Apolipoprotein E Genotype and Cardiovascular Diseases in the Elderly

The apolipoprotein E (APOE) genotype is a genetic risk factor for dementia, Alzheimer’s disease, and cardiovascular disease (CVD). It includes three alleles (e2, e3, e4) that are located on chromosome 19q3.2. The e3 allele is the most common and is more common in people of Northern European ancestry and less common in those of Asian ancestry. Those with at least one e4 allele are at increased risk for CVD outcomes. It is well established that the presence of an e4 allele is linked to higher low-density lipoprotein cholesterol levels, even at young ages. Even though most CVD occurs in older people, there are few studies of the effects of APOE on CVD in older people. This review addresses recent research on the links between APOE, CVD, and vascular mechanisms by which APOE may affect CVD in the elderly.     

Mortality From Heart Failure and Dementia in the United States: CDC WONDER 1999–2016

Background

Heart failure and dementia are diseases of the elderly that result in billions of dollars in annual health care expenditure. With the aging of the United States population and increasing evidence of shared risk factors, there is a need to understand the conditions’ shared contributions to nationwide mortality. The objectives of this study were to estimate the burden of mortality from heart failure and dementia and characterize the demographics of affected individuals.

Apolipoprotein E epsilon4, Alzheimer's disease, and cognitive performance in elderly Mexican Mestizos

OBJECTIVES: To determine the relationship between apolipoprotein E (APOE) ɛ4 and Alzheimer's disease (AD) in the Mexican Mestizo population, as well as its effects on the cognitive profile of AD and elderly Mestizos without dementia.
DESIGN: Cross-sectional analysis of a cohort study.
SETTING: Evaluations were conducted at the geriatrics clinic of an academic medical hospital in Mexico City.
PARTICIPANTS: Forty-nine elderly subjects with AD and 141 controls selected from a representative sample of Mexican Mestizos aged 65 to 96 who participated in the Prevalence Survey of Dementia in the Mexico City Elderly Population cohort.
MEASUREMENTS: All subjects underwent APOE genotypification and a comprehensive clinical and neuropsychological evaluation.
RESULTS: There were no significant differences in ɛ3 and ɛ4 frequencies between the subjects with and without AD and a tendency toward higher ɛ4 and lower ɛ3 allele frequencies in subjects aged 75 and older. No association was found between APOE ɛ4 and the presence of AD. The age-, sex-, and education-adjusted risk for AD associated with at least one ɛ4 allele was 1.01 (95% confidence interval=0.45–2.23). Performance on a long-term visual memory test was significantly worse in APOE ɛ4 carriers than in APOE ɛ3 carriers only in the group with AD.
CONCLUSION: APOE ɛ4 did not increase the risk for AD in this Mexican Mestizo elderly urban population sample, although the presence of this allele seems to modify its clinical expression.     

Association of Apolipoprotein E Polymorphisms in Patients with Non-Alcoholic Steatohepatitis

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of abnormal hepatic steatosis in the absence of alcohol abuse worldwide. Non-alcoholic steatohepatitis (NASH) is the most progressive form of NAFLD. The aim of this study was to investigate the role of apolipoprotein E (APOE) polymorphisms in the development of NASH. We analysed 57 NASH patients and 245 healthy controls using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in a case–control study. The diagnosis of the patients was based on liver biopsy. The serum levels of glucose, lipids, vitamin B12, folic acid, homocysteine, insulin, total biluribin, total protein, albumin, ferritin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were determined in all of the subjects. Body mass index (BMI), waist circumference (WC), AST, ALT, fasting blood sugar (FBS), total cholesterol, triglyceride (TG), low-density lipoprotein (LDL) cholesterol, very low-density lipoprotein (VLDL) cholesterol, insulin and ferritin levels were significantly higher in the 57 patients with NASH compared with the 245 healthy controls. The APOE ε3 allele was overrepresented in the whole group of NASH patients (ε3=97.37% in NASH versus 82.45% in controls). The APOE polymorphism was statistically significantly associated with NASH (χ²=15.741; p=0.008). The APOE3/3 genotype (odds ratio [OR]=7.941; p=0.000) was strongly associated with increased risk for NASH in all NASH patients. Consequently, the APOE3/3 genotype may play a role in the aetiopathogenesis of NASH.     

