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Cox SR, Lyall DM, Ritchie SJ, Bastin ME, Harris MA, Buchanan CR, Fawns-Ritchie C, Barbu MC, de Nooij L, Reus LM, Alloza C, Shen X, Neilson E, Alderson HL, Hunter S, Liewald DC, Whalley HC, McIntosh AM, Lawrie SM, Pell JP, Tucker-Drob EM, Wardlaw JM, Gale CR, Deary IJ. Associations between vascular risk factors and brain MRI indices in UK Biobank. Eur Heart J 2020; 40:2290-2300. [PMID: 30854560 PMCID: PMC6642726 DOI: 10.1093/eurheartj/ehz100] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/23/2019] [Accepted: 02/19/2019] [Indexed: 12/30/2022] Open
Abstract
Aims Several factors are known to increase risk for cerebrovascular disease and dementia, but there is limited evidence on associations between multiple vascular risk factors (VRFs) and detailed aspects of brain macrostructure and microstructure in large community-dwelling populations across middle and older age. Methods and results Associations between VRFs (smoking, hypertension, pulse pressure, diabetes, hypercholesterolaemia, body mass index, and waist–hip ratio) and brain structural and diffusion MRI markers were examined in UK Biobank (N = 9722, age range 44–79 years). A larger number of VRFs was associated with greater brain atrophy, lower grey matter volume, and poorer white matter health. Effect sizes were small (brain structural R2 ≤1.8%). Higher aggregate vascular risk was related to multiple regional MRI hallmarks associated with dementia risk: lower frontal and temporal cortical volumes, lower subcortical volumes, higher white matter hyperintensity volumes, and poorer white matter microstructure in association and thalamic pathways. Smoking pack years, hypertension and diabetes showed the most consistent associations across all brain measures. Hypercholesterolaemia was not uniquely associated with any MRI marker. Conclusion Higher levels of VRFs were associated with poorer brain health across grey and white matter macrostructure and microstructure. Effects are mainly additive, converging upon frontal and temporal cortex, subcortical structures, and specific classes of white matter fibres. Though effect sizes were small, these results emphasize 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.
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Affiliation(s)
- Simon R Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK
| | - Donald M Lyall
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.,Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - Stuart J Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, UK
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.,Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK
| | - Mathew A Harris
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Colin R Buchanan
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK
| | - Chloe Fawns-Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK
| | - Miruna C Barbu
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Laura de Nooij
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Lianne M Reus
- Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, VU University Amsterdam, Amsterdam UMC, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - Clara Alloza
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Xueyi Shen
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Emma Neilson
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | | | - Stuart Hunter
- NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, UK
| | - David C Liewald
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK
| | - Heather C Whalley
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Andrew M McIntosh
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Stephen M Lawrie
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - Elliot M Tucker-Drob
- Department of Psychology, University of Texas, 108 E Dean Keeton St, Austin, Texas, USA
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.,Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK.,UK Dementia Research Institute at the University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK
| | - Catharine R Gale
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK
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Gregory MA, Manuel-Apolinar L, Sánchez-Garcia S, Villa Romero AR, de Jesús Iuit Rivera J, Basurto Acevedo L, Grijalva-Otero I, Cuadros-Moreno J, Garcia-de la Torre P, Guerrero Cantera J, Garcia Dominguez JA, Martínez Gallardo S, Vega Garcia S, Mejía Alonso LA, Sánchez-Arenas R. Soluble Intercellular Adhesion Molecule-1 (sICAM-1) as a Biomarker of Vascular Cognitive Impairment in Older Adults. Dement Geriatr Cogn Disord 2020; 47:243-253. [PMID: 31408858 DOI: 10.1159/000500068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 04/01/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Endothelial dysfunction and subsequent inflammation contribute to the development of vascular cognitive impairment (VCI). Soluble intercellular adhesion molecule-1 (sICAM-1) is upregulated in endothelial dysfunction and promotes an inflammatory response; however, the relationship between sICAM-1 and VCI remains equivocal. OBJECTIVE To determine whether sICAM-1 contributes to the prediction of VCI. METHODS Community-dwelling older adults (n = 172) from the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA) study were identified as VCI or controls using standard neuropsychological evaluations and neuroimaging. sICAM-1 was quantified using ELISA, and multivariate logistic regression determined the association between sICAM-1 and VCI. RESULTS A total of 31 VCI cases were identified. sICAM-1 was higher in VCI (VCI: 450.7 [241.6] ng/mL vs. controls: 296.9 [140.9] ng/mL). sICAM-1 concentrations above the 90th percentile (464.1 ng/mL) were associated with VCI group membership in all models (OR: 6.9, 95% CI: 1.1-42.2). The final saturated model explained 64% of the variance in VCI group membership. CONCLUSION High concentrations of sICAM-1 are independently associated with VCI group membership. Efforts to further characterize the relationship between indices of endothelial dysfunction and pathological changes to the aging brain should be further pursued.
