Williamson, Wilby, Lewandowski, Adam J., Forkert, Nils D., Griffanti, Ludovica, Okell, Thomas W., Betts, Jill, Boardman, Henry, Siepmann, Timo, McKean, David, Huckstep, Odaro, Francis, Jane M., Neubauer, Stefan, Phellan, Renzo, Jenkinson, Mark, Doherty, Aiden, Dawes, Helen, Eleni, Frangou, Malamateniou, Christina, Foster, Charlie and Leeson, Paul (2018) Association of cardiovascular risk factors with MRI indices of cerebrovascular structure and function and white matter hyperintensities in young adults. JAMA: the Journal of the American Medical Association, 320 (7). pp. 665-673. ISSN 0098-7484 (Print), 1538-3598 (Online) (doi:10.1001/jama.2018.11498)

Preview

PDF (Author Draft Manuscript) 15994_MALAMATENIOU_Association_of_Cardiovascular_Risk_Factors_with_MRI_Indices_of_Cerebrovascular_Structure_2018.pdf - Draft Version Download (1MB) | Preview

Abstract

Importance:
Risk of stroke and brain atrophy in later life relate to levels of cardiovascular risk in early adulthood. However, it is unknown whether cerebrovascular changes are already present in young adults.

Objective:
To examine relationships between modifiable cardiovascular risk factors and cerebrovascular structure, function and white matter integrity in young adults.

Design, Setting, and Participants:
A cross-sectional observational study completed between August 2014 and May 2016 at the University of Oxford, United Kingdom. Participants recruited through active and passive recruitment from the local community, including invitation from the Oxford University Hospitals Hypertension Service.

Exposures:
Clinic and ambulatory blood pressure (mmHg), body mass index (kg/m2), objective physical activity (hours/week), alcohol intake (drinks/week), smoking (pack years), peak oxygen uptake (ml/kg/min), peak exercise blood 65 pressure (mmHg), lipid profile (mg/dL), insulin resistance and use of anti-66 hypertension medication. 67

Main Outcomes and Measures:
Cerebral vessel density (vessels/cm3), caliber (μm) and tortuosity, brain white matter hyperintensity lesion count (number), and in a subgroup (n=52) brain blood arrival time (seconds) and cerebral blood flow (ml/100g/min) assessed by brain magnetic resonance.

Results:
125 participants (mean age 25±5 years, 49% female) were recruited. Cerebrovascular morphology and white matter hyperintensity count correlated with cardiovascular risk factors in univariable and multivariable models. In a risk score, for each healthier modifiable risk factor, characterised as: ambulatory blood pressure ; BMI < 25kg/m2; top tertile of cardiovascular fitness; non-smoker; <8 alcoholic drinks/week; normotensive exercise blood pressure response; cholesterol <200mg/dL; and fasting glucose <100mg/dL, vessel density increased by 0.3 vessels/cm3 (95%CI 0.1 to 0.5, p=0.003), vessel caliber by 8μm (95%CI 3 to 13, p=0.01) and white matter hyperintensity lesions reduced by 1.6 lesions (95%CI 0.6 to 2.8, p=0.006). In subgroup analysis, cerebral blood flow varied with vessel density and increased by 2.5ml/min/100g per risk score (95%CI 0.05 to 4.98, p=0.05).

Conclusions and Relevance:
In this preliminary study, involving young adults without clinical evidence of cerebrovascular disease, modifiable cardiovascular risk factors were associated with MR indices of cerebral vessel structure and function, and white matter hyperintensities. Further research is needed to determine the clinical importance of these findings for the primordial prevention of cerebrovascular disease.

Item Type:	Article
Uncontrolled Keywords:	brain health, cardiovascular risk factors, young adults
Subjects:	R Medicine > R Medicine (General)
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Health & Society Research Group Faculty of Education, Health & Human Sciences > School of Health Sciences (HEA)
Last Modified:	07 Oct 2021 21:02
URI:	http://gala.gre.ac.uk/id/eprint/15994

Actions (login required)

View Item

Downloads