Apolipoprotein E Genotype and Mortality: Findings from the Cache County Study

Objectives: To evaluate the association between apolipoprotein E (apo E) ɛ4 and mortality, the population attributable risk for mortality with ɛ4, and relative contributions of cardiovascular disease (CVD) and Alzheimer's disease (AD). Design: Population‐based cohort study. Setting: Community‐b...

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Veröffentlicht in:Journal of the American Geriatrics Society (JAGS) 2005-06, Vol.53 (6), p.935-942
Hauptverfasser: Hayden, Kathleen M., Zandi, Peter P., Lyketsos, Constantine G., Tschanz, JoAnn T., Norton, Maria C., Khachaturian, Ara S., Pieper, Carl F., Welsh-Bohmer, Kathleen A., Breitner, John C. S.
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container_end_page 942
container_issue 6
container_start_page 935
container_title Journal of the American Geriatrics Society (JAGS)
container_volume 53
creator Hayden, Kathleen M.
Zandi, Peter P.
Lyketsos, Constantine G.
Tschanz, JoAnn T.
Norton, Maria C.
Khachaturian, Ara S.
Pieper, Carl F.
Welsh-Bohmer, Kathleen A.
Breitner, John C. S.
description Objectives: To evaluate the association between apolipoprotein E (apo E) ɛ4 and mortality, the population attributable risk for mortality with ɛ4, and relative contributions of cardiovascular disease (CVD) and Alzheimer's disease (AD). Design: Population‐based cohort study. Setting: Community‐based. Participants: Permanent residents of Cache County, Utah, aged 65 and older as of January 1, 1995. Measurements: Participants were genotyped at the apo E locus using buccal‐swab deoxyribonucleic acid. Cardiovascular health was ascertained using self‐ or proxy‐report interviews at participants' residences. AD was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders criteria. Utah Department of Vital Statistics quarterly reports were reviewed to identify participants who died. Results: Crude evaluations showed nonsignificantly greater risk of death for ɛ2/2 (hazard ratio (HR)=1.66, 95% confidence interval (CI)=0.92–2.76) and ɛ3/4 (HR=1.11, 95% CI=0.97–1.26) genotypes and significantly greater risk for ɛ4/4 (HR=1.48, 95% CI=1.09–1.96). After adjustment for age, age2, sex, and education, risks increased to 1.98 (95% CI=1.08–3.35), 1.28 (95% CI=1.12–1.46), and 2.02 (95% CI=1.47–2.71), respectively, compared with ɛ3/3 genotypes. Adjustment for presence of any CVD did not change the risk of death for ɛ3/4 and ɛ4/4. Adjustment for AD reduced the risk of death for ɛ3/4 (HR=1.13, 95% CI=0.99–1.30) and ɛ4/4 (HR=1.59, 95% CI=1.15–2.14). The population attributable risk of death for ɛ3/4 and ɛ4/4 genotypes combined is estimated at 9.6%. Conclusion: These findings suggested that the ɛ2/2, ɛ3/4, and ɛ4/4 genotypes have greater early mortality risks. Further analyses showed that AD partially mediates the association between ɛ3/4, ɛ4/4, and death.
