Background Both education and cardiovascular risk factors are strongly associated with dementia risk. However, it is not clear whether these associations persist or vary among individuals with high genetic risk for Alzheimer’s Disease. We examined the interactive relationship between lifestyle and genetic dementia risk factors in a prospective cohort study. Methods Our data came from the Atherosclerosis Risk in Communities study participants (n=13,715; baseline age 45-64; 25% Black; 55% female), who were followed for incident dementia from 1987 through 2017. We used Cox proportional hazard models to estimate the risk of dementia (ascertained through in-person examination, telephone cognitive screeners, and/or hospital and death records) associated with baseline education and cardiovascular risk factors (measured using the American Heart Association’s “Life Simple 7”) among ε4 carriers and non-carriers separately. We also examined differences by race and sex. Results 2,226 incident dementia cases occurred over a median 25 years of follow-up. Lower educational attainment and poorer cardiovascular health were associated with greater risk of incident dementia. There was an education by APOE status interaction (p=0.005) whereby the association of education and dementia was weaker for ε4 carriers (HR college graduates vs. less than high school: 0.71 (0.59-0.84) than non-carriers (0.54 (0.47-0.63)). There was no interaction between APOE status and cardiovascular health on dementia risk. These relationships did not vary significantly by race or sex. Conclusions Education and cardiovascular health were associated with lower dementia risk regardless of APOE genotype, though the protective effects of education were somewhat diminished among ε4 carriers.

中文翻译：

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教育和心血管健康作为 APOE ε4 对痴呆症的影响调节剂：社区动脉粥样硬化风险 (ARIC) 研究

背景 教育和心血管风险因素都与痴呆症风险密切相关。然而，尚不清楚这些关联是否持续存在或在具有阿尔茨海默氏病高遗传风险的个体中有所不同。我们在一项前瞻性队列研究中检查了生活方式与遗传性痴呆风险因素之间的交互关系。方估计痴呆症的风险（通过亲自检查、电话认知筛查、和/或医院和死亡记录）分别与 ε4 携带者和非携带者的基线教育和心血管危险因素（使用美国心脏协会的“Life Simple 7”测量）相关。我们还检查了种族和性别的差异。结果 2,226 例痴呆症病例发生在中位 25 年的随访期间。较低的教育程度和较差的心血管健康与较高的痴呆症风险相关。通过 APOE 状态相互作用进行教育 (p=0.005)，其中教育和痴呆症的关联对于 ε4 携带者（HR 大学毕业生与高中以下：0.71 (0.59-0.84) 比非携带者 (0.54 (0.47) -0.63)). APOE 状态和心血管健康对痴呆风险没有相互作用。这些关系没有因种族或性别而显着变化。