Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.
Int Psychogeriatr. 2019 Oct;31(10):1421-1432. doi: 10.1017/S1041610219001066.
To assess independent and joint effects of pairs of vascular and cardiometabolic risk factors (VCMRFs) in relation to risk of all-cause dementia.
Population-based longitudinal cohort study of cognitive impairment. We used an algorithm to select pairs of VCMRFs and tested their joint effects in time-dependent Cox models. We used attributable proportions (AP) to measure the proportion of risk from interactions beyond any additive effect.
Economically depressed small-town population.
Adults age 65+ years with up to 10 yearly study visits (N=1701, median (Q1, Q3) age, 78 (71.0, 83.0), 62.3% female, 94.9% white).
Among 1701 participants free from prevalent dementia with at least one follow-up visit, 109 developed incident all-cause dementia. In pairings of APOE4 with hypertension (HTN) and congestive heart failure (CHF), the variables contributed independently and additively to all-cause dementia risk. In pairings of APOE4 with stroke and stroke with CHF, the variables demonstrated independent contributions to all-cause dementia risk; their joint effects showed excess detriment demonstrating synergistic interactions (joint HR [95% CI]: 28.33 [6.74, 119.01] and 50.30 [14.57, 173.57] respectively, fully adjusted models). Physical activity (PA) was independently associated with lower all-cause dementia risk when paired with APOE4, stroke, and CHF in unadjusted models; these associations did not survive covariate adjustment. The joint effect of low PA and APOE4 was associated with additively increased all-cause dementia risk (joint HR [95% CI]: 4.61 [2.07, 10.23], fully adjusted model).
Reduction of VCMRFs, including low PA, could be valuable for dementia prevention, especially among APOE*4 carriers.
评估血管和心血管代谢危险因素（VCMRFs）对全因痴呆风险的独立和联合作用。
认知障碍的基于人群的纵向队列研究。我们使用算法选择 VCMRF 对，并在时间依赖的 Cox 模型中测试它们的联合作用。我们使用归因比例（AP）来衡量超出任何附加效应的相互作用风险的比例。
经济萧条的小镇人群。
年龄在 65 岁及以上、每年最多进行 10 次研究访问的成年人（N=1701，中位（Q1，Q3）年龄，78（71.0，83.0），62.3%为女性，94.9%为白人）。
在 1701 名无首发痴呆且至少有一次随访的参与者中，有 109 名发生了全因痴呆。在 APOE4 与高血压（HTN）和充血性心力衰竭（CHF）配对中，这些变量独立且累加地增加了全因痴呆的风险。在 APOE4 与中风和中风与 CHF 配对中，这些变量独立地增加了全因痴呆的风险；它们的联合作用显示出过度的危害，表明存在协同作用（联合 HR [95%CI]：28.33 [6.74，119.01] 和 50.30 [14.57，173.57]，分别为完全调整模型）。在未调整模型中，当与 APOE4、中风和 CHF 配对时，身体活动（PA）与全因痴呆风险呈独立负相关；这些关联在调整协变量后并不存在。低 PA 和 APOE4 的联合作用与全因痴呆风险的累加增加相关（联合 HR [95%CI]：4.61 [2.07，10.23]，完全调整模型）。
降低 VCMRFs，包括低 PA，可能对预防痴呆有价值，尤其是在 APOE*4 携带者中。