doi_str_mv 10.1111/j.1532-5415.2005.53301.x
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S.</creator><creatorcontrib>Hayden, Kathleen M. ; Zandi, Peter P. ; Lyketsos, Constantine G. ; Tschanz, JoAnn T. ; Norton, Maria C. ; Khachaturian, Ara S. ; Pieper, Carl F. ; Welsh-Bohmer, Kathleen A. ; Breitner, John C. S. ; Cache County Investigators ; for the Cache County Investigators</creatorcontrib><description>Objectives: To evaluate the association between apolipoprotein E (apo E) ɛ4 and mortality, the population attributable risk for mortality with ɛ4, and relative contributions of cardiovascular disease (CVD) and Alzheimer's disease (AD). Design: Population‐based cohort study. Setting: Community‐based. Participants: Permanent residents of Cache County, Utah, aged 65 and older as of January 1, 1995. Measurements: Participants were genotyped at the apo E locus using buccal‐swab deoxyribonucleic acid. Cardiovascular health was ascertained using self‐ or proxy‐report interviews at participants' residences. AD was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders criteria. Utah Department of Vital Statistics quarterly reports were reviewed to identify participants who died. Results: Crude evaluations showed nonsignificantly greater risk of death for ɛ2/2 (hazard ratio (HR)=1.66, 95% confidence interval (CI)=0.92–2.76) and ɛ3/4 (HR=1.11, 95% CI=0.97–1.26) genotypes and significantly greater risk for ɛ4/4 (HR=1.48, 95% CI=1.09–1.96). After adjustment for age, age2, sex, and education, risks increased to 1.98 (95% CI=1.08–3.35), 1.28 (95% CI=1.12–1.46), and 2.02 (95% CI=1.47–2.71), respectively, compared with ɛ3/3 genotypes. Adjustment for presence of any CVD did not change the risk of death for ɛ3/4 and ɛ4/4. Adjustment for AD reduced the risk of death for ɛ3/4 (HR=1.13, 95% CI=0.99–1.30) and ɛ4/4 (HR=1.59, 95% CI=1.15–2.14). The population attributable risk of death for ɛ3/4 and ɛ4/4 genotypes combined is estimated at 9.6%. Conclusion: These findings suggested that the ɛ2/2, ɛ3/4, and ɛ4/4 genotypes have greater early mortality risks. Further analyses showed that AD partially mediates the association between ɛ3/4, ɛ4/4, and death.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/j.1532-5415.2005.53301.x</identifier><identifier>PMID: 15935014</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Inc</publisher><subject>Age Distribution ; Aged ; Aged, 80 and over ; Alzheimer Disease - genetics ; Alzheimer Disease - mortality ; Alzheimer's disease ; apolipoprotein E ; Apolipoprotein E4 ; Apolipoproteins E - genetics ; Biological and medical sciences ; Cardiovascular disease ; Cardiovascular Diseases - genetics ; Cardiovascular Diseases - mortality ; Cohort Studies ; Confidence Intervals ; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases ; Female ; Follow-Up Studies ; Gene Frequency ; General aspects ; Genetics, Population ; Genotype ; Genotype &amp; phenotype ; Humans ; Longitudinal Studies ; Male ; Medical sciences ; Mortality ; Neurology ; Older people ; Prevalence ; Proteins ; Risk Factors ; Sex Distribution ; Survival Analysis ; Utah - epidemiology</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2005-06, Vol.53 (6), p.935-942</ispartof><rights>2005 INIST-CNRS</rights><rights>Copyright Lippincott Williams &amp; Wilkins Jun 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4941-9a5969b7a18a72c54d03537dde9200869d419ed75e3c7a2a06e1ae4740f5c0e43</citedby><cites>FETCH-LOGICAL-c4941-9a5969b7a18a72c54d03537dde9200869d419ed75e3c7a2a06e1ae4740f5c0e43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1532-5415.2005.53301.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1532-5415.2005.53301.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=16908375$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15935014$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hayden, Kathleen M.</creatorcontrib><creatorcontrib>Zandi, Peter P.</creatorcontrib><creatorcontrib>Lyketsos, Constantine G.</creatorcontrib><creatorcontrib>Tschanz, JoAnn T.</creatorcontrib><creatorcontrib>Norton, Maria C.</creatorcontrib><creatorcontrib>Khachaturian, Ara S.</creatorcontrib><creatorcontrib>Pieper, Carl F.</creatorcontrib><creatorcontrib>Welsh-Bohmer, Kathleen A.</creatorcontrib><creatorcontrib>Breitner, John C. S.