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Gottesman RF, Albert MS, Alonso A, Coker LH, Coresh J, Davis SM, Deal JA, McKhann GM, Mosley TH, Sharrett AR, Schneider AL, Windham BG, Wruck LM, Knopman DS. Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort. JAMA Neurol. 2017 Oct 1;74(10):1246-1254. PubMed.
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Weill College Medicine, New York
The findings in this study really nail down the link between midlife risk factor, race, and risk of dementia. I find particularly interesting the racial disparity data on dementia risk.
Also very interesting is the link between prehypertension—that is, blood pressure of >120 systolic but <140 mmHg—and dementia. Prehypertension is linked to a 31 percent increase in dementia risk, while full-blown hypertension to a 39 percent greater risk, not a large difference between the two.
Although the study was not designed to test treatments, this finding supports starting treatment of elevated blood pressure earlier than currently done in medical practice.
That ApoE4 is more relevant in white than black people has been described previously. One possibility, not yet proven, is that it may reflect the influence of genetic factors on ApoE4 transcription, which could be more efficient in whites resulting in more ApoE4 protein.
One caveat is that the relationship between ApoE4 in whites and dementia is not driven by stroke, but the role of white-matter disease was not examined.
As for the previous ARIC study suggesting equal amyloid deposition in whites and blacks, that result seems in conflict with the effect of ApoE (which seems to be involved in amyloid deposition) being more relevant in whites. While the possibility of increased ApoE4 transcription in whites could contribute, a confounder may be that amyloid deposition as assessed by PET tracers is also present in normal individuals. Therefore, the comparison between the two studies is complex.
The take-home message is that healthy vessels are key to keeping a healthy mind, and this new study suggests that this has to be a lifelong effort since the harmful impact of vascular risk factors starts decades earlier.
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