Book Review

Genetics of Cerebrovascular Disease

N Engl J Med 1999; 341:216July 15, 1999

Article

Genetics of Cerebrovascular Disease
Edited by Mark J. Alberts. 386 pp., illustrated. Armonk, N.Y., Futura, 1999. $120. ISBN: 0-87993-584-7

Is stroke a genetic disease? Genetics of Cerebrovascular Disease puts forth the message that genetic factors do play a part in the pathogenesis of stroke. Traditionally, stroke has not been considered an inherited disease, and most cerebrovascular events are thought to be sporadic. However, there is considerable evidence supporting the view that cerebrovascular diseases are, in part, genetically determined. The chief risk factors for stroke, such as hypertension and diabetes, have a genetic component, and certain familial diseases affecting blood vessels or blood clotting are associated with an increased incidence of cerebrovascular events. The application of molecular genetic techniques to the study of cerebrovascular diseases and their risk factors has led to a wealth of information on the contribution of genetic factors to cerebrovascular disorders. Genetics of Cerebrovascular Disease provides, for the first time, a synopsis of such evidence in a series of competently written chapters by experts in the field.

Appropriately, the book begins with an outline of genetic principles and techniques. This section, especially the readable and informative first chapter, provides an excellent introduction to some of the subsequent chapters. The next section examines the genetics of risk factors for cerebrovascular disease. This section, which provides a detailed review of the genetics of hypertension, lipid metabolism, atherosclerosis, and coagulation disorders, is likely to appeal more to readers with a specific interest in these topics than to other readers. The seven chapters in the third section focus on the genetics of specific causes of stroke and stroke syndromes. This section, the heart of the book, deals with the genetics of vasculopathies, vascular malformations, intracranial aneurysms, and systemic diseases associated with stroke. A chapter on pediatric stroke is included. These chapters are uniformly excellent and provide up-to-date and detailed coverage of the respective topics. It is surprising, however, that vasculitis and connective-tissue disease are not dealt with in greater detail. The last section of the book focuses on practical issues concerning the evaluation of patients for inherited causes of stroke and genetic counseling. The final chapter, on gene therapy, reviews the methods of gene transfer and lists the diseases in which gene therapy might be useful. The material presented, however, has few practical implications, at least for the time being.

Overall, this useful book provides the specialist and the general reader with an extensive and up-to-date review of genetic factors that may play a part in cerebrovascular diseases. The chapters are packed with information and have been written clearly. The book is an excellent resource for physicians dealing with cases of cerebrovascular diseases in which the family history suggests the role of inheritance. The citations are numerous and current, not uncommonly including contributions published in the late 1990s. The figures are generally clear and, although not lavish, make the point intended. Some aspects of the book could have been improved. For example, a glossary of terms would have helped the less informed reader with sections in which molecular genetic terms are used frequently. In addition, redundant information in the many chapters dealing with risk factors and coagulation disorders could have been eliminated. However, these are relatively minor shortcomings that could easily be rectified in future editions of the book. On the whole, this book fills an obvious gap in the field and is therefore a welcome addition to the neurologic and general medical literature.

Costantino Iadecola, M.D.
University of Minnesota, Minneapolis, MN 55455