Sposato Luciano A, Ruíz Vargas Estefanía, Riccio Patricia M, Toledo Jon B, Trojanowski John Q, Kukull Walter A, Cipriano Lauren E, Nucera Antonia, Whitehead Shawn N, Hachinski Vladimir
Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada; London Stroke, Dementia & Heart Disease Laboratory, Western University, London, Ontario, Canada.
Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada.
Alzheimers Dement. 2017 Jul;13(7):770-777. doi: 10.1016/j.jalz.2016.12.002. Epub 2017 Feb 5.
Heart failure (HF) and atrial fibrillation (AF) have been associated with a higher risk of Alzheimer's disease (AD). Whether HF and AF are related to AD by enhancing AD neuropathological changes is unknown.
We applied network analyses and multiple logistic regression models to assess the association between HF and AF with severity of AD neuropathology in patients from the National Alzheimer's Coordinating Center database with primary neuropathological diagnosis of AD.
We included 1593 patients, of whom 129 had HF and 250 had AF. HF and AF patients were older and had milder AD pathology. In the network analyses, HF and AF were associated with milder AD neuropathology. In the regression analyses, age (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.93-0.95 per 1-year increase in age, P < .001) and the interaction term HF × AF (OR 0.61, 95% CI 0.40-0.91, P = .014) were inversely related to severe AD pathology, whereas APOE ε4 genotype showed a direct association (OR 1.68, 95% CI 1.31-2.16). Vascular neuropathology was more frequent in patient with HF and AF patients than in those without.
HF and AF had milder AD neuropathology. Patients with milder AD lived longer and had more exposure to vascular risk factors. HF and AF patients showed a higher frequency of vascular neuropathology, which could have contributed to lower the threshold for clinically evident dementia.
心力衰竭（HF）和心房颤动（AF）与阿尔茨海默病（AD）的较高风险相关。HF和AF是否通过增强AD神经病理变化与AD相关尚不清楚。
我们应用网络分析和多元逻辑回归模型，评估来自国家阿尔茨海默病协调中心数据库、经原发性神经病理学诊断为AD的患者中，HF和AF与AD神经病理学严重程度之间的关联。
我们纳入了1593例患者，其中129例有HF，250例有AF。HF和AF患者年龄较大，AD病理学较轻。在网络分析中，HF和AF与较轻的AD神经病理学相关。在回归分析中，年龄（每增加1岁，比值比[OR]为0.94，95%置信区间[CI]为0.93 - 0.95，P <.001）和交互项HF×AF（OR为0.61，95% CI为0.40 - 0.91，P = 0.014）与严重AD病理学呈负相关，而APOE ε4基因型呈正相关（OR为1.68，95% CI为1.31 - 2.16）。HF患者和AF患者的血管神经病理学比无HF和AF的患者更常见。
HF和AF的AD神经病理学较轻。AD较轻的患者寿命更长，更多地暴露于血管危险因素。HF患者和AF患者的血管神经病理学频率较高，这可能导致临床明显痴呆的阈值降低。
