ArticleThe journals of gerontology. Series A, Biological sciences and medical sciences2022
Education and Cardiovascular Health as Effect Modifiers of APOE ε4 on Dementia: The Atherosclerosis Risk in Communities Study.
Article in The journals of gerontology. Series A, Biological sciences and medical sciences, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- Beneficial Effect of Societal Factors on APOE-ε2 and ε4 Carriers' Brain Health: A Systematic Review.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Pooled it
- Heterogeneity in the association between APOE ε4 carrier status and dementia risk by modifiable and non-modifiable risk factors.GeroScience · 2026Article
- Educational attainment is associated with reduced functional decline in Puerto Ricans with elevated pTau181.Journal of Alzheimer's disease : JAD · 2026Article
- Machine learning-based LASSO-Cox model for dementia prediction: The role of midlife cardiometabolic, inflammatory, and genetic risk factors in a US cohort.Annals of epidemiology · 2026Article
- Sex differences in the association of vascular risk and APOE Genotype with cognitive decline and dementia: evidence from a U.S. longitudinal study.Lancet regional health. Americas · 2026Article
- Evaluating the association of apolipoprotein E genotype and cognitive resilience in SuperAgers.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Article
- APOE genotype and cognitive decline: educational context as a moderator of genetic risk.The journals of gerontology. Series B, Psychological sciences and social sciences · 2025Article
- The impact of educational attainment on the risk of three types of atherosclerosis: A two-sample mendelian randomization analysis.Cerebral circulation - cognition and behavior · 2025Article
- Dementia risk scores, apolipoprotein E, and risk of Alzheimer's disease: One size does not fit all.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024Article
- Is the Relationship Between Cardiovascular Disease and Alzheimer's Disease Genetic? A Scoping Review.Genes · 2024Article
- The effect of diabetes in the multifaceted relationship between education and cognitive function.BMC public health · 2024Article
- Dementia Risk Scores,medRxiv : the preprint server for health sciences · 2024Article
- Effect of apolipoprotein E ε4 and its modification by sociodemographic characteristics on cognitive measures in South Asians from LASI-DAD.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024Article
- Cardiovascular risk burden, dementia risk and brain structural imaging markers: a study from UK Biobank.General psychiatry · 2024Article
- Education counteracts the genetic risk of Alzheimer's disease without an interaction effect.Frontiers in public health · 2023Article
- Gene-environment interactions in Alzheimer disease: the emerging role of epigenetics.Nature reviews. Neurology · 2022Review
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundBoth 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.
methodsOur 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.
resultsTwo thousand two hundred and twenty-six 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 apolipoprotein E (APOE) status interaction (p = .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.
conclusionsEducation 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.
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