TY - JOUR
T1 - Nighttime Blood Pressure Interacts with APOE Genotype to Increase the Risk of Incident Dementia of the Alzheimer's Type in Hispanics
AU - Melgarejo, Jesus D.
AU - Aguirre-Acevedo, Daniel C.
AU - Gaona, Ciro
AU - Chavez, Carlos A.
AU - Calmon, Gustavo E.
AU - Silva, Egle R.
AU - De Erausquin, Gabriel A.
AU - Gil, Mario
AU - Mena, Luis J.
AU - Terwilliger, Joseph D.
AU - Arboleda, Humberto
AU - Scarmeas, Nikolaos
AU - Lee, Joseph H.
AU - Maestre, Gladys E.
N1 - Funding Information:
The authors thank Drs. Mary Carmen Nava, Ledys Mata, and Ney Alliey, who performed the follow-up assessments with G.E.M. and C.C. Sabrina Gonzalez, Elvilena Passeri, Carina Pacheco, and Eduardo Arteaga performed the neuropsychological assessments and participated in clinical discussions with G.P. and M.U. Lenys Araujo performed the preclinical assessments. Javier Aracena managed the database. Dr. Aldrin Molero contributed critically to the standardization of instruments used in the assessments. Mr. Fidencio Montero, a Maracaibo Aging Study (MAS) participant, provided rides to fellow participants and the MAS team for more than 10 years and helped to keep the refusal rate low. We particularly thank the volunteers of FundaConCiencia who worked hard to keep MAS participants engaged and enthusiastic. Most of all, we are grateful to the families of Santa Lucia who welcomed and trusted us and supported the participation of their elderly relatives. We also thank Mr. Edvin Jaimes for professionally processing all the illustrated figures. Dr. Jesus Melgarejo thanks the International Brian Research Organization (IBRO) for supporting his research training at the National University of Colombia Genetics Institute during July-December, 2018.
Funding Information:
This research was supported by the Gene-Environment Interaction in Cognition in Venezuela Families project, funded by the NIA-NIH under award numbers R01AG036469, 1 R03 AG054186-01 (Maestre & Terwilliger) and 1 P30 AG059305-01 (Maestre, de Erausquin and Gil).
Publisher Copyright:
© 2020 - IOS Press and the authors. All rights reserved.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020
Y1 - 2020
N2 - Background: 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-ϵ4 and blood pressure (BP) levels, remains uncertain among Hispanics. Objective: To investigate the association of APOE-ϵ4 and BP levels, measures with 24-h ambulatory BP monitoring, with incidence of DAT in an elderly cohort of Hispanics. Methods: 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. Results: The average follow-up time was 5.3 years. DAT incidence was 5.8 per 1000 person-year. APOE-ϵ4 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-ϵ4 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-ϵ4. Conclusion: In this Hispanic population, both APOE-ϵ4 genotype and assessment of nocturnal systolic BP (rather than diurnal or office BP) were necessary to estimate DAT risk.
AB - Background: 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-ϵ4 and blood pressure (BP) levels, remains uncertain among Hispanics. Objective: To investigate the association of APOE-ϵ4 and BP levels, measures with 24-h ambulatory BP monitoring, with incidence of DAT in an elderly cohort of Hispanics. Methods: 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. Results: The average follow-up time was 5.3 years. DAT incidence was 5.8 per 1000 person-year. APOE-ϵ4 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-ϵ4 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-ϵ4. Conclusion: In this Hispanic population, both APOE-ϵ4 genotype and assessment of nocturnal systolic BP (rather than diurnal or office BP) were necessary to estimate DAT risk.
KW - Alzheimer's disease
KW - ambulatory blood pressure monitoring
KW - Apolipoprotein E
KW - dementia of Alzheimer's type
KW - Hispanics
KW - night-time blood pressure
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U2 - 10.3233/JAD-200430
DO - 10.3233/JAD-200430
M3 - Article
C2 - 32675415
AN - SCOPUS:85091470219
VL - 77
SP - 569
EP - 579
JO - Journal of Alzheimer's Disease
JF - Journal of Alzheimer's Disease
SN - 1387-2877
IS - 2
ER -