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Studied in 1972, 1977, 1982, and 1987. After an average of 21 years, participants then age 65-79 ; took part in a final examination in 1998. 2. Main outcome measures -- midlife BP and cholesterol concentrations and development of Alzheimer's disease in late life. RESULTS 1. A total of 57 participants were diagnosed as having dementia; 48 fulfilled the diagnostic criteria DSM - IV ; for probable or possible Alzheimer's. 2. All 48 showed generalized or temporal brain atrophy. None had appreciable vascular pathology on magnetic resonance scans. 3. After adjustment for possible confounders, those with raised systolic BP 160 ; or high cholesterol 250 ; had a significantly greater risk of Alzheimer's in later life. Odds ratio for raised systolic BP 2.3; for raised cholesterol 2.1; for the combination of both 3.5. DISCUSSION 1. Both raised systolic BP but not diastolic ; and high cholesterol in midlife were associated with later development of Alzheimer's disease. The combination of both increased risk to a greater degree. 2. Participants who developed Alzheimer's were more likely to have received antihypertensive drug treatment. 3. "Our findings are partly corroborated by the only drug trial to date showing that blood pressure control may prevent dementia, which was carried out in patients with isolated systolic blood pressure." "Prevention of Dementia in Randomized, Double-blind, Placebo-controlled Systolic Hypertension in Europe Syst-Eur ; Trial" Lancet 1998; 352: 1347-51 ; 4. "Hypertension and hypercholesterolemia may increase the risk of dementia by inducing atherosclerosis and impairing blood flow, but they may also directly induce the neurodegeneration of Alzheimer's disease." CONCLUSION Raised systolic BP and high cholesterol concentrations, and particularly the combination, in midlife were associated with increased risk of Alzheimer's disease later in life. BMJ June 16, 2001; 322: Original investigation, first author Miia Kivipelto, University of Kuipo, Finland. bmj cgi content full 322 7300 1447 Comment: More a hypothesis-suggesting study than a conclusive study. We should treat and control both abnormalities in midlife. It is possible that there is an important benefit in addition to that on cardiovascular disease. RTJ and protonix.
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