Variants at APOE influence risk of deep and lobar intracerebral hemorrhage

Ann Neurol. 2010 Dec;68(6):934-43. doi: 10.1002/ana.22134.

Abstract

Objective: Prior studies investigating the association between APOE alleles ε2/ε4 and risk of intracerebral hemorrhage (ICH) have been inconsistent and limited to small sample sizes, and did not account for confounding by population stratification or determine which genetic risk model was best applied.

Methods: We performed a large-scale genetic association study of 2189 ICH cases and 4041 controls from 7 cohorts, which were analyzed using additive models for ε2 and ε4. Results were subsequently meta-analyzed using a random effects model. A proportion of the individuals (322 cases, 357 controls) had available genome-wide data to adjust for population stratification.

Results: Alleles ε2 and ε4 were associated with lobar ICH at genome-wide significance levels (odds ratio [OR] = 1.82, 95% confidence interval [CI] = 1.50-2.23, p = 6.6 × 10(-10); and OR = 2.20, 95%CI = 1.85-2.63, p = 2.4 × 10(-11), respectively). Restriction of analysis to definite/probable cerebral amyloid angiopathy ICH uncovered a stronger effect. Allele ε4 was also associated with increased risk for deep ICH (OR = 1.21, 95% CI = 1.08-1.36, p = 2.6 × 10(-4)). Risk prediction evaluation identified the additive model as best for describing the effect of APOE genotypes.

Interpretation: APOE ε2 and ε4 are independent risk factors for lobar ICH, consistent with their known associations with amyloid biology. In addition, we present preliminary findings on a novel association between APOE ε4 and deep ICH. Finally, we demonstrate that an additive model for these APOE variants is superior to other forms of genetic risk modeling previously applied.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans
  • Aged
  • Aged, 80 and over
  • Apolipoprotein E2 / genetics*
  • Apolipoprotein E4 / genetics*
  • Cerebral Amyloid Angiopathy
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / genetics*
  • Cohort Studies
  • Cross-Cultural Comparison
  • European Continental Ancestry Group
  • Female
  • Gene Frequency
  • Genetic Predisposition to Disease*
  • Genetic Variation / genetics*
  • Genome-Wide Association Study
  • Genotype
  • Humans
  • Male
  • Meta-Analysis as Topic
  • Middle Aged
  • Models, Genetic
  • Principal Component Analysis
  • Radiography
  • Risk Factors

Substances

  • Apolipoprotein E2
  • Apolipoprotein E4