Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort
Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort
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DOI：
10.1001/jamaneurol.2017.1658
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发表时间：
2017-10-01
期刊：
影响因子：
29
通讯作者：
Knopman, David S.
中科院分区：
文献类型：
--
作者：
Gottesman, Rebecca F.;Albert, Marilyn S.;Knopman, David S.
重要性血管危险因素与认知能力下降有关。中年暴露于这些因素可能是最重要的，在赋予晚年的认知功能障碍的风险。目的是检查社区动脉粥样硬化风险（ARIC）参与者在中年和探讨中年血管危险因素和25年痴呆发病率之间的关联。这项社区动脉粥样硬化风险（ARIC）研究的前瞻性队列研究从1987-1989年到2011年进行，2013.本分析的日期为2015年4月至2016年8月。地点是ARIC现场中心（马里兰州的华盛顿县、北卡罗来纳州的福赛斯县、密西西比的杰克逊和明尼苏达州的明尼阿波利斯郊区）。该研究包括15744名参与者（其中27.1%为黑人，72.9%为白色），基线时年龄为44 - 66岁。主要结果和测量方法在基线时测量人口统计学和血管危险因素（肥胖、吸烟、糖尿病、高血压前期、高血压和高胆固醇血症）以及载脂蛋白E β（4）基因型的存在。基线访视后，参与者有4个额外的亲自访问，总共5个亲自访问，住院监测，电话和重复的认知评估。最近，在2011-2013年，通过ARIC神经认知研究（ARIC-NCS），参与者接受了详细的神经认知电池，线人访谈和裁定审查，以定义痴呆症病例。通过认知状态电话访谈或知情人访谈确定其他病例，对于未参加ARIC-NCS访视的参与者，或通过住院期间的国际疾病分类第九版痴呆代码。完全调整后的考克斯比例风险回归被用来评估协会的基线血管和人口统计学危险因素与dementions.RESULTS，共1516例痴呆症（57.0%的女性和34.9%的黑人，与平均[SD]年龄在访问1的57.4 [5.2]岁）被确定在15744名参与者。黑人种族（风险比[HR]，1.36; 95% CI，1.21-1.54），年龄较大（HR，8.06; 60-66岁受试者的95% CI，6.69-9.72），教育程度较低（HR，1.61; 95%CI，1.28-2.03，低于高中教育），和APOE基因型（风险比，1.98; 95%可信区间，1.78-2.21）与老年痴呆风险增加相关，中年吸烟也是如此（HR，1.41; 95% CI，1.23-1.61）、糖尿病（HR，1.77; 95% CI，1.53-2.04）、高血压前期（HR，1.31; 95% CI，1.14-1.51）和高血压（HR，1.39; 95% CI，1.22-1.59）。糖尿病痴呆的HR几乎与APOE β（4）基因型一样高。结论和相关性中年血管危险因素与黑人和白色ARIC研究参与者痴呆风险增加相关。需要进一步的研究来评估这些危险因素在中年认知后遗症的预防机制和机会。
IMPORTANCE Vascular risk factors have been associated with cognitive decline. Midlife exposure to these factors may be most important in conferring late-life risk of cognitive impairment.OBJECTIVES To examine Atherosclerosis Risk in Communities (ARIC) participants in midlife and to explore associations between midlife vascular risk factors and 25-year dementia incidence.DESIGN, SETTING, AND PARTICIPANTS This prospective cohort investigation of the Atherosclerosis Risk in Communities (ARIC) Study was conducted from 1987-1989 through 2011-2013. The dates of this analysis were April 2015 through August 2016. The setting was ARIC field centers (Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and Minneapolis suburbs, Minnesota). The study comprised 15 744 participants (of whom 27.1% were black and 72.9% white) who were aged 44 to 66 years at baseline.MAIN OUTCOMES AND MEASURES Demographic and vascular risk factors were measured at baseline (obesity, smoking, diabetes, prehypertension, hypertension, and hypercholesterolemia) as well as presence of the APOE epsilon(4) genotype. After the baseline visit, participants had 4 additional in-person visits, for a total of 5 in-person visits, hospitalization surveillance, telephone calls, and repeated cognitive evaluations. Most recently, in 2011-2013, through the ARIC Neurocognitive Study (ARIC-NCS), participants underwent a detailed neurocognitive battery, informant interviews, and adjudicated review to define dementia cases. Additional cases were identified through the Telephone Interview for Cognitive Status-Modified or informant interview, for participants not attending the ARIC-NCS visit, or by an International Classification of Diseases, Ninth Revision dementia code during a hospitalization. Fully adjusted Cox proportional hazards regression was used to evaluate associations of baseline vascular and demographic risk factors with dementia.RESULTS In total, 1516 cases of dementia (57.0% female and 34.9% black, with a mean [SD] age at visit 1 of 57.4 [5.2] years) were identified among 15 744 participants. Black race (hazard ratio [HR], 1.36; 95% CI, 1.21-1.54), older age (HR, 8.06; 95% CI, 6.69-9.72 for participants aged 60-66 years), lower educational attainment (HR, 1.61; 95% CI, 1.28-2.03 for less than a high school education), and APOE epsilon(4) genotype (HR, 1.98; 95% CI, 1.78-2.21) were associated with increased risk of dementia, as were midlife smoking (HR, 1.41; 95% CI, 1.23-1.61), diabetes (HR, 1.77; 95% CI, 1.53-2.04), prehypertension (HR, 1.31; 95% CI, 1.14-1.51), and hypertension (HR, 1.39; 95% CI, 1.22-1.59). The HR for dementia for diabetes was almost as high as that for APOE epsilon(4) genotype.CONCLUSIONS AND RELEVANCE Midlife vascular risk factors are associated with increased risk of dementia in black and white ARIC Study participants. Further studies are needed to evaluate the mechanism of and opportunities for prevention of the cognitive sequelae of these risk factors in midlife.