期刊
JOURNAL OF ALZHEIMERS DISEASE
卷 66, 期 1, 页码 297-306出版社
IOS PRESS
DOI: 10.3233/JAD-180449
关键词
Dementia; pulse wave velocity; risk factors; vascular stiffness
资金
- National Heart, Lung, and Blood Institute (NHLBI) [HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC 85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, R01HL64587, U01HL080295, U01HL130114]
- National Institute of Neurological Disorders and Stroke (NINDS)
- National Institute on Aging (NIA) [R01AG15928, R01AG20098, R01AG023629, RF1AG051615]
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [K01HL125658, U01HL130114, U01HL080295, R01HL064587, R01HL085083] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES [R21ES029734] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE ON AGING [P50AG005133, R01AG020098, R01AG015928, R01AG023629, RF1AG051615] Funding Source: NIH RePORTER
Cardiovascular disease risk factors, including age, hypertension, and diabetes, contribute to aortic stiffness and subclinical cardiovascular and brain disease, increasing dementia risk. Aortic stiffness, measured by carotid-femoral pulse wave velocity (cfPWV), reduces the buffering of pulsatile blood flow, exposing cerebral small arteries to microvascular damage. High cfPWV is related to white matter hyperintensities and brain amyloid deposition, and to cognitive decline, but it is unclear whether cfPWV independently predicts incident dementia. Therefore, we tested the hypothesis that cfPWV predicts incident dementia in older adults, independent of potential confounders. The Cardiovascular Health Study Cognition Study followed 532 non-demented older adults with annual cognitive exams from 1998-99 through 2013. CfPWV was measured on 356 (mean age = 78, 59% women) between 1996-2000. Over 15 years, 212 (59.6%) developed dementia (median time from cfPWV measurement = 4 years). In age and sex-adjusted Cox models, cfPWV was significantly associated with increased risk of dementia, but systolic blood pressure, mean arterial pressure and pulse pressure were not. CfPWV (transformed as -1/cfPWV) remained significantly associated with dementia risk when further adjusted for education, race, APOE epsilon 4, diabetes, body mass index, mean arterial pressure, and anti-hypertensive medication (hazard ratio = 1.60, 95%CI = 1.02, 2.51). Results were similar when further adjusted for baseline global cognition, subclinical brain measures, and coronary artery calcification. Finally, higher cfPWV was related to lower physical activity intensity and higher systolic blood pressure, heart rate, and waist circumference measured 5 years prior. An important unanswered question is whether interventions to slow arterial stiffening can reduce the risk of dementia.
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