NEJM Journal Watch
Jennifer Rose V. Molano, MD, reviewing
Behavioral, biological, and genetic measures of cardiovascular health are associated with MRI measures of vascular brain aging.
Cardiovascular health (CVH) has been associated with brain health. To explore this relationship further, investigators conducted a population-based cohort study that determined how global, behavioral, and biological CVH profiles as well as metabolic genetic risk factors are associated with MRI measures of vascular brain aging in 317 Swedish adults (age, ≥60 years; 62% women).
Favorable, intermediate, and unfavorable CVH profiles were determined at baseline by four behavioral factors (smoking, physical activity, dietary habits, and body-mass index) and three biological factors (total cholesterol, blood pressure, and fasting plasma glucose) from Life’s Simple 7 metrics for CVH from the American Heart Association (AHA). Metabolic genetic risk scores were determined by the presence of risk alleles for hypertension, diabetes, or dyslipidemia in DNA extracted from whole blood samples. Participants received baseline and one or more follow-up brain MRI scans over 6 years.
Results after adjustment for age, sex, and education were as follows:
- Favorable and intermediate versus unfavorable global CVH profiles were associated with slower white matter hyperintensity (WMH) progression.
- Intermediate versus unfavorable behavioral CVH profiles were associated with slower WMH progression.
- Intermediate and favorable versus unfavorable biological CVH profiles were associated with slower gray matter atrophy.
- High versus low metabolic genetic risk scores were associated with faster WMH progression, except in those with favorable global or behavioral CVH profiles.
- Intermediate versus low metabolic genetic risk scores were associated with faster grey matter atrophy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATIONS
Li Y et al. Association between behavioral, biological, and genetic markers of cardiovascular health and MRI markers of brain aging: A cohort study. Neurology 2022 Nov 1; [e-pub]. (https://doi.org/10.1212/WNL.0000000000201346)
COMMENT
These results provide further evidence that optimizing CVH is important for brain health. The AHA recently revised its Life’s Simple 7 approach to include sleep health as a part of its Life’s Essential 8 for CVH. To determine whether the inclusion of sleep health in a CVH profile affects MRI measures of vascular brain aging remains to be determined.