Neurology 1999;53:1308
© 1999 American Academy of Neurology
Articles
APOE genotype as a risk factor for ischemic cerebrovascular disease
A meta-analysis
Mark O. McCarron, MA, MRCP,
David Delong, PhD and
Mark J. Alberts, MD
From the Department of Neurology (Dr. McCarron), Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK; and the Divisions of Biometry (Dr. Delong) and Neurology (Dr. Alberts), Duke University Medical Center, Durham, NC.
Address correspondence and reprint requests to Dr. Mark McCarron, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, G51 4TF, Scotland, UK; e-mail: mmc18f{at}clinmed.gla.ac.uk
OBJECTIVE: To determine whether a specific apolipoprotein E (APOE) polymorphism is a risk factor for ischemic cerebrovascular disease (CVD; stroke or TIA).
BACKGROUND: The APOE  4 allele is overrepresented in AD, atherosclerosis, and ischemic heart disease. In addition, 4 carriers have higher plasma cholesterol levels than non-4 carriers.
METHODS: Using Medline (OVID and PubMed), a search was performed for all studies that examined APOE in ischemic CVD. The authors identified nine case–control studies that were suitable for analysis.
RESULTS: There were 926 patients with ischemic stroke or TIAs and 890 age- and sex-matched control subjects. Overall analysis revealed a significantly higher APOE-4 allelic frequency in affected patients compared with control subjects (0.14 versus 0.09; odds ratio, 1.68; 95% CI, 1.36 to 2.09; p < 0.001 ). There was a significant excess of the 3 allele (0.85 versus 0.80) but not the 2 allele (0.06 versus 0.06) in the control subjects compared with the ischemic CVD patients. Seven studies had data on APOE genotypes. Carriers of 4 were more frequent among ischemic CVD patients than control subjects (27% versus 18%; odds ratio, 1.73; 95% CI, 1.34 to 2.23; p < 0.001).
CONCLUSIONS: The APOE-4 allele and carriers of 4 are more frequent among patients with ischemic CVD compared with control subjects. The 2 allele does not appear to be protective for ischemic CVD. These findings imply a role for the APOE genotype in the pathogenesis of some cases of ischemic CVD.
Key words: Apolipoprotein E—Ischemic cerebrovascular disease.
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