Association of Apolipoprotein E With Intracerebral Hemorrhage Risk by Race/Ethnicity: A Meta-analysis

International Stroke Genetics Consortium

Research output: Contribution to journalArticle

Abstract

Importance: Genetic studies of intracerebral hemorrhage (ICH) have focused mainly on white participants, but genetic risk may vary or could be concealed by differing nongenetic coexposures in nonwhite populations. Transethnic analysis of risk may clarify the role of genetics in ICH risk across populations.

Objective: To evaluate associations between established differences in ICH risk by race/ethnicity and the variability in the risks of apolipoprotein E (APOE) ε4 alleles, the most potent genetic risk factor for ICH.

Design, Setting, and Participants: This case-control study of primary ICH meta-analyzed the association of APOE allele status on ICH risk, applying a 2-stage clustering approach based on race/ethnicity and stratified by a contributing study. A propensity score analysis was used to model the association of APOE with the burden of hypertension across race/ethnic groups. Primary ICH cases and controls were collected from 3 hospital- and population-based studies in the United States and 8 in European sites in the International Stroke Genetic Consortium. Participants were enrolled from January 1, 1999, to December 31, 2017. Participants with secondary causes of ICH were excluded from enrollment. Controls were regionally matched within each participating study.

Main Outcomes and Measures: Clinical variables were systematically obtained from structured interviews within each site. APOE genotype was centrally determined for all studies.

Results: In total, 13 124 participants (7153 [54.5%] male with a median [interquartile range] age of 66 [56-76] years) were included. In white participants, APOE ε2 (odds ratio [OR], 1.49; 95% CI, 1.24-1.80; P < .001) and APOE ε4 (OR, 1.51; 95% CI, 1.23-1.85; P < .001) were associated with lobar ICH risk; however, within self-identified Hispanic and black participants, no associations were found. After propensity score matching for hypertension burden, APOE ε4 was associated with lobar ICH risk among Hispanic (OR, 1.14; 95% CI, 1.03-1.28; P = .01) but not in black (OR, 1.02; 95% CI, 0.98-1.07; P = .25) participants. APOE ε2 and ε4 did not show an association with nonlobar ICH risk in any race/ethnicity.

Conclusions and Relevance: APOE ε4 and ε2 alleles appear to affect lobar ICH risk variably by race/ethnicity, associations that are confirmed in white individuals but can be shown in Hispanic individuals only when the excess burden of hypertension is propensity score-matched; further studies are needed to explore the interactions between APOE alleles and environmental exposures that vary by race/ethnicity in representative populations at risk for ICH.

Original languageEnglish
Pages (from-to)480-91
Number of pages11
JournalJAMA Neurology
Volume76
Issue number4
DOIs
Publication statusPublished - Feb 6 2019

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Cerebral Hemorrhage
Apolipoproteins E
Meta-Analysis
Apolipoprotein E4
Apolipoprotein E2
Propensity Score
Alleles
Odds Ratio
Hispanic Americans
Hypertension
Population
Environmental Exposure
Ethnic Groups
Cluster Analysis
Case-Control Studies
Stroke
Genotype
Outcome Assessment (Health Care)

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Association of Apolipoprotein E With Intracerebral Hemorrhage Risk by Race/Ethnicity : A Meta-analysis. / International Stroke Genetics Consortium.

In: JAMA Neurology, Vol. 76, No. 4, 06.02.2019, p. 480-91.

