The apolipoprotein E ε4 haplotype is an important predictor for recurrence in ischemic cerebrovascular disease

Objective: To determine whether a specific apolipoprotein E (APOE) allele is a predictor for ischemic cerebrovascular disease (ICVD). Background: The role of APOE in atherosclerosis has been a focus of intensive research. The APOE ε4 allele is overrepresented in Alzheimer's disease, atherosclerosis, ischemic heart disease, and ICVD. Also, ε4 carriers have higher cholesterol levels than non-ε4 carriers. Methods: We performed a prospective, longitudinal study on patients who have ICVD. The patients were recruited from St. Mary Hospital, Korea, and investigated for ICVD through interviews and by reviewing their medical records and neuroimaging studies. APOE genotypes were determined for each patient. Results: 20 of the 91 enrolled patients had recurrent ICVD, yielding a 3-year cumulative recurrence rate of 22%. Carriers of the ε4 allele had a 3-year recurrence rate of 53%, as compared with only 16% for patients who had the APOE non-ε4 allele (the risk ratio was 4.11; the 95% CI was 1.49-11.32; P<0.01). Conclusions: Our results make possible the identification of patients with ICVD who are at high risk for recurrence by assessing their APOE genotype. Also, this data might be clinically useful in methods for assessing potential strategies for prevention.