Apolipoprotein E-ε4 polymorphism and cognitive dysfunction after carotid endarterectomy.

Area of Science:

• Neurology
• Genetics
• Vascular Surgery

Background:

• Cognitive dysfunction (CD) affects approximately 25% of patients post-carotid endarterectomy (CEA).
• The apolipoprotein E (apoE)-ε4 polymorphism is a known risk factor for CD one month after CEA.

Purpose of the Study:

• To investigate if the apoE-ε4 polymorphism is an independent risk factor for CD as early as one day after CEA.
• To confirm apoE-ε4 as a risk factor for CD one month after CEA.

Main Methods:

• Prospective observational study of 411 patients undergoing elective CEA.
• Cognitive dysfunction evaluated using a comprehensive neuropsychometric battery.
• Multivariate regression analysis to identify independent predictors of CD.

Main Results:

• apoE-ε4 carriers showed significantly higher rates of CD at 1 day (30.1% vs 17.9%) and 1 month (25.7% vs 9.8%) post-CEA.
• At 1 day, apoE-ε4 (OR: 2.24) increased CD risk, while statin use (OR: 0.40) decreased it.
• At 1 month, apoE-ε4 (OR: 3.14) increased CD risk, while symptomatic status (OR: 0.45) decreased it.

Conclusions:

• The apoE-ε4 polymorphism is an independent risk factor for early-onset CD (1 day post-CEA).
• apoE-ε4 is confirmed as an independent risk factor for CD at 1 month post-CEA.
• Statin use and symptomatic status may influence post-CEA cognitive outcomes.