{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T11:10:40Z","timestamp":1784113840731,"version":"3.55.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,5,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, atorvastatin (80\u2009mg per day) was compared with placebo in patients with recent stroke or transient ischemic attack and no known coronary artery disease. Given the central role of apoE (apolipoprotein E) in lipoprotein metabolism and in the central nervous system, we assessed the contribution of apoE to subsequent cerebrovascular and cardiovascular events in this trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      ApoE concentrations and major isoforms (E2\/E3\/E4) were determined by liquid\u2010chromatography high resolution mass\u2010spectrometry in plasma samples collected at baseline from 4348 SPARCL participants. Patients in the lowest quartile were compared with those in the highest quartiles of apoE concentrations. Multivariable\u2010adjusted hazard\u2010ratios (HR) and 95% CIs were calculated using Cox proportional hazards regression models. We found a significant association between low apoE concentrations and the risk of recurrent strokes or cerebrovascular events (HR, 1.401 [95% CI, 1.154\u20131.701],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001 and 1.467 [95% CI, 1.260\u20131.708],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) driven by a higher incidence of ischemic strokes and transient ischemic attacks in the entire cohort as well as separately in each treatment arm of SPARCL. In contrast, apoE concentrations did not significantly associate with the incidence of hemorrhagic strokes in SPARCL. We also found a significant association between reduced apoE concentrations and the risk of subsequent coronary events (HR, 1.373 ([95% CI, 1.064\u20131.772],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.015) in the entire cohort that was, however, significant only in the placebo arm of SPARCL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Low apoE concentrations are predictive of recurring cerebrovascular events in patients with a history of stroke or transient ischemic attack.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Identifier: NTC00147602.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.036630","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T23:32:31Z","timestamp":1744846351000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Apolipoprotein E Plasma Concentrations Are Predictive of Recurrent Strokes: Insights From the SPARCL Trial"],"prefix":"10.1161","volume":"14","author":[{"given":"K\u00e9vin","family":"Chemello","sequence":"first","affiliation":[{"name":"Universit\u00e9 de La R\u00e9union, Inserm, UMR1188 Diab\u00e8te Ath\u00e9rothrombose Th\u00e9rapies R\u00e9union Oc\u00e9an Indien (D\u00e9TROI)","place":["Sainte\u2010Pierre (R\u00e9union), France"]},{"name":"University of New South Wales","place":["Sydney, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4571-6219","authenticated-orcid":false,"given":"Alexis F.","family":"Guedon","sequence":"additional","affiliation":[{"name":"Universitaire Inflammation Immunopathologie Bioth\u00e9rapie (DMUi3), Sorbonne Universit\u00e9, AP\u2010HP, Service de M\u00e9decine Interne","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romuald","family":"Techer","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de La R\u00e9union, Inserm, UMR1188 Diab\u00e8te Ath\u00e9rothrombose Th\u00e9rapies R\u00e9union Oc\u00e9an Indien (D\u00e9TROI)","place":["Sainte\u2010Pierre (R\u00e9union), France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8450-2611","authenticated-orcid":false,"given":"Ali K.","family":"Jaafar","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de La R\u00e9union, Inserm, UMR1188 Diab\u00e8te Ath\u00e9rothrombose Th\u00e9rapies R\u00e9union Oc\u00e9an Indien (D\u00e9TROI)","place":["Sainte\u2010Pierre (R\u00e9union), France"]},{"name":"University of New South Wales","place":["Sydney, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Guilhen","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de La R\u00e9union, Inserm, UMR1188 Diab\u00e8te Ath\u00e9rothrombose Th\u00e9rapies R\u00e9union Oc\u00e9an Indien (D\u00e9TROI)","place":["Sainte\u2010Pierre (R\u00e9union), France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Swietek","sequence":"additional","affiliation":[{"name":"Pfizer Inc.","place":["Groton, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5632-0685","authenticated-orcid":false,"given":"Gilles","family":"Lambert","sequence":"additional","affiliation":[{"name":"Universitaire Inflammation Immunopathologie Bioth\u00e9rapie (DMUi3), Sorbonne Universit\u00e9, AP\u2010HP, Service de M\u00e9decine Interne","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8887-994X","authenticated-orcid":false,"given":"Antonio","family":"Gallo","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de La R\u00e9union, Inserm, UMR1188 Diab\u00e8te Ath\u00e9rothrombose Th\u00e9rapies R\u00e9union Oc\u00e9an Indien (D\u00e9TROI)","place":["Sainte\u2010Pierre (R\u00e9union), France"]},{"name":"Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, AP\u2010HP, Sorbonne University, INSERM UMR1166, IHU\u2010ICAN, Lipidology and cardiovascular prevention Unit","place":["Paris, 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