Low Ankle Brachial Index in Acute Ischemic Stroke: Does ApoE Gene Polymorphism Have a Role?


Background: The existence of asymptomatic peripheral arterial disease among patients with acute ischemic stroke has been studied and proved. Low ankle brachial index (ABI) is considered as a marker of atherosclerosis, and its relation to stroke severity was documented in some studies. The effect of different alleles of ApoE gene on acute ischemic stroke presentation in patients with low ABI is not known. Objective: To study the effect of ApoE gene polymorphism on stroke severity, outcome and recurrence in patients with asymptomatic peripheral arterial disease identified by low ABI. Methods: Patients with acute ischemic stroke were screened for the presence of asymp-tomatic peripheral arterial disease by estimating the ABI using a pocket Doppler ultrasound device. Assay of ApoE gene was done using the real-time PCR technique. Results: Low ABI was present in 31% of patients with acute ischemic stroke. There was no significant difference among patients with different ApoE alleles regarding the severity of their symptoms. Also, there was no significant difference among patients with normal ABI and those with abnormal ABI regarding the ApoE gene polymorphism. Conclusion: The current study showed that there was no significant relation between ApoE gene polymorphism and low ABI in ischemic stroke patients who had asymptomatic peripheral arterial disease.

Share and Cite:

El-Jaafary, S. , El-Tamawy, M. , Hosny, H. , Fathy, M. , Shaker, E. and Abd-Allah, F. (2015) Low Ankle Brachial Index in Acute Ischemic Stroke: Does ApoE Gene Polymorphism Have a Role?. World Journal of Cardiovascular Diseases, 5, 42-47. doi: 10.4236/wjcd.2015.52006.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Hiatt, W.R. (2001) Medical Treatment of Peripheral Arterial Disease and Claudication. New England Journal of Medicine, 344, 1608-1621.
[2] Hirsch, A.T., Criqui, M.H., Treat-Jacobson, D., Regensteiner, J.G., Creager, M.A., Olin, J.W., et al. (2001) Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care. The Journal of the American Medical Association, 286, 1317-1324.
[3] Busch, M.A., Lutz, K., Rohl, J.-E., Neuner, B. and Masuhr, F. (2009) Low Ankle-Brachial Index Predicts Cardiovascular Risk after Acute Ischemic Stroke or Transient Ischemic Attack. A Journal of Cerebral Circulation, 40, 3700-3705.
[4] Weimar, C., Goertler, M., Rother, J., Ringelstein, E.B., Darius, H., Nabavi, D.G., et al. (2008) Predictive Value of the Essen Stroke Risk Score and Ankle Brachial Index in Acute Ischaemic Stroke Patients from 85 German Stroke Units. Journal of Neurology, Neurosurgery & Psychiatry, 79, 1339-1343.
[5] Sudlow, C., Martínez González, N.A., Kim, J. and Clark, C. (2006) Does Apolipoprotein E Genotype Influence the Risk of Ischemic Stroke, Intracerebral Hemorrhage, or Subarachnoid Hemorrhage? Systematic Review and Meta-Analyses of 31 Studies among 5961 Cases and 17,965 Controls. A Journal of Cerebral Circulation, 37, 364-370.
[6] Khan, T.A., Shah, T., Prieto, D., Zhang, W., Price, J., Fowkes, G.R., et al. (2013) Apolipoprotein E Genotype, Cardiovascular Biomarkers and Risk of Stroke: Systematic Review and Meta-Analysis of 14,015 Stroke Cases and Pooled Analysis of Primary Biomarker Data from up to 60,883 Individuals. International Journal of Epidemiology, 42, 475- 492.
[7] Resnick, H.E., Rodriguez, B., Havlik, R., Ferrucci, L., Foley, D., Curb, J.D., et al. (2000) Apo E Genotype, Diabetes, and Peripheral Arterial Disease in Older Men: The Honolulu Asia-Aging Study. Genetic Epidemiology, 19, 52-63.
[8] Bérard, A.M., Bedel, A., Le Trequesser, R., Freyburger, G., Nurden, A., Colomer, S., et al. (2013) Novel Risk Factors for Premature Peripheral Arterial Occlusive Disease in Non-Diabetic Patients: A Case-Control Study. PloS One, 8, e37882.
[9] Odderson, I.R. (1999) The National Institutes of Health Stroke Scale and Its Importance in Acute Stroke Management. Physical Medicine & Rehabilitation Clinics of North America, 4, 787-800, vii.
[10] Rankin, J. (1957) Cerebral Vascular Accidents in Patients over the Age of 60. III. Diagnosis and Treatment. Scottish Medical Journal, 6, 254-268.