Research output: Contribution to journalArticle

International Stroke Genetics Consortium. / Association of Apolipoprotein E With Intracerebral Hemorrhage Risk by Race/Ethnicity : A Meta-analysis. In: JAMA Neurology. 2019 ; Vol. 76, No. 4. pp. 480-91.
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title = "Association of Apolipoprotein E With Intracerebral Hemorrhage Risk by Race/Ethnicity: A Meta-analysis",
abstract = "Importance: Genetic studies of intracerebral hemorrhage (ICH) have focused mainly on white participants, but genetic risk may vary or could be concealed by differing nongenetic coexposures in nonwhite populations. Transethnic analysis of risk may clarify the role of genetics in ICH risk across populations.Objective: To evaluate associations between established differences in ICH risk by race/ethnicity and the variability in the risks of apolipoprotein E (APOE) ε4 alleles, the most potent genetic risk factor for ICH.Design, Setting, and Participants: This case-control study of primary ICH meta-analyzed the association of APOE allele status on ICH risk, applying a 2-stage clustering approach based on race/ethnicity and stratified by a contributing study. A propensity score analysis was used to model the association of APOE with the burden of hypertension across race/ethnic groups. Primary ICH cases and controls were collected from 3 hospital- and population-based studies in the United States and 8 in European sites in the International Stroke Genetic Consortium. Participants were enrolled from January 1, 1999, to December 31, 2017. Participants with secondary causes of ICH were excluded from enrollment. Controls were regionally matched within each participating study.Main Outcomes and Measures: Clinical variables were systematically obtained from structured interviews within each site. APOE genotype was centrally determined for all studies.Results: In total, 13 124 participants (7153 [54.5{\%}] male with a median [interquartile range] age of 66 [56-76] years) were included. In white participants, APOE ε2 (odds ratio [OR], 1.49; 95{\%} CI, 1.24-1.80; P < .001) and APOE ε4 (OR, 1.51; 95{\%} CI, 1.23-1.85; P < .001) were associated with lobar ICH risk; however, within self-identified Hispanic and black participants, no associations were found. After propensity score matching for hypertension burden, APOE ε4 was associated with lobar ICH risk among Hispanic (OR, 1.14; 95{\%} CI, 1.03-1.28; P = .01) but not in black (OR, 1.02; 95{\%} CI, 0.98-1.07; P = .25) participants. APOE ε2 and ε4 did not show an association with nonlobar ICH risk in any race/ethnicity.Conclusions and Relevance: APOE ε4 and ε2 alleles appear to affect lobar ICH risk variably by race/ethnicity, associations that are confirmed in white individuals but can be shown in Hispanic individuals only when the excess burden of hypertension is propensity score-matched; further studies are needed to explore the interactions between APOE alleles and environmental exposures that vary by race/ethnicity in representative populations at risk for ICH.",
author = "{International Stroke Genetics Consortium} and Sandro Marini and Katherine Crawford and Andrea Morotti and Lee, {Myung J} and Alessandro Pezzini and Moomaw, {Charles J} and Flaherty, {Matthew L} and Joan Montaner and Jaume Roquer and Jordi Jimenez-Conde and Eva Giralt-Steinhauer and Roberto Elosua and Elisa Cuadrado-Godia and Carolina Soriano-Tarraga and Agnieszka Slowik and Jagiella, {Jeremiasz M} and Joanna Pera and Andrzej Urbanik and Alexander Pichler and Hansen, {Bj{\"o}rn M} and McCauley, {Jacob L} and Tirschwell, {David L} and Magdy Selim and Brown, {Devin L} and Silliman, {Scott L} and Worrall, {Bradford B} and Meschia, {James F} and Kidwell, {Chelsea S} and Testai, {Fernando D} and Kittner, {Steven J} and Helena Schmidt and Christian Enzinger and Deary, {Ian J} and Kristiina Rannikmae and Neshika Samarasekera and Salman, {Rustam Al-Shahi} and Sudlow, {Catherine L} and Klijn, {Catharina J M} and {van Nieuwenhuizen}, {Koen M} and Israel Fernandez-Cadenas and Pilar Delgado and Bo Norrving and Arne Lindgren and Goldstein, {Joshua N} and Anand Viswanathan and Greenberg, {Steven M} and Falcone, {Guido J} and Alessandro Biffi and Langefeld, {Carl D} and Daniel Woo",
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TY - JOUR

T1 - Association of Apolipoprotein E With Intracerebral Hemorrhage Risk by Race/Ethnicity

T2 - A Meta-analysis

AU - International Stroke Genetics Consortium

AU - Marini, Sandro

AU - Crawford, Katherine

AU - Morotti, Andrea

AU - Lee, Myung J

AU - Pezzini, Alessandro

AU - Moomaw, Charles J

AU - Flaherty, Matthew L

AU - Montaner, Joan

AU - Roquer, Jaume

AU - Jimenez-Conde, Jordi

AU - Giralt-Steinhauer, Eva

AU - Elosua, Roberto

AU - Cuadrado-Godia, Elisa

AU - Soriano-Tarraga, Carolina

AU - Slowik, Agnieszka

AU - Jagiella, Jeremiasz M

AU - Pera, Joanna

AU - Urbanik, Andrzej

AU - Pichler, Alexander

AU - Hansen, Björn M

AU - McCauley, Jacob L

AU - Tirschwell, David L

AU - Selim, Magdy

AU - Brown, Devin L

AU - Silliman, Scott L

AU - Worrall, Bradford B

AU - Meschia, James F

AU - Kidwell, Chelsea S

AU - Testai, Fernando D

AU - Kittner, Steven J

AU - Schmidt, Helena

AU - Enzinger, Christian

AU - Deary, Ian J

AU - Rannikmae, Kristiina

AU - Samarasekera, Neshika

AU - Salman, Rustam Al-Shahi

AU - Sudlow, Catherine L

AU - Klijn, Catharina J M

AU - van Nieuwenhuizen, Koen M

AU - Fernandez-Cadenas, Israel

AU - Delgado, Pilar

AU - Norrving, Bo

AU - Lindgren, Arne

AU - Goldstein, Joshua N

AU - Viswanathan, Anand

AU - Greenberg, Steven M

AU - Falcone, Guido J

AU - Biffi, Alessandro

AU - Langefeld, Carl D

AU - Woo, Daniel

PY - 2019/2/6

Y1 - 2019/2/6

N2 - Importance: Genetic studies of intracerebral hemorrhage (ICH) have focused mainly on white participants, but genetic risk may vary or could be concealed by differing nongenetic coexposures in nonwhite populations. Transethnic analysis of risk may clarify the role of genetics in ICH risk across populations.Objective: To evaluate associations between established differences in ICH risk by race/ethnicity and the variability in the risks of apolipoprotein E (APOE) ε4 alleles, the most potent genetic risk factor for ICH.Design, Setting, and Participants: This case-control study of primary ICH meta-analyzed the association of APOE allele status on ICH risk, applying a 2-stage clustering approach based on race/ethnicity and stratified by a contributing study. A propensity score analysis was used to model the association of APOE with the burden of hypertension across race/ethnic groups. Primary ICH cases and controls were collected from 3 hospital- and population-based studies in the United States and 8 in European sites in the International Stroke Genetic Consortium. Participants were enrolled from January 1, 1999, to December 31, 2017. Participants with secondary causes of ICH were excluded from enrollment. Controls were regionally matched within each participating study.Main Outcomes and Measures: Clinical variables were systematically obtained from structured interviews within each site. APOE genotype was centrally determined for all studies.Results: In total, 13 124 participants (7153 [54.5%] male with a median [interquartile range] age of 66 [56-76] years) were included. In white participants, APOE ε2 (odds ratio [OR], 1.49; 95% CI, 1.24-1.80; P < .001) and APOE ε4 (OR, 1.51; 95% CI, 1.23-1.85; P < .001) were associated with lobar ICH risk; however, within self-identified Hispanic and black participants, no associations were found. After propensity score matching for hypertension burden, APOE ε4 was associated with lobar ICH risk among Hispanic (OR, 1.14; 95% CI, 1.03-1.28; P = .01) but not in black (OR, 1.02; 95% CI, 0.98-1.07; P = .25) participants. APOE ε2 and ε4 did not show an association with nonlobar ICH risk in any race/ethnicity.Conclusions and Relevance: APOE ε4 and ε2 alleles appear to affect lobar ICH risk variably by race/ethnicity, associations that are confirmed in white individuals but can be shown in Hispanic individuals only when the excess burden of hypertension is propensity score-matched; further studies are needed to explore the interactions between APOE alleles and environmental exposures that vary by race/ethnicity in representative populations at risk for ICH.

AB - Importance: Genetic studies of intracerebral hemorrhage (ICH) have focused mainly on white participants, but genetic risk may vary or could be concealed by differing nongenetic coexposures in nonwhite populations. Transethnic analysis of risk may clarify the role of genetics in ICH risk across populations.Objective: To evaluate associations between established differences in ICH risk by race/ethnicity and the variability in the risks of apolipoprotein E (APOE) ε4 alleles, the most potent genetic risk factor for ICH.Design, Setting, and Participants: This case-control study of primary ICH meta-analyzed the association of APOE allele status on ICH risk, applying a 2-stage clustering approach based on race/ethnicity and stratified by a contributing study. A propensity score analysis was used to model the association of APOE with the burden of hypertension across race/ethnic groups. Primary ICH cases and controls were collected from 3 hospital- and population-based studies in the United States and 8 in European sites in the International Stroke Genetic Consortium. Participants were enrolled from January 1, 1999, to December 31, 2017. Participants with secondary causes of ICH were excluded from enrollment. Controls were regionally matched within each participating study.Main Outcomes and Measures: Clinical variables were systematically obtained from structured interviews within each site. APOE genotype was centrally determined for all studies.Results: In total, 13 124 participants (7153 [54.5%] male with a median [interquartile range] age of 66 [56-76] years) were included. In white participants, APOE ε2 (odds ratio [OR], 1.49; 95% CI, 1.24-1.80; P < .001) and APOE ε4 (OR, 1.51; 95% CI, 1.23-1.85; P < .001) were associated with lobar ICH risk; however, within self-identified Hispanic and black participants, no associations were found. After propensity score matching for hypertension burden, APOE ε4 was associated with lobar ICH risk among Hispanic (OR, 1.14; 95% CI, 1.03-1.28; P = .01) but not in black (OR, 1.02; 95% CI, 0.98-1.07; P = .25) participants. APOE ε2 and ε4 did not show an association with nonlobar ICH risk in any race/ethnicity.Conclusions and Relevance: APOE ε4 and ε2 alleles appear to affect lobar ICH risk variably by race/ethnicity, associations that are confirmed in white individuals but can be shown in Hispanic individuals only when the excess burden of hypertension is propensity score-matched; further studies are needed to explore the interactions between APOE alleles and environmental exposures that vary by race/ethnicity in representative populations at risk for ICH.

U2 - 10.1001/jamaneurol.2018.4519

DO - 10.1001/jamaneurol.2018.4519

M3 - Article

C2 - 30726504

VL - 76

SP - 480

EP - 491

JO - JAMA Neurology

JF - JAMA Neurology

SN - 2168-6149

IS - 4

ER -