Vascular risk factors and Alzheimer's disease: are these risk factors for plaques and tangles or for concomitant vascular pathology that increases the likelihood of dementia? An evidence-based review

Chui, Helena C; Zheng, Ling; Reed, Bruce R; Vinters, Harry V; Mack, Wendy J

doi:10.1186/alzrt98

Alzheimer's Research & Therapy

Table 5 Cholesterol and relative risk of subsequent dementia

From: Vascular risk factors and Alzheimer's disease: are these risk factors for plaques and tangles or for concomitant vascular pathology that increases the likelihood of dementia? An evidence-based review

					Number of subjects		RR (95% CI)
Grade	Study	Age@Chol (years)	Follow-up (years)	Definition (mmol/L)	High	NL	All dementia	VaD	AD + VaD	AD
Mid-life cholesterol and relative risk of subsequent dementia
B1	Notkola et al. 1998 [33]; Finnish cohorts (n = 444)	40-59 (men)	30	Chol ≥6.5 mmol/L averaged over 4 visits	184	260				3.1 (1.2, 8.5) ^a
B1	Kalmijn et al. 2000 [36]; HAAS (n = 3,734)	52.7 ± 4.7 (men)	27	Per 1 SD = 0.92			1.10 (0.95, 1.26)
B1	Kivipelto et al. 2002 [35]; FIN-MONICA (n = 2,293)	50.2 ± 6.0	21	Chol ≥6.5 mmol/L	NA	NA			2.6 (1.2, 6.0) ^b	2.8 (1.2, 6.7) ^b
Late-life cholesterol and relative risk of subsequent dementia
B1	Tan et al. 2003 [34]; 1988 Framingham (n = 1,026)	76.1	12	Per 0.3 mmol/L average chol over previous 15 visits (1950-1980)						0.95 (0.87, 1.04)^c
				Per 0.3 mmol/L cholesterol at visit 20 (1988)						0.97 (0.90, 1.05)^c
B1	Reitz et al. 2004 [38]; 1992 WHICAP - prospective (n = 1,168)	78.4 ± 6.2	4.8 ± 2.9	Chol ≥5.9 mmol/L	291	877		1.61 (0.7, 3.74)^d 1.05 (0.42, 2.60)^e		0.55 (0.32, 0.95) ^d 0.48 (0.26, 0.86) ^e
				LDLc ≥3.67 mmol/L				2.45 (1.05, 5.7) ^d		0.88 (0.51, 1.51)^d
								2.07 (0.85, 5.06)^e		0.80 (0.46, 1.40)^e
B2	Li et al. 2005 [37]; Group Health Cooperative (n = 2,141)	≥65	5.6 ± 1.8	Triglyceride >254 mg/dL HDLc <1.2 mmol/L			1.16 (0.81,1.67)^f 1.04 (0.69, 1.55)^f			1.0 (0.71, 2.15)^f 1.23 (0.71, 2.15)^f
B1	Mielke et al. 2005 [40]; Göteborg (n = 973)	70	18	Chol >8.0 mmol/L	56	326	0.31 (0.11, 0.85)^g
B1	Reitz et al. 2010 [39]; 1999 WHICAP (n = 1,130)	75.7 ± 6.3	3.96	HDLc >1.42 mmol/L	284	846				0.4 (0.2, 0.9) ^h
				3.1 < LDLc < 3.7 mmol/L	283	847				0.5 (0.2, 0.9) ^h

Note that 1 mmol/L cholesterol = 38.6 mg/dl cholesterol. ^aAdjusted for age and APOE4. ^bAdjusted for age and APOE4, education, sex, smoking, alcohol. ^cAdjusted for age, sex, APOE4, coronary artery disease, body mass index, and lipid-lowering medication. ^dAdjusted for sex, age, education and race. ^eAdjusted for body mass index, APOE4, diabetes, heart disease, hyperten sion. ^fAdusted for age, sex, education, Cognitice Abilities Screening Instrument, body mass index, hypertension, coronary artery disease, cerebrovascular disease, diabetes mellitus. ^gAdjusted for body mass index, diastolic blood pressure, sex, education, smoking. ^hAdjusted for age, sex, education, ethnic group APOE ε4 genotype, diabetes, hypertension, heart disease, body mass index, lipid-lowering treatment. Entries in bold indicate significant relative risk (RR) ratios. Age@Chol, age of subject when cholesterol was measured; AD, Alzheimer's disease; Chol, cholesterol; FIN-MONICA, Finnish part of Multinational Monitoring of Trends and Determinants in Cardiovascular Disease; HAAS, Honolulu Asia Aging Study; HDLc, high-density lipoprotein cholesterol; LDLc, low-density lipoprotein cholesterol; NA, not available; NL, normal; SD, standard deviation; VaD, vascular dementia; WHICAP, Washington Heights-Inwood Columbia Aging Project.

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