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Vascular risk factors associated with poor brain health

By Melanie Hinze
Vascular risk factors including smoking, hypertension and diabetes, have been linked with brain atrophy, reduced grey matter volume and poorer white matter health in a recent study published in the European Heart Journal.

The study examined the associations between multiple vascular risk factors and brain structural and diffusion MRI markers in 9722 community dwelling adults aged between 44 and 79 years from the UK Biobank – a large general population cohort containing both brain imaging and vascular risk factor data.

Smoking, hypertension, pulse pressure, diabetes, hypercholesterolaemia, body mass index and waist-hip ratio were investigated, along with brain MRI data.

With the exception of hypercholesterolaemia, all other vascular risk factors were linked with brain atrophy, reduced grey matter and poorer white matter health. Smoking, hypertension and diabetes had the most consistent associations across all brain measures, and larger numbers of vascular risk factors were linked with poorer brain health across both grey and white matter macro- and microstructure.

The researchers found that the brain effects were most pronounced in areas linked with increased susceptibility to stroke and hypoperfusion, and typical Alzheimer’s disease atrophy, and in the white matter pathways facilitating their connectivity.

Heart Foundation Chief Medical Advisor, Professor Garry Jennings, said that while these results were not likely to impact clinical practice immediately, they provided interesting insights into associations between well-known vascular risk factors and brain and cognitive ageing. They also provided useful direction to researchers and clinicians for future research in this area.

‘The results also reinforce the importance of risk factor screening in older adults (as recommended by guidelines) and indeed awareness of vascular risk factors in younger age groups as a way of ensuring long-term cardiovascular and cognitive health’, he told Cardiology Today.

The researchers said their findings emphasised ‘the vulnerability of brain health to vascular factors even in relatively healthy middle and older age, and the potential to partly ameliorate cognitive decline by addressing these malleable risk factors.’
Eur Heart J 2019; 00: 1–11; doi: 10.1093/eurheartj/ehz100.