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  • Review Article
  • Published:

Genetic risk factors for spontaneous intracerebral haemorrhage

Nature Reviews Neurology volume 12, pages 40–49 (2016)Cite this article

Subjects

Key Points

  • The strongest established risk factors for intracerebral haemorrhage (ICH) are related to lifestyle; however, ICH is familially aggregated

  • Identification of genetic risk factors for ICH could improve strategies to prevent ICH and aid development of more-effective therapeutic interventions

  • The strongest associations between ICH and genetic variants include two apolipoprotein E alleles that contribute to cerebral amyloid angiopathy, and a locus containing PMF1 and SLC25A44 that has been linked to hypertension and small vessel disease

  • Hypertension is the most important risk factor of ICH, and strong evidence supports an association between ICH and variants of the genes MTHFR, ACE, TRHDE and COL4A2

  • To confirm whether genetic risk factors have a clinically relevant role in ICH, genome-wide association studies with larger, more-heterogeneous cohorts are needed

Abstract

Intracerebral haemorrhage (ICH) is associated with the greatest morbidity and mortality of all stroke subtypes. Established risk factors for ICH include hypertension, alcohol use, current cigarette smoking, and use of oral anticoagulants and/or antiplatelet agents. Familial aggregation of ICH has been observed, and the heritability of ICH risk has been estimated at 44%. Few genes have been found to be associated with ICH at the population level, and much of the evidence for genetic risk factors for ICH comes from single studies conducted in relatively small and homogenous populations. In this Review, we summarize the current knowledge of genetic variants associated with primary spontaneous ICH. Two variants of the gene encoding apolipoprotein E (APOE) — which also contributes to the pathogenesis of cerebral amyloid angiopathy — are the most likely candidates for variants that increase the risk of ICH. Other promising candidates for risk alleles in ICH include variants of the genes ACE, PMF1/SLC25A44, COL4A2, and MTHFR. Other genetic variants, related to haemostasis, lipid metabolism, inflammation, and the CNS microenvironment, have been linked to ICH in single candidate gene studies. Although evidence for genetic contributions to the risk of ICH exists, we do not yet fully understand how and to what extent this information can be utilized to prevent and treat ICH.

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Figure 1: Genetic variants contributing to risk of ICH.

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Authors and Affiliations

  1. St. George's University, 3500 Sunrise Highway, Great River, 11739, NY, USA

    Amanda M. Carpenter

  2. Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street Suite 8100, Newark, 07103, New Jersey, USA

    Inder P. Singh, Chirag D. Gandhi & Charles J. Prestigiacomo

Authors
  1. Amanda M. Carpenter
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  2. Inder P. Singh
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  3. Chirag D. Gandhi
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  4. Charles J. Prestigiacomo
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Contributions

A.M.C. researched data for the article. All authors provided substantial contributions to discussion of content, writing, and reviewing/editing of the manuscript before submission.

Corresponding author

Correspondence to Charles J. Prestigiacomo.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Details of genetic variants associated with ICH with strongest (+++) level of available evidence (DOC 62 kb)

Supplementary Table 2

Details of genetic variants associated with ICH with intermediate (++) evidence (DOC 70 kb)

Supplementary Table 3

Data of genetic variants with weak (+) association with ICH (DOC 60 kb)

Supplementary Table 4

Details of genetic variants with single positive study with n <100 individuals (DOC 51 kb)

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Carpenter, A., Singh, I., Gandhi, C. et al. Genetic risk factors for spontaneous intracerebral haemorrhage. Nat Rev Neurol 12, 40–49 (2016). https://doi.org/10.1038/nrneurol.2015.226

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