Assessment and treatment of cardiovascular disease (CVD) risk factors as a preventable cause of cognitive decline, morbidity and mortality is an important clinical goal. The apolipoprotein E (Apo E) gene provides a genetic link between CVD and the development of Alzheimer's disease (AD). The E4 allele increases the risk of coronary heart disease by more than 40% and contributes to the development of late-onset AD in more than 50% of affected patients. Disease expression in the presence of this allele is triggered by interaction with modifiable risk factors such as smoking, alcohol intake and high-calorie diets. It also displays differential therapeutic responses with use of cholesterol-lowering statins and acetylcholinesterase inhibitors. Apo E genotyping as part of a comprehensive evaluation of multiple CVD risk factors, performed in conjunction with nutrition and cognitive assessments, provides the opportunity to optimise treatment to the needs of the individual.