Apolipoprotein E genotype predicts hematoma expansion in lobar intracerebral hemorrhage.
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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
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Journal | Stroke
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Volume | 43
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Issue | 6
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Pages | 1490-5
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Date Published | 2012 Jun
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ISSN | 1524-4628
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URL | |
DOI | 10.1161/STROKEAHA.111.643262
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PubMed ID | 22535266
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PubMed Central ID | PMC3361564
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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
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