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

Eric J Heyer1, Joanna L Mergeche2, Yaakov Stern3

  • 1Department of Anesthesiology, Columbia University, 630 West 168th Street, P&S Box 46, New York, NY 10032, USA; Department of Neurology, Columbia University, New York, NY, USA.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|October 22, 2013
PubMed
Summary

The apolipoprotein E ε4 gene variant increases the risk of cognitive dysfunction after carotid endarterectomy (CEA) both 1 day and 1 month post-surgery. Statin use was linked to a lower risk of cognitive dysfunction.

Keywords:
Apolipoprotein ECarotid endarterectomyCognitionCognitive dysfunction

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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.