Aggregation of vascular risk factors and risk of incident Alzheimer disease.
BACKGROUND
The prevalence of Alzheimer disease (AD) is increasing in the elderly, and vascular risk factors may increase its risk.


OBJECTIVE
To explore the association of the aggregation of vascular risk factors with AD.


METHODS
The authors followed 1,138 individuals without dementia at baseline (mean age 76.2) for a mean of 5.5 years. The presence of vascular risk factors was related to incident possible and probable AD.


RESULTS
Four risk factors (diabetes, hypertension, heart disease, and current smoking) were associated with a higher risk of AD (p < 0.10) when analyzed individually. The risk of AD increased with the number of risk factors (diabetes + hypertension + heart disease + current smoking). The adjusted hazards ratio of probable AD for the presence of three or more risk factors was 3.4 (95% CI: 1.8, 6.3; p for trend < 0.0001) compared with no risk factors. Diabetes and current smoking were the strongest risk factors in isolation or in clusters, but hypertension and heart disease were also related to a higher risk of AD when clustered with diabetes, smoking, or each other.


CONCLUSIONS
The risk of Alzheimer disease (AD) increased with the number of vascular risk factors. Diabetes and current smoking were the strongest risk factors, but clusters including hypertension and heart disease also increased the risk of AD. These associations are unlikely to be explained by misclassification of the outcome, given strong associations when only probable AD is considered.
Luchsinger
J A
JA
Taub Institute for Research of Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA. jal94@columbia.edu
Reitz
C
C
Honig
L S
LS
Tang
M X
MX
Shea
Steven
S
Mayeux
R
R
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D015984:Causality; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology; D015140:Dementia, Vascular / Q000453:epidemiology / Q000503:physiopathology; D048909:Diabetes Complications / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology