ε2 on hematoma expansion in deep ICH and APOE ε4 had no effect on hematoma expansion in lobar or deep ICH.

CONCLUSIONS: Possession of APOE ε2 predisposes individuals with lobar ICH to hematoma expansion. This effect is even more pronounced in patients with amyloid angiopathy-related ICH, consistent with the ε2 allele's role in vascular amyloid deposition and vessel fragility.

Year of Publication
2012
Journal
Stroke
Volume
43
Issue
6
Pages
1490-5
Date Published
2012 Jun
ISSN
1524-4628
URL
DOI
10.1161/STROKEAHA.111.643262
PubMed ID
22535266
PubMed Central ID
PMC3361564
Links
Grant list
K23 NS064052 / NS / NINDS NIH HHS / United States
K23 NS059774 / NS / NINDS NIH HHS / United States
5K23NS059774 / NS / NINDS NIH HHS / United States
R01 NS059727-01A1 / NS / NINDS NIH HHS / United States
K23 NS059774-01A2 / NS / NINDS NIH HHS / United States
P50NS051343 / NS / NINDS NIH HHS / United States
P50 NS051343 / NS / NINDS NIH HHS / United States
R01 NS059727 / NS / NINDS NIH HHS / United States
R01NS059727 / NS / NINDS NIH HHS / United States
R01 NS073344 / NS / NINDS NIH HHS / United States