</creatorcontrib><creatorcontrib>Cache County Investigators</creatorcontrib><creatorcontrib>for the Cache County Investigators</creatorcontrib><title>Apolipoprotein E Genotype and Mortality: Findings from the Cache County Study</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Objectives: To evaluate the association between apolipoprotein E (apo E) ɛ4 and mortality, the population attributable risk for mortality with ɛ4, and relative contributions of cardiovascular disease (CVD) and Alzheimer's disease (AD). Design: Population‐based cohort study. Setting: Community‐based. Participants: Permanent residents of Cache County, Utah, aged 65 and older as of January 1, 1995. Measurements: Participants were genotyped at the apo E locus using buccal‐swab deoxyribonucleic acid. Cardiovascular health was ascertained using self‐ or proxy‐report interviews at participants' residences. AD was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders criteria. Utah Department of Vital Statistics quarterly reports were reviewed to identify participants who died. Results: Crude evaluations showed nonsignificantly greater risk of death for ɛ2/2 (hazard ratio (HR)=1.66, 95% confidence interval (CI)=0.92–2.76) and ɛ3/4 (HR=1.11, 95% CI=0.97–1.26) genotypes and significantly greater risk for ɛ4/4 (HR=1.48, 95% CI=1.09–1.96). After adjustment for age, age2, sex, and education, risks increased to 1.98 (95% CI=1.08–3.35), 1.28 (95% CI=1.12–1.46), and 2.02 (95% CI=1.47–2.71), respectively, compared with ɛ3/3 genotypes. Adjustment for presence of any CVD did not change the risk of death for ɛ3/4 and ɛ4/4. Adjustment for AD reduced the risk of death for ɛ3/4 (HR=1.13, 95% CI=0.99–1.30) and ɛ4/4 (HR=1.59, 95% CI=1.15–2.14). The population attributable risk of death for ɛ3/4 and ɛ4/4 genotypes combined is estimated at 9.6%. Conclusion: These findings suggested that the ɛ2/2, ɛ3/4, and ɛ4/4 genotypes have greater early mortality risks. Further analyses showed that AD partially mediates the association between ɛ3/4, ɛ4/4, and death.</description><subject>Age Distribution</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alzheimer Disease - genetics</subject><subject>Alzheimer Disease - mortality</subject><subject>Alzheimer's disease</subject><subject>apolipoprotein E</subject><subject>Apolipoprotein E4</subject><subject>Apolipoproteins E - genetics</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases - genetics</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cohort Studies</subject><subject>Confidence Intervals</subject><subject>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gene Frequency</subject><subject>General aspects</subject><subject>Genetics, Population</subject><subject>Genotype</subject><subject>Genotype &amp; phenotype</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Neurology</subject><subject>Older people</subject><subject>Prevalence</subject><subject>Proteins</subject><subject>Risk Factors</subject><subject>Sex Distribution</subject><subject>Survival Analysis</subject><subject>Utah - epidemiology</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkV9v0zAUxS0EYt3gKyALCd6SXcd2HPOANFVbt6kDqvJH4sXyEgdc0jjYidZ8e5y12iRewA-2Jf_u8T33IIQJpCSu001KOM0SzghPMwCeckqBpLsnaPbw8BTNACBLipywI3QcwgaAZFAUz9ER4ZJyIGyGbs4619jOdd71xrb4HC9M6_qxM1i3Fb5xvteN7cd3-MK2lW1_BFx7t8X9T4Pnupx2N7T9iNf9UI0v0LNaN8G8PJwn6MvF-ef5ZbL8uLiany2TkklGEqm5zOWt0KTQIis5q4ByKqrKyOimyGXFiDSV4IaWQmcackO0YYJBzUswjJ6gt3vd2PbvwYRebW0oTdPo1rghqFzIaD3n_wSJoFxKyCL4-i9w4wbfRhMqI0CFpKSIULGHSu9C8KZWnbdb7UdFQE3BqI2a5q-m-aspGHUfjNrF0lcH_eF2a6rHwkMSEXhzAHQodVN73ZY2PHK5hIKKydH7PXdnGzP-dwPqerG-v0aBZC9gQ292DwLa_4pjiz-obx8WarX8tF6tvjP1lf4B0IS2Mw</recordid><startdate>200506</startdate><enddate>200506</enddate><creator>Hayden, Kathleen M.</creator><creator>Zandi, Peter P.</creator><creator>Lyketsos, Constantine G.</creator><creator>Tschanz, JoAnn T.</creator><creator>Norton, Maria C.</creator><creator>Khachaturian, Ara S.</creator><creator>Pieper, Carl F.</creator><creator>Welsh-Bohmer, Kathleen A.</creator><creator>Breitner, John C. S.</creator><general>Blackwell Science Inc</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>200506</creationdate><title>Apolipoprotein E Genotype and Mortality: Findings from the Cache County Study</title><author>Hayden, Kathleen M. ; Zandi, Peter P. ; Lyketsos, Constantine G. ; Tschanz, JoAnn T. ; Norton, Maria C. ; Khachaturian, Ara S. ; Pieper, Carl F. ; Welsh-Bohmer, Kathleen A. ; Breitner, John C. 