title: The APOE-epsilon4 allele and the risk of Alzheimer disease among African Americans, whites, and Hispanics.
abstract: BACKGROUND
  Although the association between Alzheimer disease (AD) and the apolipoprotein E epsilon4 (APOE-epsilon4) allele has been confirmed worldwide, it appears to be inconsistent among African Americans, Hispanics, and Nigerians.
  
  
  OBJECTIVE
  To investigate the association between the APOE-epsilon4 allele and AD in elderly African Americans, Hispanics, and whites.
  
  
  METHODS
  Prospective, population-based, longitudinal study over a 5-year period (1991-1996).
  
  
  METHODS
  The Washington Heights-Inwood community of New York City.
  
  
  METHODS
  A total of 1079 Medicare recipients without AD or a related disorder at baseline.
  
  
  METHODS
  Risk of clinically diagnosed AD in the 3 ethnic groups and among individuals with and without an APOE-epsilon4 allele.
  
  
  RESULTS
  Compared with individuals with the APOE-epsilon3/epsilon3 genotype, the relative risk (RR) of AD associated with 1 or more copies of the APOE-epsilon4 allele was significantly increased among whites (RR, 2.5; 95% confidence interval [CI], 1.1-6.4), but not among African Americans (RR, 1.0; 95% CI, 0.6-1.6) or Hispanics (RR, 1.1; 95% CI, 0.7-1.6). In the absence of the APOE-epsilon4 allele, the cumulative risks of AD to age 90 years, adjusted for education and sex, were 4 times higher for African Americans (RR, 4.4; 95% CI, 2.3-8.6) and 2 times higher for Hispanics (RR, 2.3; 95% CI, 1.2-4.3) than for whites. In the presence of an APOE-epsilon4 allele, the cumulative risk of AD to age 90 years was similar for individuals in all 3 ethnic groups.
  
  
  CONCLUSIONS
  The presence of an APOE-epsilon4 allele is a determinant of AD risk in whites, but African Americans and Hispanics have an increased frequency of AD regardless of their APOE genotype. These results suggest that other genes or risk factors may contribute to the increased risk of AD in African Americans and Hispanics.
authors.affiliation: Gertrude H. Sergievsky Center, Division of Biostatistics, Columbia University College of Physicians and Surgeons and Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
authors.forename: M X
authors.initials: MX
authors.lastname: Tang
authors.forename: Y
authors.initials: Y
authors.lastname: Stern
authors.forename: K
authors.initials: K
authors.lastname: Marder
authors.forename: K
authors.initials: K
authors.lastname: Bell
authors.forename: B
authors.initials: B
authors.lastname: Gurland
authors.forename: R
authors.initials: R
authors.lastname: Lantigua
authors.forename: H
authors.initials: H
authors.lastname: Andrews
authors.forename: L
authors.initials: L
authors.lastname: Feng
authors.forename: B
authors.initials: B
authors.lastname: Tycko
authors.forename: R
authors.initials: R
authors.lastname: Mayeux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D000544:Alzheimer Disease / Q000453:epidemiology / Q000208:ethnology* / Q000235:genetics*; D001057:Apolipoproteins E / Q000235:genetics*; D044383:Black People / Q000235:genetics; D005260:Female; D005787:Gene Frequency; D006630:Hispanic or Latino / Q000235:genetics; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D044465:White People / Q000235:genetics; D001741:Black or African American
chemical_list: D001057:Apolipoproteins E