In a recent announcement, renowned actor Chris Hemsworth (of Marvel fame) shared his ApoE 4/4 genotype, igniting a very public conversation regarding genetic risk factors associated with Alzheimer’s Disease. As the ApoE genotype plays a central role in the disease risk analysis we utilize here at the Prevention Center for Heart and Brain Health, Hemsworth’s announcement provides an opportunity to review the importance of ApoE genotypes while highlighting the utility of the Bale Doneen Method to mitigate genetic risk through personalized medicine and intensive lifestyle modifications.

As a review, Apolipoprotein E — or ApoE — is a protein involved in the transport and metabolism of cholesterol and other lipids. ApoE exists in different forms (with one inherited from each parent), ApoE2, ApoE3, and ApoE4. Research has clearly demonstrated a connection between the ApoE4 genotype and an increased risk for developing Alzheimer’s Disease. Since each individual carries two copies of the ApoE gene, it is possible to carry not one, but two copies of the ApoE4 gene, a situation affecting about 2-5% of the American population, including Hemsworth. 

Individuals who inherit one copy of the ApoE4 allele from either parent have roughly three times the risk of developing Alzheimer’s Disease when compared to those without the allele. In fact, 45-60% of those diagnosed with Alzheimer’s Disease have at least one copy of ApoE4.

Hemsworth’s decision to make his ApoE genotype public was a brave, unexpected, and important step toward raising public awareness of the genetic risk factor, encouraging others to learn more about their individualized risk. However, reports that he will step back from his acting career based on his Apo E 4/4 genetics (which he has since clarified) reveal a huge opportunity to remind both the public and the medical community that genetics are not our destiny. While the ApoE4 risk is well-established, genetics are just one piece of the puzzle.

In the now dual-award winning Healthy Heart Healthy Brain, Drs. Doneen and Bale emphasize the strong connection between genetics, cardiovascular health and brain health. The book outlines several targeted genetic markers associated with increased or decreased risk for disease, while emphasizing lifestyle, diet, targeted supplementation and appropriate medical therapy as a part of a comprehensive and individualized prevention program. 

We know from decades of research utilizing Bale Doneen Method that genetics should play a key role in identifying individuals at increased risk for disease, subsequently driving individualized recommendations. For instance, initial genetic testing may reveal one copy of ApoE4 and one copy of 9P21 (“the heart attack gene”). This testing provides us with information about potential future risk, allowing for the personalization of treatment and monitoring. This individual, for example, wold want to be extremely proactive in terms of preventing insulin resistance and Type 2 Diabetes, as newer research has highlighted the connection between insulin resistance and the development of Alzheimer’s Disease.

In our most recent publication, “The critical issue linking lipids and inflammation: Clinical utility of stopping oxidative stress,” Drs. Doneen, Bale and Leimgruber discuss the impact of oxidative stress (inflammation) on the manifestation of disease in those at a genetically increased risk. It is vital to partner any conversation about genetic risk factors with a conversation about monitoring and lowering inflammation. Maintaining optimal health to lower levels of inflammation has a significant and positive impact on the future development of both cardiovascular and brain diseases such as Alzheimer’s.

If an individual becomes aware of a high-risk genotype such as ApoE4/4, the first response may understandably be fear. At the Prevention Center, however, we encourage a paradigm shift, seeing this information as a roadmap to plan a highly personalized prevention plan. Genetic markers essentially give patients and their healthcare providers a “heads up” for what may be lurking in the future if oxidative stress, inflammation and other risk factors are not well-managed. Along with stabilizing vascular disease, it is well documented that maintaining optimal oral health, optimal blood pressure management and treating sleep apnea are key factors in reducing Alzheimer’s risk.

The recent media attention surrounding ApoE genotypes will undoubtedly continue to spur important conversations about genetics and disease risk; it is our job to remind the public that genetics are only part of the story. A personalized prevention program based on a healthy lifestyle and targeted interventions can absolutely impact the expression of genes, even high-risk ones, throughout the lifespan.

If you, or someone you love, are experiencing fear regarding the future risk for either cardiovascular or brain disease, genetic testing is helpful but regardless of results, there is hope. Healthy Heart, Healthy Brain has recently been awarded the American Society for Journalists and Authors’ (ASJA) 2023 June Roth Memorial Award for Outstanding Medical Book, along with the 2023 Nautilus Award. The book offers a wealth of knowledge on the personalization and prevention of arterial disease, which includes both cardiovascular and brain disorders, and will provide a great deal of direction and hope for anyone experiencing anxiety regarding their genetic testing results.