Pneumonia and Influenza Hospitalizations in Elderly People with Dementia

OBJECTIVES: To compare the demographic and geographic patterns of pneumonia and influenza (P&I) hospitalizations in older adults with dementia with those of the U.S. population and to examine the relationship between healthcare accessibility and P&I. DESIGN: Observational study using historical medical claims from the Centers for Medicare and Medicaid Services (CMS) and CMS records supplemented with information derived from other large national sources. SETTING: Retrospective analysis of medical records uniformly collected over a 5‐year period with comprehensive national coverage. PARTICIPANTS: A study population representative of more than 95% of all people aged 65 and older residing in the continental United States. MEASUREMENTS: Six million two hundred seventy‐seven thousand six hundred eighty‐four records of P&I between 1998 and 2002 were abstracted, and county‐specific outcomes for hospitalization rates of P&I, mean length of hospital stay, and percentage of deaths occurring in a hospital setting were estimated. Associations with county‐specific elderly population density, percentage of nursing home residents, median household income per capita, and rurality index were assessed. RESULTS: Rural and poor counties had the highest rate of P&I and percentage of influenza. Patients with dementia had a lower frequency of influenza diagnosis, a shorter length of hospital stay, and 1.5 times as high a rate of death as the national average. CONCLUSION: The results suggest strong disparities in healthcare practices in rural locations and vulnerable populations; infrastructure, proximity, and access to healthcare are significant predictors of influenza morbidity and mortality. These findings have important implications for influenza vaccination, testing, and treatment policies and practices targeting the growing fraction of patients with cognitive impairment.     

Elderly Hispanic migration in the United States

The specific aim of this study was to extend the analysis of migration patterns to Hispanics (Mexican, Cuban, Puerto Rican, and Other Hispanic) over the age of 60. The 1980 Census public use sample provided the data for this study, which was structured by four research expectations derived from features of the Hispanic population and from migration concepts. First, because of population growth, migration from abroad was expected to be heavy, and about half came from abroad. Second, because of the pattern of Hispanic population concentration and the different settlement patterns of the four subgroups, a relatively small migration system with distinct subsystems for the four nationality groups was expected and found. Florida is the major ethnomagnet. Third, traditional family values, as reflected in dependent living arrangements, were expected to be more prevalent among migrants from abroad, and they were. Finally, returning to one's state of birth was highest among Mexican interstate migrants, as expected.     

Oral Hygiene in the Elderly with Different Degrees of Cognitive Impairment and Dementia

The control of bacterial dental plaque through daily oral hygiene is essential to prevent oral diseases such as caries or periodontal disease, especially in at‐risk populations, including the elderly with mild cognitive impairment and dementia. The aim of this study was to determine the association between different levels of cognitive impairment and dementia in an elderly population and their capacity to maintain adequate oral hygiene. A case–control study (elderly with versus without mild cognitive impairment or dementia) was performed in Granada, Spain. Outcome variables were tooth/prosthesis‐brushing frequency/day, bacterial plaque index, and gingival bleeding index. Statistical models were adjusted by age, sex, educational level, and tobacco and alcohol habits. The study included 240 cases and 324 controls. The final model, adjusted by age, sex, educational level, and tobacco and alcohol consumption, showed a significant association between degree of cognitive impairment and daily oral hygiene, accumulation of bacterial plaque, and gingival bleeding. In summary, deficient daily oral hygiene, evidenced by greater bacterial dental plaque accumulation and gingival inflammation, is independently associated with cognitive impairment, even at its earliest stage.     

Inflammation in Relation to Cardiovascular Disease Risk: Comparison of Black and White Women in the United States, United Kingdom, and South Africa

Ethnic differences in the prevalence of cardiovascular disease and type 2 diabetes mellitus and associated metabolic risk factors have been shown in both developed and developing countries. This review explores the hypothesis that ethnic differences in the inflammatory response are associated with the disparities in disease risk in black and white women from South Africa, the United States of America, and the United Kingdom. Higher inflammatory profiles at the genetic, adipose tissue, and circulating level have been reported in black compared to white women but do not explain the disparity in disease risk between black and white women. Ethnic differences in inflammation and their association with disease risk have been shown to be partly mediated by differences in underlying genetic variation, body fat and its distribution, socioeconomic status and lifestyle factors, as well as their interactions.     