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Prion diseases</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gene Frequency</topic><topic>General aspects</topic><topic>Genetics, Population</topic><topic>Genotype</topic><topic>Genotype &amp; phenotype</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Neurology</topic><topic>Older people</topic><topic>Prevalence</topic><topic>Proteins</topic><topic>Risk Factors</topic><topic>Sex Distribution</topic><topic>Survival Analysis</topic><topic>Utah - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hayden, Kathleen M.</creatorcontrib><creatorcontrib>Zandi, Peter P.</creatorcontrib><creatorcontrib>Lyketsos, Constantine G.</creatorcontrib><creatorcontrib>Tschanz, JoAnn T.</creatorcontrib><creatorcontrib>Norton, Maria C.</creatorcontrib><creatorcontrib>Khachaturian, Ara S.</creatorcontrib><creatorcontrib>Pieper, Carl F.</creatorcontrib><creatorcontrib>Welsh-Bohmer, Kathleen A.</creatorcontrib><creatorcontrib>Breitner, John C. S.</creatorcontrib><creatorcontrib>Cache County Investigators</creatorcontrib><creatorcontrib>for the Cache County Investigators</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hayden, Kathleen M.</au><au>Zandi, Peter P.</au><au>Lyketsos, Constantine G.</au><au>Tschanz, JoAnn T.</au><au>Norton, Maria C.</au><au>Khachaturian, Ara S.</au><au>Pieper, Carl F.</au><au>Welsh-Bohmer, Kathleen A.</au><au>Breitner, John C. S.</au><aucorp>Cache County Investigators</aucorp><aucorp>for the Cache County Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Apolipoprotein E Genotype and Mortality: Findings from the Cache County Study</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2005-06</date><risdate>2005</risdate><volume>53</volume><issue>6</issue><spage>935</spage><epage>942</epage><pages>935-942</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>Objectives: To evaluate the association between apolipoprotein E (apo E) ɛ4 and mortality, the population attributable risk for mortality with ɛ4, and relative contributions of cardiovascular disease (CVD) and Alzheimer's disease (AD). Design: Population‐based cohort study. Setting: Community‐based. Participants: Permanent residents of Cache County, Utah, aged 65 and older as of January 1, 1995. Measurements: Participants were genotyped at the apo E locus using buccal‐swab deoxyribonucleic acid. Cardiovascular health was ascertained using self‐ or proxy‐report interviews at participants' residences. AD was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders criteria. Utah Department of Vital Statistics quarterly reports were reviewed to identify participants who died. Results: Crude evaluations showed nonsignificantly greater risk of death for ɛ2/2 (hazard ratio (HR)=1.66, 95% confidence interval (CI)=0.92–2.76) and ɛ3/4 (HR=1.11, 95% CI=0.97–1.26) genotypes and significantly greater risk for ɛ4/4 (HR=1.48, 95% CI=1.09–1.96). After adjustment for age, age2, sex, and education, risks increased to 1.98 (95% CI=1.08–3.35), 1.28 (95% CI=1.12–1.46), and 2.02 (95% CI=1.47–2.71), respectively, compared with ɛ3/3 genotypes. Adjustment for presence of any CVD did not change the risk of death for ɛ3/4 and ɛ4/4. Adjustment for AD reduced the risk of death for ɛ3/4 (HR=1.13, 95% CI=0.99–1.30) and ɛ4/4 (HR=1.59, 95% CI=1.15–2.14). The population attributable risk of death for ɛ3/4 and ɛ4/4 genotypes combined is estimated at 9.6%. Conclusion: These findings suggested that the ɛ2/2, ɛ3/4, and ɛ4/4 genotypes have greater early mortality risks. Further analyses showed that AD partially mediates the association between ɛ3/4, ɛ4/4, and death.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Inc</pub><pmid>15935014</pmid><doi>10.1111/j.1532-5415.2005.53301.x</doi><tpages>8</tpages></addata></record>
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subjects Age Distribution
Aged
Aged, 80 and over
Alzheimer Disease - genetics
Alzheimer Disease - mortality
Alzheimer's disease
apolipoprotein E
Apolipoprotein E4
Apolipoproteins E - genetics
Biological and medical sciences
Cardiovascular disease
Cardiovascular Diseases - genetics
Cardiovascular Diseases - mortality
Cohort Studies
Confidence Intervals
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Female
Follow-Up Studies
Gene Frequency
General aspects
Genetics, Population
Genotype
Genotype & phenotype
Humans
Longitudinal Studies
Male
Medical sciences
Mortality
Neurology
Older people
Prevalence
Proteins
Risk Factors
Sex Distribution
Survival Analysis
Utah - epidemiology
title Apolipoprotein E Genotype and Mortality: Findings from the Cache County Study
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