title: Apolipoprotein E-ε4 polymorphism and cognitive dysfunction after carotid endarterectomy.
abstract: Approximately 25% of patients undergoing carotid endarterectomy (CEA) exhibit cognitive dysfunction (CD) 1 day and 1 month after CEA. The apolipoprotein E (apoE)-ε4 polymorphism has been previously identified as a robust independent risk factor for CD 1 month after CEA. We aimed to determine whether the apoE-ε4 polymorphism is also an independent risk factor for CD as early as 1 day after CEA and to confirm the previous findings at 1 month. Patients undergoing elective CEA (n=411) were enrolled with written informed consent in this follow-up observational study. CD was evaluated via an extensive neuropsychometric battery. apoE-ε4 carriers exhibited significantly more CD 1 day (30.1% versus 17.9%, p=0.01) and 1 month (25.7% versus 9.8%, p=0.001) after CEA compared to non-carriers. Multivariate regression models were generated to determine independent predictors of CD. At 1 day, apoE-ε4 was significantly associated with higher risk of CD (odds ratio [OR]: 2.24 [95% confidence interval 1.29-3.84], p=0.004), while statin use was significantly associated with lower risk (OR: 0.40 [0.24-0.67], p<0.001). At 1 month, apoE-ε4 was significantly associated with higher risk of CD (OR: 3.14 [1.53-6.38], p=0.002), while symptomatic status was significantly associated with lower risk (OR: 0.45 [0.20-0.94], p=0.03). The apoE-ε4 polymorphism is an independent risk factor for CD as early as 1 day after CEA and is confirmed to be an independent risk factor for CD at 1 month as well.
authors.affiliation: Department of Anesthesiology, Columbia University, 630 West 168th Street, P&S Box 46, New York, NY 10032, USA; Department of Neurology, Columbia University, New York, NY, USA. Electronic address: ejh3@columbia.edu.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heyer
authors.affiliation: Department of Anesthesiology, Columbia University, 630 West 168th Street, P&S Box 46, New York, NY 10032, USA.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Mergeche
authors.affiliation: Department of Neurology, Columbia University, New York, NY, USA.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
authors.affiliation: Department of Neurological Surgery, Columbia University, New York, NY, USA.
authors.forename: Hani R
authors.initials: HR
authors.lastname: Malone
authors.affiliation: Department of Neurological Surgery, Columbia University, New York, NY, USA.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Bruce
authors.affiliation: Department of Anesthesiology, Columbia University, 630 West 168th Street, P&S Box 46, New York, NY 10032, USA.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Ward
authors.affiliation: Department of Neurology, Columbia University, New York, NY, USA; Department of Neurological Surgery, Columbia University, New York, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Sander Connolly
mesh_terms: D000368:Aged; D053327:Apolipoprotein E4 / Q000235:genetics*; D016893:Carotid Stenosis / Q000601:surgery; D003072:Cognition Disorders / Q000209:etiology* / Q000235:genetics*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006579:Heterozygote; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011110:Polymorphism, Genetic; D012307:Risk Factors; D013997:Time Factors
chemical_list: D053327:Apolipoprotein E4
keywords: Apolipoprotein E; Carotid endarterectomy; Cognition; Cognitive dysfunction