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Affiliation(s)
- Michael A Gregory
- Department of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Leticia Manuel-Apolinar
- Endocrine Research Unit, Centro Medico Nacional, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Sergio Sánchez-Garcia
- Research Unit in Epidemiology and Health Services. Aging Area, Centro Médico Nacional, IMSS, Mexico City, Mexico
| | | | - Jaime de Jesús Iuit Rivera
- Specialties Hospital "Dr. Bernardo Sepúlveda Gutiérrez" Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Lourdes Basurto Acevedo
- Endocrine Research Unit, Centro Medico Nacional, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Israel Grijalva-Otero
- Medical Research Unit in Neurological Diseases, Centro Médico Nacional, IMSS, Mexico City, Mexico
| | - Juan Cuadros-Moreno
- Innovation Division. Health Education Coordination, IMSS, Mexico City, Mexico
| | - Paola Garcia-de la Torre
- Medical Research Unit in Neurological Diseases, Centro Médico Nacional, IMSS, Mexico City, Mexico
| | | | | | - Sergio Martínez Gallardo
- Specialties Hospital "Dr. Bernardo Sepúlveda Gutiérrez" Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Sara Vega Garcia
- Endocrine Research Unit, Centro Medico Nacional, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Laura Alejandra Mejía Alonso
- Specialties Hospital "Dr. Bernardo Sepúlveda Gutiérrez" Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
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Gorelick PB, Qureshi S, Farooq MU. Management of blood pressure in stroke. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2019; 3:100021. [PMID: 33447751 PMCID: PMC7803067 DOI: 10.1016/j.ijchy.2019.100021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/09/2019] [Indexed: 01/01/2023]
Abstract
Objective In this review and opinion piece, we discuss recent United States (US)-based guidance statements on the management of BP in stroke according to stroke type and stage of stroke. Methods We reviewed the most recent guidance statements on BP control from United States (US)-based organizations such as the American Heart Association/American Stroke Association (AHA/ASA) and American College of Cardiology (ACC), and articles available to the authors in their personal files. Results The key BP target before starting alteplase (t-PA) is < 185/110 mm Hg, and the maintenance BP after tPA administration is < 180/105 mm Hg. For IPH patients with systolic BP between 150 and 220 mm Hg and no contraindication to acute BP reduction therapy, acute lowering to 140 mm Hg systolic BP is safe. For persons with small vessel or lacunar cerebral ischemia, a reasonable BP lowering target is < 130 mm Hg systolic. For primary stroke prevention, the target BP for those with hypertension is < 140/90 mm Hg and self-measured BP is recommended to assist in BP control. Recent study and guidance suggest a BP target of <130/80 mm Hg for both primary and recurrent stroke prevention. BP control is reasonable for the prevention of cognitive decline or dementia. Conclusions BP targets for the proper management of stroke vary by chronological stage of stroke and by stroke subtype. Furthermore, consideration should be given to control of BP variability, especially in the acute phases of stroke, as it may play a role in conferring longer term outcomes. Stroke is an important cause of morbidity and mortality worldwide, and is well suited for prevention and acute treatment with proper BP management. BP targets in acute ischemic stroke vary whether intravenous alteplase is administered or an endovascular intervention is implemented or not. In acute intraparenchymal hemorrhage of the brain (IPH), it is reasonable to lower BP to a systolic level of 140–150 or up to 160 mm Hg. For both first and recurrent stroke prevention it is reasonable to aim for a BP target of <130/80 mm Hg based on the recent data. The revised BP target has been lowered to <130/80 mm Hg for prevention of major cardiovascular outcomes including stroke. Intensive BP control potentially preserves cognition, brain health, and brain structural integrity. Blood pressure variability is a new target for study in the acute treatment and prevention of stroke.
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Affiliation(s)
- Philip B Gorelick
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Translational Neuroscience, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Shakaib Qureshi
- Hauenstein Neurosciences, 220 Cherry Street SE, Grand Rapids, MI 49503, USA
| | - Muhammad U Farooq
- Hauenstein Neurosciences, 220 Cherry Street SE, Grand Rapids, MI 49503, USA
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