Kalmijn S, Feskens E J, Launer L J, Kromhout D
Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and the Environment, Bilthoven, Netherlands.
Stroke. 1996 Dec;27(12):2230-5. doi: 10.1161/01.str.27.12.2230.
Cerebrovascular disease and the apolipoprotein e4 (APOE4) allele are both important risk factors for cognitive decline. We investigated the combined effect of APOE4 and cerebrovascular disease on cognitive decline.
Data are from a cohort of 353 men, aged 69 to 89 years at baseline, living in Zutphen, Netherlands. The 30-point Mini-Mental State Examination (MMSE) was used to measure cognitive decline (drop of > 2 points) from 1990 to 1993 (14% of the sample). Odds ratios (OR [95% confidence interval]) for cognitive decline were adjusted for age, education, and baseline MMSE score.
Compared with those without APOE4 and without a history of cerebrovascular disease, the adjusted OR was 4.7 (1.7 to 12.7) for subjects without APOE4 but with cerebrovascular disease, 3.3 (1.6 to 6.8) for those with APOE4 and no cerebrovascular disease, and 17.2 (2.7 to 110.0) for those with both risk factors. The risk for cerebrovascular disease and APOE4 combined was more than expected from the separate effects. The combined risk of coronary heart disease and APOE4 was 6.1 (1.7 to 22.3). The analysis of cardiovascular risk factors showed that the risk of cognitive decline was highest in subjects with both APOE4 and a high cholesterol level, high fibrinogen level, normal blood pressure, or diabetes mellitus.
Cerebrovascular disease and APOE*4 may have a synergistic effect on cognitive decline.
脑血管疾病和载脂蛋白E4（APOE4）等位基因均为认知功能衰退的重要危险因素。我们研究了APOE4与脑血管疾病对认知功能衰退的联合影响。
数据来自荷兰祖特芬的一个队列，共353名男性，基线年龄为69至89岁。采用30分的简易精神状态检查表（MMSE）测量1990年至1993年期间的认知功能衰退（下降超过2分）（样本的14%）。认知功能衰退的比值比（OR[95%置信区间]）根据年龄、教育程度和基线MMSE评分进行了调整。
与无APOE4且无脑血管疾病史的人相比，无APOE4但有脑血管疾病的受试者调整后的OR为4.7（1.7至12.7），有APOE4但无脑血管疾病的受试者为3.3（1.6至6.8），两种危险因素都有的受试者为17.2（2.7至110.0）。脑血管疾病和APOE4联合存在时的风险高于各自单独作用时的预期。冠心病和APOE4联合存在时的风险为6.1（1.7至22.3）。对心血管危险因素的分析表明，同时具有APOE4和高胆固醇水平、高纤维蛋白原水平、正常血压或糖尿病的受试者认知功能衰退的风险最高。
脑血管疾病和APOE*4可能对认知功能衰退具有协同作用。
