Cerebral amyloid angiopathy-related hemorrhage interaction of APOE ε2 with putative clinical risk factors

被引:64
作者
McCarron, MO [1 ]
Nicoll, JAR
Ironside, JW
Love, S
Alberts, MJ
Bone, I
机构
[1] So Gen Hosp, Inst Neurol Sci, Dept Neuropathol, Glasgow G51 4TF, Lanark, Scotland
[2] Univ Edinburgh, Western Gen Hosp, Dept Neuropathol, Edinburgh, Midlothian, Scotland
[3] Frenchay Hosp, Dept Neuropathol, Bristol BS16 1LE, Avon, England
[4] Duke Univ, Med Ctr, Dept Med, Div Neurol, Durham, NC 27710 USA
关键词
apolipoproteins; cerebral amyloid angiopathy; intracerebral hemorrhage;
D O I
10.1161/01.STR.30.8.1643
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Current evidence suggests that the apolipoprotein E (APOE for gene; apoE for protein) epsilon 4 allele predisposes to cerebral amyloid angiopathy (CAA) whereas epsilon 2 is associated with CAA-related hemorrhage (CAAH). The clinical risk factors for other forms of intracranial hemorrhage are a less-frequent feature of CAAH. In this study we examined potential clinical risk factors in patients with CAAH and assessed these with respect to APOE genotype. Methods-Thirty-six patients were identified with a pathological diagnosis of CAAH. Clinical notes were reviewed to document age of hemorrhage onset, history of dementia, antiplatelet/anticoagulant medication, hypertension, minor head trauma, or transient neurological events. In a review of reported cases of CAAH, the frequency of these clinical features was also recorded. APOE genotypes were determined with use of polymerase chain reaction techniques. Results-There were 24 women and 12 men; the mean age was 70.3 years. One third (n=12) had been taking antiplatelet medication, and a similar number were demented. Nine patients were hypertensive, and 4 had a history of recent minor head trauma. The relative frequency of each of these clinical features was similar to that in previous reports. Forty-four percent (16 of 36) possessed an epsilon 2 allele. Antiplatelet or anticoagulant medication, hypertension, or minor head trauma were significantly more frequent antecedents of CAAH in epsilon 2 carriers than in non-a carriers (81% versus 35%, P=0.008), antiplatelet/anticoagulant medication in particular (P=0.038). Conclusions-Our findings suggest that antiplatelet or anticoagulant medication, hypertension, or minor head trauma are most likely to precipitate cerebral hemorrhage in patients with CAA who are also epsilon 2 carriers. This may result from isoform-specific effects of apoE on the structure of amyloid-laden blood vessel walls.
引用
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页码:1643 / 1646
页数:4
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