Elsevier

Surgical Neurology

Volume 60, Issue 5, November 2003, Pages 391-396
Surgical Neurology

Aneurysm
Apolipoprotein e ϵ4 and the risk of unfavorable outcome after aneurysmal subarachnoid hemorrhage

https://doi.org/10.1016/S0090-3019(03)00323-9Get rights and content

Section snippets

Patients

Between July 1, 2000 and June 31, 2001, a total of 120 patients with aneurysms were admitted to the Department of Neurosurgery at Beijing Tiantan Hospital. Digital Subtraction Angiography (DSA) or surgery was used to confirm all aneurysms. Patients with subarachnoid hemorrhage (SAH) without confirmation by DSA or surgical detection were excluded from this study. All patients with aneurysmal SAH underwent computed tomography (CT) scanning on admission and were classified using Fisher's grade [6]

Results

A final total of 104 patients were included in this study; 16 patients without confirmed SAH had been excluded. Of these 104 patients available for clinical assessment of aneurysmal SAH and APOE genotype, 12 had unfavorable outcomes at 3 months following SAH, 4 patients had died, and another 8 had a dependent lifestyle.

Except for the genotype with ϵ2/ϵ2, 5 other genotypes were identified in this study. The distributions of APOE genotypes of patients closely resembled those of control subjects (

Discussion

This study also demonstrated that the APOE-ϵ4 allele predisposed to an unfavorable outcome after aneurysmal SAH. The association of APOE-ϵ4 with unfavorable outcome was still observed after multiple regression analysis. Genetic susceptibility for unfavorable outcome after SAH associated with APOE-ϵ4 was implied, but an association of APOE with the incidence of SAH was not supported because there were similar distributions of this gene in both patients and control subjects.

Recent studies showed

Conclusions

Despite the limitations discussed above, our study supports the premise that patients with APOE-ϵ4 allele are likely predisposed to unfavorable outcomes. This may involve the adverse effects of apoE4 on neurobiology and its potential links with risk factors such as vasospasm. But it does not support an association of APOE with the incidence of aneurysmal SAH. Genetic susceptibility needs further study in regard to aneurysmal SAH.

First page preview

First page preview
Click to open first page preview

References (40)

  • G.M. Teasdale et al.

    Association of apolipoprotein E polymorphism with outcome after head injury

    Lancet

    (1997)
  • P. Amarenco

    Hypercholesterolemia, lipid-lowering agents, and the risk for brain infarction

    Neurology

    (2001)
  • H.S. Clarence et al.

    Apolipoprotein E genotype and outcome in aneurysmal subarachnoid hemorrhage

    Stroke

    (2002)
  • E.H. Corder et al.

    Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families

    Science

    (1993)
  • A.G. Dyker et al.

    Influence of cholesterol on survival after strokeretrospective study

    BMJ

    (1997)
  • C.M. Fisher et al.

    Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning

    Neurosurgery

    (1980)
  • G. Friedman et al.

    Apolipoprotein E-epsilon4 genotype predicts a poor outcome in survivors of traumatic brain injury

    Neurology

    (1999)
  • D.C. Hess et al.

    HMG-CoA reductase inhibitors (statins)a promising approach to stroke prevention

    Neurology

    (2000)
  • W.E. Hunt et al.

    Surgical risk as related to time of intervention in the repair of intracranial aneurysms

    J Neurosurg

    (1968)
  • I. Liaquat et al.

    Effect of apolipoprotein E genotype on hematoma volume after trauma

    J Neurosurg

    (2002)
  • Cited by (46)

    • Role of Apolipoprotein E Genotypes in Aneurysmal Subarachnoid Hemorrhage: Susceptibility, Complications, and Prognosis

      2018, World Neurosurgery
      Citation Excerpt :

      The NOS score of included studies ranged from 6 to 9 (median 7) (Table 1). Detailed NOS assessments are illustrated in Supplementary Table 1.18,19,21,22,25-38 Funnel plots were created for publication bias assessment on meta-analysis including at least 9 studies according to the Cochrane Handbook.39

    • Search for Biomarkers of Intracranial Aneurysms: A Systematic Review

      2015, World Neurosurgery
      Citation Excerpt :

      With the limited sample size of 11 patients in the study, further evaluation is needed to understand the role of LPA in IAs (31). Three studies performed genetic analyses of APOE, a primary mediator of cholesterol and lipid transport in the brain in IAs, but did not find any association between the APOE gene and IA occurrence (38). However, Tang et al. reported a tendency for unfavorable outcomes after SAH in the presence of the APOE-e4 allele (38).

    View all citing articles on Scopus
    View full text