Cardiovascular genetic assessment and treatment in middle age to reduce the risk of heart disease and dementia in old age

Abstract

Assessment and treatment of cardiovascular disease (CVD) risk factors as a preventable cause of cognitive decline, morbidity and mortality is an important clinical goal. The apolipoprotein E (Apo E) gene provides a genetic link between CVD and the development of Alzheimer’s disease (AD). The E4 allele increases the risk of coronary heart disease by more than 40% and contributes to the development of late-onset AD in more than 50% of affected patients. Disease expression in the presence of this allele is triggered by interaction with modifiable risk factors such as smoking, alcohol intake and high-calorie diets. It also displays differential therapeutic responses with use of cholesterol-lowering statins and acetylcholinesterase inhibitors. Apo E genotyping as part of a comprehensive evaluation of multiple CVD risk factors, performed in conjunction with nutrition and cognitive assessments, provides the opportunity to optimise treatment to the needs of the individual.