Racial/ethnic variation of <i>APOE</i> alleles for lobar intracerebral hemorrhage.
case_control · Level III
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- Record sourced from PubMed, PMID 29959260.
- Also identified by DOI 10.1212/WNL.0000000000005908 and PMC identifier 6093767.
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Abstract
<i>APOE</i> ε2 and ε4 alleles have been associated with lobar intracerebral hemorrhage (ICH) in predominately white populations; we sought to evaluate whether this held true among black and Hispanic populations. The Ethnic/Racial Variations of Intracerebral Hemorrhage study is a prospective, multicenter case-control study of ICH among white, black, and Hispanic participants. Controls were recruited to match cases based on age, ethnicity/race, sex, and geographic location. <i>APOE</i> genotyping and ICH location was determined blinded to clinical data. There were 907 cases of lobar ICH and 2,660 controls with <i>APOE</i> results. Both <i>APOE</i> ε<i>2</i> (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.0, <i>p</i> = 0.01) and <i>APOE</i> ε<i>4</i> (OR 2.0, 95% CI 1.5-2.6, <i>p</i> < 1 × 10<sup>-4</sup>) were associated with lobar ICH among white participants. Among black participants, neither <i>APOE</i> ε<i>2</i> (OR 1.0, 95% CI 0.7-1.5, <i>p</i> = 0.97) nor <i>APOE</i> ε<i>4</i> (OR 1.0, 95% CI 0.7-1.4, <i>p</i> = 0.90) were independent risk factors for lobar ICH. Similarly, among Hispanic participants, neither <i>APOE</i> ε<i>2</i> (OR 1.0, 95% CI 0.6-1.8, <i>p</i> = 0.89) nor <i>APOE</i> ε<i>4</i> (OR 1.2, 95% CI 0.8-1.7, <i>p</i> = 0.36) were associated with lobar ICH. Hypertension was a significant risk factor for lobar ICH in all 3 racial/ethnic groups. In contrast to Caucasian patients, in which amyloid risk factors predominate in lobar ICH, we found that hypertension was the predominant risk factor for lobar ICH. While <i>APOE</i> alleles are a risk factor for lobar ICH in white patients, they appear to have a much lower effect in lobar ICH in African American and Hispanic American populations. This suggests <i>APOE</i> ε<i>2</i> and <i>APOE</i> ε<i>4</i> do not affect lobar ICH risk homogeneously across ethnic populations. In addition, hypertension has a prominent role in lobar ICH risk, particularly among minorities.
Medical subject headings
- Alleles
- Apolipoprotein E2
- Cerebral Hemorrhage
- Ethnicity
- Genetic Variation
- Racial Groups