烟台市2015-2018年人感染戊型肝炎病毒基因型分析北大核心CSCD

目的分析2015-2018年烟台市人感染戊型肝炎病毒(HEV)基因型别变化,探讨分子流行病特征。方法选取烟台市2015-2018年国家法定传染病报告系统上报的戊型肝炎病例为研究对象,采集血清标本检测HEV-IgM抗体,对血清HEV-IgM阳性病例的血清和粪便标本提取HEV核酸,采用逆转录PCR方法对HEV开放式阅读框架2区域内的核苷酸片段(644 bp)进行扩增,测序后进行系统进化分析。结果共采集360份血清样本,198份(55%)样本HEV-IgM阳性。HEV-IgM阳性的血清标本,HEV核酸检出率27.78%(55/198);粪便标本HEV核酸检测阳性率39.58%(19/48)。总阳性病例数72例,男性48例,女性24例。本次检测的72例HEV病毒株基因型全部是Ⅳ型,以4d亚型为主,占77.78%(56株);其次是4b亚型,占19.44%(14株);4a亚型占2.78%(2株)。72株HEV核苷酸序列的遗传距离为0.002~0.303。56株4d亚型HEV序列与山东地区猪源(KF176351)、羊源(KU904267)、牛源(KU904278)HEV序列的遗传距离为0.021~0.160、0.010~0.178、0.008~0.176。结论基因Ⅳ型HEV在2015-2018年烟台地区占主导趋势,4d亚型为主要流行株。本地人感染HEV可能与进食动物制品或密切接触动物相关。     

Vascular Dementia: Distinguishing Characteristics, Treatment, and Prevention

Vascular dementia (VaD) is the second-most-common cause of dementia in the elderly, after Alzheimer's disease (AD). VaD is defined as loss of cognitive function resulting from ischemic, hypoperfusive, or hemorrhagic brain lesions due to cerebrovascular disease or cardiovascular pathology. Diagnosis requires the following criteria: cognitive loss, often predominantly subcortical; vascular brain lesions demonstrated by imaging; a temporal link between stroke and dementia; and exclusion of other causes of dementia. Poststroke VaD may be caused by large-vessel disease with multiple strokes (multiinfarct dementia) or by a single stroke (strategic stroke VaD). A common form is subcortical ischemic VaD caused by small-vessel occlusions with multiple lacunas and by hypoperfusive lesions resulting from stenosis of medullary arterioles, as in Binswanger's disease. Unlike with AD, in VaD, executive dysfunction is commonly seen, but memory impairment is mild or may not even be present. The cholinesterase inhibitors used for AD are also useful in VaD. Prevention strategies should focus on reduction of stroke and cardiovascular disease, with attention to control of risk factors such as hypertension, diabetes mellitus, hypercholesterolemia, and hyperhomocysteinemia.     

脑出血患者载脂蛋白E基因型分布及相关研究

目的研究脑出血患者载脂蛋白E(apoE)基因多态性分布特点,探讨脑出血患者apoE基因型与神经功能缺损和血清高敏C反应蛋白(hs-CRP)水平的关系。方法选择脑出血患者78例(脑出血组)和健康体检者91例(对照组),利用PCR-RFLP技术,测定apoE基因型;采用生化全自动仪分别对TC、TG、LDL-C、HDL-C、空腹血糖和血清hs-CRP水平等进行测定;脑出血患者入院时采用美国国立卫生研究院卒中量表(NIHSS)进行神经功能缺损评分。结果脑出血组apoEε4基因频率明显高于对照组,apoEε2基因频率明显低于对照组(P<0.05,P<0.01);脑出血组TC、TG、LDL-C、空腹血糖水平明显高于对照组,HDL-C水平明显低于对照组(P<0.05);脑出血组apoEε4携带者NIHSS评分明显高于非apoEε4携带者(P<0.05);脑出血组apoEε2和apoEε4携带者血清hs-CRP水平明显高于非apoEε2和非apoEε4携带者(P<0.05)。结论 apoEε4可能是脑出血的危险因素;脑出血急性期炎性反应可能与apoEε2和apoEε4有关。