title: Angiotensin converting enzyme inhibitors and Alzheimer disease in the presence of the apolipoprotein E4 allele.
abstract: OBJECTIVE
  The effect of angiotensin converting enzyme (ACE) inhibitors on Alzheimer disease (AD) remains unclear, with conflicting results reported. We studied the interaction of the Apolipoprotein E (ApoE) genotype and ACE inhibitors on AD.
  
  
  METHODS
  This was a cross-sectional study of homebound elderly with an AD diagnosis and documentation of medications taken. ApoE genotype was determined.
  
  
  RESULTS
  A total of 355 subjects with status on ApoE alleles and cognitive diagnoses were studied. The average age (mean ± SD) of this population was 73.3 ± 8.3 years old, and 73% were female. Cross-sectionally, there was no difference in the number of AD cases between ApoE4 carriers and ApoE4 non-carriers or between ACE inhibitor users and non-users in the homebound elderly. ApoE4 carriers treated with ACE inhibitors, however, had more diagnoses of AD compared with those who did not have the treatment (28% versus 6%, p = 0.01) or ApoE4 non-carriers treated with an ACE inhibitor (28% versus 10%, p = 0.03). ACE inhibitor use was associated with AD diagnosis only in the presence of an E4 allele. Using multivariate logistic regression analysis, we found that in diagnosed AD cases there was a significant interaction between ApoE4 and ACE inhibitor use (odds ratio: 20.85; 95% confidence interval: 3.08-140.95; p = 0.002) after adjusting for age, sex, ethnicity, and education.
  
  
  CONCLUSIONS
  The effects of ACE inhibitors on AD may be different depending on ApoE genotype. A prospective study is needed to determine whether ACE inhibitor use accelerates or poorly delays AD development in ApoE4 carriers compared with ApoE4 non-carriers.
authors.affiliation: Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA; Department of Alzheimer Disease Center, Boston University School of Medicine, Boston, MA. Electronic address: wqiu67@bu.edu.
authors.forename: Wendy Wei Qiao
authors.initials: WW
authors.lastname: Qiu
authors.affiliation: Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA.
authors.forename: Angela
authors.initials: A
authors.lastname: Lai
authors.affiliation: Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Mon
authors.affiliation: Department of Public Health and Community Medicine, Tufts University, Boston, MA.
authors.forename: Mkaya
authors.initials: M
authors.lastname: Mwamburi
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
authors.forename: Warren
authors.initials: W
authors.lastname: Taylor
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: James
authors.initials: J
authors.lastname: Rosenzweig
authors.affiliation: Department of Alzheimer Disease Center, Boston University School of Medicine, Boston, MA.
authors.forename: Neil
authors.initials: N
authors.lastname: Kowall
authors.affiliation: Department of Alzheimer Disease Center, Boston University School of Medicine, Boston, MA.
authors.forename: Robert
authors.initials: R
authors.lastname: Stern
authors.affiliation: Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA.
authors.forename: Haihao
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Psychiatry, University of Connecticut Health Center, Farmington, CT.
authors.forename: David C
authors.initials: DC
authors.lastname: Steffens
mesh_terms: D000368:Aged; D000483:Alleles; D000544:Alzheimer Disease / Q000097:blood / Q000188:drug therapy* / Q000235:genetics* / Q000523:psychology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D053327:Apolipoprotein E4 / Q000235:genetics*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D007703:Peptidyl-Dipeptidase A / Q000097:blood
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D053327:Apolipoprotein E4; D007703:Peptidyl-Dipeptidase A
keywords: ACE inhibitor; Alzheimer disease; Apolipoprotein E4 allele (ApoE4); angiotensin converting enzyme (ACE)