A review published in the European Heart Journal pointed out that dementia is a genetic disease, and cardiovascular disease and dementia share common risk factors, so a risk score that combines genetic variation and cardiovascular risk factors can help identify high-risk groups for dementia.
Age and family history were the strongest immutable dementia risk factors, and there were 12 modifiable risk factors associated with dementia, half of which were cardiovascular risk factors, including high blood pressure, smoking, diabetes, obesity, low education, and physical strength Insufficient activity and the rest were traumatic brain injury, hearing impairment, depression, social isolation and air pollution.
The incidence of dementia in Europe and the United States is declining, partly due to improved control of cardiovascular risk factors, improved population education, and increased awareness of the importance of a healthy lifestyle.
Genetic variation is the most important risk factor for Alzheimer’s disease, and genome-wide association analysis studies have shown that apolipoprotein E (APOE) is the strongest genetic risk factor for Alzheimer’s disease.
Carriers of the APOE-ɛ4 allele have an 8- to 15-fold increased risk of Alzheimer’s disease. Non-Alzheimer’s disease dementias are primarily caused by vascular pathology in and around the cerebral vessels.
A study combining cardiovascular risk factors, education, age, sex, and genetic variants associated with Alzheimer’s disease developed a 10-year absolute risk prediction map for all-cause dementia and Alzheimer’s disease, similar to heart Risk prediction map for vascular diseases, easy to apply in clinic.
The 10-year absolute risk was determined by the patient’s sex, diabetes, smoking and education status, APOE genotype and the number of GWAS risk alleles.
In addition to APOE genotype, the genetic risk score included 19 common SNPs associated with increased risk of Alzheimer’s disease, grouped into four categories.
The 10-year absolute risk was further stratified according to sex and three cardiovascular risk factors and showed that maintaining cardiovascular fitness was associated with a 41% lower genetic susceptibility to all-cause dementia among APOE 4 homozygotes and ≥70-year-olds .
Further analysis found that maintaining cardiovascular fitness almost halved the risk and genetic risk of dementia in all age groups.
From a public health perspective, dementia prevention is of paramount importance. Some scholars suggest that by 2050, reducing the prevalence of cardiovascular risk factors by 10% can prevent more than 9 million dementias worldwide.
Risk stratification is important, and high-risk groups benefit most from interventions.
Pathological changes begin decades before dementia symptoms appear, so risk stratification will further enable targeted interventions for high-risk populations.
To ensure effective interventions, more research is needed to elucidate the pathogenesis of dementia and the potential shared causal risk factors between cardiovascular disease and dementia.
來源：Juul Rasmussen I, Frikke-Schmidt R. Modifiable cardiovascular risk factors and genetics for targeted prevention of dementia. Eur Heart J. 2023 May 24:ehad293.
2023-05-29 08:40:57
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