Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela.
Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU University of Leuven, Leuven, Belgium.
J Alzheimers Dis. 2020;77(2):569-579. doi: 10.3233/JAD-200430.
Dementia of the Alzheimer's type (DAT) impacts Hispanics disproportionately, with almost a twofold elevated risk of developing DAT, as well as earlier onset of the disease, than in non-Hispanic Whites. However, the role of main risk factors for DAT, such as APOE-ɛ4 and blood pressure (BP) levels, remains uncertain among Hispanics.
To investigate the association of APOE-ɛ4 and BP levels, measures with 24-h ambulatory BP monitoring, with incidence of DAT in an elderly cohort of Hispanics.
1,320 participants from the Maracaibo Aging Study, free of dementia at the baseline, and with ambulatory BP measurements and APOE genotype available were included. Adjusted Cox proportional models were performed to examine 1) the incidence of DAT and 2) the relationship between BP levels and DAT according to APOE genotypes. Models were adjusted by competing risk of death before the onset of DAT. Model performance was assessed by likelihood test.
The average follow-up time was 5.3 years. DAT incidence was 5.8 per 1000 person-year. APOE-ɛ4 carriers had a higher risk of DAT. In unadjusted analyses, conventional, 24-h, and nighttime systolic BP levels were significantly higher in participants who developed DAT and of APOE-ɛ4 carriers (p < 0.05). After adjustment for competing risks, only higher nighttime systolic BP was associated with DAT incidence, but only among subjects carrying APOE-ɛ4.
In this Hispanic population, both APOE-ɛ4 genotype and assessment of nocturnal systolic BP (rather than diurnal or office BP) were necessary to estimate DAT risk.
阿尔茨海默病型痴呆（DAT）对西班牙裔人群的影响不成比例，与非西班牙裔白人相比，西班牙裔人群患 DAT 的风险几乎高出两倍，而且发病年龄更早。然而，对于 DAT 的主要危险因素，如 APOE-ɛ4 和血压（BP）水平，在西班牙裔人群中的作用仍不确定。
研究 APOE-ɛ4 和 BP 水平（通过 24 小时动态血压监测测量）与马拉开波老龄化研究中一组老年西班牙裔人群 DAT 发病率的关系。
共纳入 1320 名基线时无痴呆且可进行动态血压监测和 APOE 基因型检测的马拉开波老龄化研究参与者。采用校正 Cox 比例风险模型，分别检验 1）DAT 的发病率和 2）BP 水平与 APOE 基因型之间的关系。模型通过 DAT 发病前死亡的竞争风险进行调整。通过似然比检验评估模型性能。
平均随访时间为 5.3 年。DAT 的发病率为 5.8/1000 人年。APOE-ɛ4 携带者 DAT 的发病风险更高。在未校正分析中，发生 DAT 的参与者和 APOE-ɛ4 携带者的常规、24 小时和夜间收缩压均显著升高（p<0.05）。在校正竞争风险后，仅夜间收缩压与 DAT 发病率相关，但仅在携带 APOE-ɛ4 的受试者中相关。
在这一西班牙裔人群中，APOE-ɛ4 基因型和夜间收缩压（而非日间或诊室血压）评估均有助于估计 DAT 风险。
