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Stroke. 2012 Jun;43(6):1490-5. doi: 10.1161/STROKEAHA.111.643262. Epub 2012 Apr 24.

Apolipoprotein E genotype predicts hematoma expansion in lobar intracerebral hemorrhage.

Author information

1
Center for Human Genetic Research-Rosand Lab, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, CPZN-6818, Boston, MA 02114, USA. brouwers@chgr.mgh.harvard.edu

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.

PMID:
22535266
PMCID:
PMC3361564
DOI:
10.1161/STROKEAHA.111.643262
[Indexed for MEDLINE]
Free PMC Article
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