Background and Purpose -Studies investigating the relation of the apolipoprotein E (apoE) 4 allele to clinical stroke and to vascular changes on magnetic resonance imaging have been conflicting. Little data are available regarding the relation of apoE 4 to cerebral infarctions documented on postmortem examinatio n. Methods -We studied the apoE 4 allele in 214 deceased members of the Relig ious Orders Study, a longitudinal clinical-pathologic study of aging and Alzhei mer disease. The apoE genotype was determined using DNA from lymphocytes.Brains were removed a median of 5 hours (interquartile range,5.5) after death. At postm ortem examination, age, location, and size of macroscopic chronic cerebral infar ctions were recorded from 1-cm coronal slabs after paraformaldehyde fixation. W e also examined 20-μm paraffin-embedded sections of midfrontal and calcarine cortex for amyloid angiopathy on a scale of 1 to 4. R esults -Subjects included 96 males and 118 females with a mean age at death of 86 years (SD, 7). Sixty-five subjects (30.4%) had at least 1 apoE 4 allele a nd 76 (35.5%) exhibited cerebral infarctions. More than 74%of the subjects exh ibited amyloid angiopathy with a mean score of 1.4 ±1.2. After controlling for age and sex, apoE 4 increased the odds of cerebral infarction by 2.3-fold (95 %CI, 1.2 to 4.2). apoE 4 increased the odds of cortical 3.2-fold (95%CI, 1. 3 to 7.7) and subcortical infarctions 2.3-fold (95%CI, 1.2 to 4.5). The effect was unchanged after accounting for amyloid angiopathy. Conclusions -apoE 4 i ncreases the odds of chronic cerebral infarction detected at autopsy in older pe rsons. u001a Background and Purpose -Studies investigating the relation of the apolipoprotein E (apoE) 4 allele to clinical stroke and to vascular changes on magnetic resonance imaging have been conflicting. Little data are available regarding the relation of apoE 4 to cerebral infarctions documented on postmortem examinatio n. Methods -We studied the apoE 4 allele in 214 deceased members of the Religious ious Orders Study, a longitudinal clinical-pathologic study of aging and Alzheimer disease. The apoE genotype was determined using DNA from lymphocytes. Brains were removed a At postmortem examination, age, location, and size of macroscopic chronic cerebral infarctions were recorded from 1-cm coronal slabs after paraformaldehyde fixation. W e also examined 20-μm paraffin -embedded sections of midfrontal and calcarine cortex for amyloid angiopathy on a scale of 1 to 4. Résults -Subjects included 96 males and 118 females with a mean ag Sixty-five subjects (30.4%) had at least 1 apoE 4 allele a nd 76 (35.5%) showed cerebral infarctions. More than 74% of the subjects ex-ihited amyloid angiopathy After controlling for age and sex, apoE 4 increased the odds of cerebral infarction by 2.3-fold (95% CI, 1.2 to 4.2). apoE 4 increased the odds of cortical 3.2-fold (95% CI, 1.3 to 7.7) and subcortical infarctions 2.3-fold (95% CI, 1.2 to 4.5). The effect was unchanged after accounting for amyloid angiopathy. Conclusions-apoE 4 i ncreases the odds of chronic cerebral infarction detected at autopsy in older pe rsons. u001a