Apolipoprotein E genotype does not influence the risk of symptomatic hemorrhage in acute ischemic stroke

Abstract Background APOE e4 is independently associated with lobar intracranial hemorrhages (ICH). Although the e4 allele enhances amyloid deposition in blood vessels, the e2 allele predisposes to vasculopathic changes leading to rupture of amyloid laden vessels. Thus, e4 and e2 carriers might have increased susceptibility to ICH. We aimed to study the impact of the apolipoprotein E alleles in the development of symptomatic ICH (sICH). Methods We included 384 consecutive ischemic anterior circulation stroke patients submitted to thrombolysis between January 2014 and March 2016. Admission CT-scans were reviewed to calculate the ASPECTS. Patients were followed for up to at least 6 months post-stroke or until death. Outcome was development of sICH, defined according to the ECASS III. Results Considering APOE genotyping, three patients had e2/e2, four had e2/e4, 38 had e2/e3, 284 had e3/e3, 51 had e3/e4 and four had e4/e4. sICH was associated with sex and diabetes. In multivariate analysis, sICH was not associated with carrying one or more e4 alleles (OR: 0.483, 95%CI = [0.059, 3.939], p = 0.497) nor with carrying one or more e2 alleles (OR: 1.369, 95%CI = [0.278, 6.734], p = 0.699). Conclusion No association was found between APOE genotype and the development of symptomatic intracranial hemorrhage.