Incorporating ethnicity into genetic risk assessment for Alzheimer disease: the REVEAL study experience.
OBJECTIVE
To describe how investigators in a multisite randomized clinical trial addressed scientific and ethical issues involved in creating risk models based on genetic testing for African American participants.


METHODS
The following informed our decision whether to stratify risk assessment by ethnicity: evaluation of epidemiological data, appraisal of benefits and risks of incorporating ethnicity into calculations, and feasibility of creating ethnicity-specific risk curves. Once the decision was made, risk curves were created based on data from a large, diverse study of first-degree relatives of patients with Alzheimer disease.


RESULTS
Review of epidemiological data suggested notable differences in risk between African Americans and whites and that Apolipoprotein E genotype predicts risk in both groups. Discussions about the benefits and risks of stratified risk assessments reached consensus that estimates based on data from whites should not preclude enrolling African Americans, but population-specific risk curves should be created if feasible. Risk models specific to ethnicity, gender, and Apolipoprotein E genotype were subsequently developed for the randomized clinical trial that oversampled African Americans.


CONCLUSIONS
The Risk Evaluation and Education for Alzheimer Disease study provides an instructive example of a process to develop risk assessment protocols that are sensitive to the implications of genetic testing for multiple ethnic groups with differing levels of risk.
Christensen
Kurt D
KD
Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-0471, USA. kdchrist@umich.edu
Roberts
J Scott
JS
Royal
Charmaine D M
CD
Fasaye
Grace-Ann
GA
Obisesan
Thomas
T
Cupples
L Adrienne
LA
Whitehouse
Peter J
PJ
Butson
Melissa Barber
MB
Linnenbringer
Erin
E
Relkin
Norman R
NR
Farrer
Lindsay
L
Cook-Deegan
Robert
R
Green
Robert C
RC
D000544:Alzheimer Disease / Q000208:ethnology / Q000235:genetics*; D001057:Apolipoproteins E / Q000235:genetics; D005006:Ethnicity; D020022:Genetic Predisposition to Disease; D006801:Humans; D018570:Risk Assessment
D001057:Apolipoproteins E