Plasma Apolipoprotein E Levels and Adverse Clinical Outcomes After Ischemic Stroke

Apolipoprotein E (ApoE) is implicated in the development of cerebrovascular diseases, but its association with the prognosis of ischemic stroke remains unclear. We aimed to explore the associations between plasma ApoE levels and adverse clinical outcomes after ischemic stroke in a prognostic cohort study.

We measured plasma ApoE levels among 5410 patients with ischemic stroke from the Minhang Stroke Cohort study. The primary outcome was the composite outcome of death and major disability (modified Rankin Scale score=3-6) at 3 months after stroke onset. Secondary outcomes included major disability, death, and the ordered 7-level categorical score of the modified Rankin Scale.

In the prognostic cohort study, the multivariable adjusted odds ratio associated with the highest quartile of plasma ApoE levels was 1.37 (95% CI=1.10-1.70; P_trend=0.003) for the primary outcome, 1.50 (95% CI=1.08-2.09; P_trend=0.019) for death, and 1.47 (95% CI=1.11-1.95; P_trend=0.005) for major disability. There was a worse shift in the distribution of modified Rankin Scale score at 3 months with higher quartiles of plasma ApoE levels among patients with ischemic stroke (P_trend=0.034). The multivariable-adjusted spline regression model further showed positive linear associations of plasma ApoE levels with the primary outcome, death, and major disability (all P for linearity<0.05).

High plasma ApoE levels were independently associated with increased risk of adverse outcomes among patients with ischemic stroke, suggesting that plasma ApoE might be implicated in the prognosis of ischemic stroke.