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

Jie Tang, Jizong Zhao, Yuanli Zhao, Shuo Wang, Baosheng Chen, Wuwei Zeng, Ralph G. Dacey

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


BACKGROUND: The APOE-ε4 allele has been identified as a risk factor for Alzheimer's disease and unfavorable outcomes after brain injuries. The purpose of this study was to confirm that APOE allele polymorphism also represents a risk factor for unfavorable outcomes following aneurysmal subarachnoid hemorrhage (SAH). METHODS: A total of 104 patients with aneurysmal SAH were studied. Computed tomography (CT) scan findings of SAH were assessed by FisherÆs grade and clinical neurologic assessment was performed using the Hunt and Hess (H&H) grading system. Serum lipids were also analyzed. Outcomes at 3 months after SAH were determined using the Glasgow Outcome Scale. RESULTS: The distributions of APOE genotypes and alleles of patients were matched with those of control subjects. That 5 of 18 patients with APOE-ε4 allele (28%) had an unfavorable outcome was significantly different from those without APOE-ε4 (8%, χ2, p = 0.032; OR = 4.34, 95%CI 1.20-15.75). However, the presence or absence ofε2 or ε3 alleles had no significant difference. The relative hazard of APOE-ε4 for unfavorable outcome exited after adjustment for clinical assessment (OR = 6.95, 95%CI 1.21-39.75). Total serum cholesterol, low-density lipoprotein and apolipoprotein B were elevated in patients with unfavorable rather than favorable outcomes. CONCLUSION: Our findings confirmed that the patients with APOE-ε4 allele were predisposed to unfavorable outcomes after aneurysmal SAH even though an association between APOE and incidence of the SAH may not exist. The effect of APOE on neurobiology and lipoprotein metabolism seems to partially explain the difference in outcomes and deserves further study.

Original languageEnglish
Pages (from-to)391-396
Number of pages6
JournalSurgical Neurology
Issue number5
StatePublished - Nov 2003


  • Apolipoproteins
  • Cerebrovascular disease
  • Outcome
  • Subarachnoid hemorrhage


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