title: Apolipoprotein E genotypes and the incidence of Alzheimer's disease among persons aged 75 years and older: variation by use of antihypertensive medication?
abstract: The authors examined the impact of the apolipoprotein E (APOE)(*)epsilon4 allele on Alzheimer's disease incidence in relation to use of antihypertensive medication. A population-based (Kungsholmen Project) cohort of 985 nondemented Swedish subjects aged >/=75 years was followed for an average of 3 years (1990-1992); 164 dementia (122 Alzheimer's disease) cases were identified. Compared with (*)epsilon3/(*)epsilon3, the APOE(*)epsilon4 allele increased the risk of developing dementia (relative risk (RR) = 1.5, 95% confidence interval (CI): 1.1, 2.1) and Alzheimer's disease (RR = 1.7, 95% CI: 1.2, 2.5). Subjects using antihypertensive medication at baseline (n = 432, 80% used diuretics) had a decreased risk of dementia (RR = 0.6, 95% CI: 0.5, 0.9) and Alzheimer's disease (RR = 0.5, 95% CI: 0.3, 0.8) after adjustment for several variables, including APOE. The effect of antihypertensive medication use was more pronounced among (*)epsilon4 carriers. For those not using antihypertensive medication, the relative risks of dementia and Alzheimer's disease for carriers were 2.2 (95% CI: 1.4, 3.4) and 2.3 (95% CI: 1.4, 3.7), respectively. The corresponding relative risks for those using antihypertensive medication were 0.9 (95% CI: 0.5, 1.6) and 1.1 (95% CI: 0.6, 2.2). The APOE(*)epsilon4 allele is an important predictor of dementia and Alzheimer's disease incidence. Further studies are needed to clarify whether use of antihypertensive medication, especially diuretics, modifies the effect of the allele.
authors.affiliation: Stockholm Gerontology Research Center and Department of Geriatric Medicine, Karolinska Institute, Stockholm, Sweden. Li.Zhu@cnsf.ki.se
authors.forename: Z
authors.initials: Z
authors.lastname: Guo
authors.forename: L
authors.initials: L
authors.lastname: Fratiglioni
authors.forename: M
authors.initials: M
authors.lastname: Viitanen
authors.forename: L
authors.initials: L
authors.lastname: Lannfelt
authors.forename: H
authors.initials: H
authors.lastname: Basun
authors.forename: J
authors.initials: J
authors.lastname: Fastbom
authors.forename: B
authors.initials: B
authors.lastname: Winblad
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D053318:Apolipoprotein E3; D053327:Apolipoprotein E4; D001057:Apolipoproteins E / Q000235:genetics*; D015140:Dementia, Vascular / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D003937:Diagnosis, Differential; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D053318:Apolipoprotein E3; D053327:Apolipoprotein E4; D001057:Apolipoproteins E