Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study

OBJECTIVE To examine the relation of midlife raised blood pressure and serum cholesterol concentrations to Alzheimer's disease in later life. DESIGN Prospective, population based study. SETTING Populations of Kuopio and Joensuu, eastern Finland. PARTICIPANTS Participants were derived from random, population based samples previously studied in a survey carried out in 1972, 1977, 1982, or 1987. After an average of 21 years' follow up, a total of 1449 (73%) participants aged 65-79 took part in the re-examination in 1998. MAIN OUTCOME MEASURES Midlife blood pressure and cholesterol concentrations and development of Alzheimer's disease in later life. RESULTS People with raised systolic blood pressure (>/=160 mm Hg) or high serum cholesterol concentration (>/=6.5 mmol/l) in midlife had a significantly higher risk of Alzheimer's disease in later life, even after adjustment for age, body mass index, education, vascular events, smoking status, and alcohol consumption, than those with normal systolic blood pressure (odds ratio 2.3, 95% confidence interval 1.0 to 5.5) or serum cholesterol (odds ratio 2.1, 1.0 to 4.4). Participants with both of these risk factors in midlife had a significantly higher risk of developing Alzheimer's disease than those with either of the risk factors alone (odds ratio 3.5, 1.6 to 7.9). Diastolic blood pressure in midlife had no significant effect on the risk of Alzheimer's disease. CONCLUSION Raised systolic blood pressure and high serum cholesterol concentration, and in particular the combination of these risks, in midlife increase the risk of Alzheimer's disease in later life.

[1]  M. D. O'Brien,et al.  Cerebral blood flow in dementia , 1986, Neurology.

[2]  Anne M Johnson,et al.  A cognitive behavioural intervention to reduce sexually transmitted infections among gay men: randomised trial , 2001, BMJ : British Medical Journal.

[3]  J. Tuomilehto,et al.  Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial , 1998, The Lancet.

[4]  E. Vartiainen,et al.  Twenty-year trends in coronary risk factors in north Karelia and in other areas of Finland. , 1994, International journal of epidemiology.

[5]  B. Psaty,et al.  Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients. , 2000, Stroke.

[6]  L. Launer,et al.  Nonresponse pattern and bias in a community-based cross-sectional study of cognitive functioning among the elderly. , 1994, American journal of epidemiology.

[7]  A. Hofman,et al.  Atherosclerosis, apolipoprotein E, and prevalence of dementia and Alzheimer's disease in the Rotterdam Study , 1997, The Lancet.

[8]  W. Applegate Hypertension in elderly patients. , 1989, Annals of internal medicine.

[9]  R. Havlik,et al.  Midlife blood pressure and dementia: the Honolulu–Asia aging study☆ , 2000, Neurobiology of Aging.

[10]  Vascular factors and Alzheimer disease. , 1999, Alzheimer disease and associated disorders.

[11]  G. Kolovou,et al.  Apolipoprotein E Polymorphism and Atherosclerosis , 2003, Angiology.

[12]  R Brookmeyer,et al.  Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset. , 1998, American journal of public health.

[13]  B. Lernfelt,et al.  15-year longitudinal study of blood pressure and dementia , 1996, The Lancet.

[14]  Irma-Leena Notkola,et al.  Serum Total Cholesterol, Apolipoprotein E {FC12}e4 Allele, and Alzheimer’s Disease , 1998, Neuroepidemiology.

[15]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[16]  H. Braak,et al.  Neuropathology of Alzheimer’s disease: what is new since A. Alzheimer? , 1999, European Archives of Psychiatry and Clinical Neuroscience.