18 Oct Aortic Stiffness is Associated with Increased Risk of Dementia in Older Adults
MedicalResearch.com Interview with:
Rachel H. Mackey, PhD, MPH, FAHA
Assistant Professor of Epidemiology
Graduate School of Public Health
University of Pittsburgh
MedicalResearch.com: What is the background for this study?
Response: “Hardening,” or stiffening, of the arteries is a risk factor for heart attacks and other cardiovascular disease. Arterial stiffness can be measured by pulse wave velocity (PWV), because the pulse pressure wave travels faster in stiffer arteries. Stiffer arteries transmit increased pulsatile blood flow to the brain and are linked with markers of silent, or subclinical, brain disease, which are related to increased risk of dementia. However, it was not clear whether arterial stiffening would predict risk of dementia, especially in older adults, who often have existing subclinical brain disease. Therefore, a University of Pittsburgh team, led by Chendi Cui, M.S, doctoral student, and Rachel Mackey, PhD, MPH, FAHA, assistant professor of epidemiology at Pitt Public Health, analyzed the association between arterial stiffness and 15-year risk of dementia among 356 older adults, with an average age of 78. Study participants were part of the Cardiovascular Health Study Cognition Study (CHS‐CS), a long‐term study to identify dementia risk factors, led by coauthors Oscar Lopez MD and Lewis Kuller, MD, DrPH. In 1996-2000, study participants had had arterial stiffness measured by pulse wave velocity (PWV), brain imaging by MRI, and had annual follow-up visits for cognitive status.
MedicalResearch.com: What are the main findings?
Response: The study, published today in the Journal of Alzheimer’s Disease found that among these older adults, higher arterial stiffness was related to 60% higher risk of dementia over 15 years. The increased risk was not explained by other cardiovascular or dementia risk factors, including age, blood pressure, diabetes, or subclinical brain disease markers. In fact, higher pulse wave velocity and higher degree of brain atrophy predicted dementia risk independently of each other. In contrast, blood pressure measures were not related to dementia risk. Finally, higher arterial stiffness was related to lower physical activity and higher blood pressure, heart rate, body mass index and waist circumference measured concurrently and measured 5 years prior.
MedicalResearch.com: What should readers take away from your report?
Response: Higher arterial stiffness was robustly associated with risk of dementia over long follow-up among these older adults, even among those with existing risk factors such as diabetes and brain atrophy. Associations of arterial stiffness with lower physical activity, and higher blood pressure, heart rate, and obesity measured 5 years prior, at average age of 73, highlight risk factors for arterial stiffness that may be modifiable even at advanced ages. This agrees with other studies showing that physical activity or anti-hypertensive medication interventions can reduce dementia risk even at older ages.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We and others are working on additional studies to 1) identify interventions that decrease the stiffness of the arterial wall, in addition to reducing blood pressure, and 2) test whether interventions that decrease arterial stiffness can prevent or delay dementia.
MedicalResearch.com: Is there anything else you would like to add?
Response: It is very exciting to identify a risk factor for dementia that should be modifiable even at advanced ages. However, prevention or slowing arterial stiffening should be a priority over the lifespan. Current evidence supports avoiding or controlling hypertension, avoiding obesity, and physical activity.
None of the authors have any disclosures relevant to this research.
Additional authors on this study include Akira Sekikawa, M.D., Ph.D., M.P.H., Lewis Kuller, M.D., Dr.P.H., Oscar Lopez, M.D., Anne Newman, M.D., M.P.H., and Allison Kuipers, Ph.D., all of Pitt. Drs. Lopez and Kuller directed the CHS‐CS study. Pitt’s Ultrasound Research Laboratory performed the PWV measurements. This research was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01‐HC55222, N01‐HC85079, N01‐HC85080, R01‐HL64587, and grants U01‐HL080295 and U01‐L130114 from the National Heart, Lung, and Blood Institute with additional contribution from the National Institute of Neurological Disorders and Stroke. The National Institute on Aging provided additional support through grants R01‐AG15928, R01‐AG023629, R01‐AG023629 and RF1‐AG051615.
J Alzheimers Dis. 2018 Sep 27. doi: 10.3233/JAD-180449. [Epub ahead of print]
Cui C1, Sekikawa A1, H Kuller L1, L Lopez O2, B Newman A1, L Kuipers A1, H Mackey R1.
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