[11] McDermott, M.M., Liu, K., Criqui, M.H., Ruth, K., Goff, D., Saad, M.F., et al. (2005) Ankle-Brachial Index and Subclinical Cardiac and Carotid Disease: The Multi-Ethnic Study of Atherosclerosis. American Journal of Epidemiology, 162, 33-41.
[12] Cacoub, P., Cambou, J-P., Kownator, S., Belliard, J-P., Beregi, J-P., Branchereau, A., et al. (2009) Prevalence of Peripheral Arterial Disease in High-Risk Patients Using Ankle-Brachial Index in General Practice: A Cross-Sectional Study. International Journal of Clinical Practice, 63, 63-70.
[13] Gil-Núnez, A., Alvarez-Sabín, J., Quintana, M. and Barbera, G. (2009) Prevalence of the Metabolic Syndrome in Patients with Transient Ischemic Attack or Non-Cardioembolic Stroke. Neurologia, 24, 446-453.
[14] Agnelli, G., Cimminiello, C., Meneghetti, G. and Urbinati, S. (2006) Low Ankle-Brachial Index Predicts an Adverse 1-Year Outcome after Acute Coronary and Cerebrovascular Events. Journal of Thrombosis and Haemostasis, 4, 2599-2606.
[15] Meves, S.H., Diehm, C., Berger, K., Pittrow, D., Trampisch, H-J., Burghaus, I., et al. (2010) Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the GetABI Study. Cerebrovascular Diseases, 29, 546-554.
[16] Topakian, R., Nanz, S., Rohrbacher, B., Koppensteiner, R. and Aichner, F.T. (2010) High Prevalence of Peripheral Arterial Disease in Patients with Acute Ischaemic Stroke. Cerebrovascular Diseases, 29, 248-254.
[17] Hoshino, H., Itoh, Y., Yamada, S. and Suzuki, N. (201) Prevalence and Clinical Features of Asymptomatic Peripheral Artery Disease in Japanese Stroke Patients. Journal of Stroke and Cerebrovascular Diseases, 22, 255-159.
[18] Nakano, T., Ohkuma, H. and Suzuki, S. (2004) Measurement of Ankle Brachial Index for Assessment of Atherosclerosis in Patients with Stroke. Cerebrovascular Diseases, 17, 212-217.
[19] Ratanakorn, D., Keandoungchun, J. and Tegeler, C.H. (2012) Prevalence and Association between Risk Factors, Stroke Subtypes, and Abnormal Ankle Brachial Index in Acute Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association, 21, 498-503.
[20] Tsivgoulis, G., Bogiatzi, C., Heliopoulos, I., Vadikolias, K., Boutati, E., Tsakaldimi, S., et al. (2012) Low Ankle-Brachial Index Predicts Early Risk of Recurrent Stroke in Patients with Acute Cerebral Ischemia. Atherosclerosis, 220, 407-412.
[21] Purroy, F., Coll, B., Oró, M., Setó, E., Pinol-Ripoll, G., Plana, A., et al. (2010) Predictive Value of Ankle Brachial Index in Patients with Acute Ischaemic Stroke. European Journal of Neurology: The Official Journal of the European Federation of Neurological Societies, 17, 602-606.
[22] Tsai, A.W., Folsom, A.R., Rosamond, W.D. and Jones, D.W. (2001) Ankle-Brachial Index and 7-Year Ischemic Stroke Incidence: The ARIC Study. Stroke: A Journal of Cerebral Circulation, 32, 1721-1724.
[23] Singh, P.P., Singh, M. and Mastana, S.S. (2006) APOE Distribution in World Populations with New Data from India and the UK. Annals of Human Biology, 33, 279-308.
[24] Chanprasertyothin, S., Ongphiphadhanakul, B., Rajatanavin, R., Piaseu, N., Chailurkit, L.O. and Puavilai, G. (2000) Correlation of Apolipoprotein E Gene Polymorphism to Serum Lipid Concentrations in Healthy Thais. Journal of the Medical Association of Thailand, Chotmaihet Thangphaet, 83, 1233-1239.
[25] MCarron, M.O., Muir, K.W., Weir, C.J., Dyker, A.G., Bone, I., Nicoll, J.A., et al. (1998) The Apolipoprotein E Epsilon4 Allele and Outcome in Cerebrovascular Disease. Stroke: A Journal of Cerebral Circulation, 29, 1882-1887. Department of Neuropathology, Institute of Neurological Sciences, Southern General Hospital, Glasgow.
[26] McCarron, M.O., Muir, K.W., Nicoll, J.A., Stewart, J., Currie, Y., Brown, K., et al. (2000) Prospective Study of Apolipoprotein E Genotype and Functional Outcome Following Ischemic Stroke. Archives of Neurology, 57, 1480-1484. American Medical Association, Chicago.
[27] Martínez-González, N.A. and Sudlow, C.L.M. (2006) Effects of Apolipoprotein E Genotype on Outcome after Ischaemic Stroke, Intracerebral Haemorrhage and Subarachnoid Haemorrhage. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 1329-1335.
[28] Catto, A.J., McCormack, L.J., Mansfield, M.W., Carter, A.M., Bamford, J.M., Robinson, P., et al. (2000) Apolipoprotein E Polymorphism in Cerebrovascular Disease. Acta Neurologica Scandinavica, 25, 521.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.