Kearney-Schwartz Anna, Rossignol Patrick, Bracard Serge, Felblinger Jacques, Fay Renaud, Boivin Jean-Marc, Lecompte Thomas, Lacolley Patrick, Benetos Athanase, Zannad Faiez
Nancy University Hospital, Clinical Investigation Centre, J d'Arc Hospital, Dommartin lès Toul, France.
Stroke. 2009 Apr;40(4):1229-36. doi: 10.1161/STROKEAHA.108.532853. Epub 2009 Feb 26.
Arterial stiffening and thickening and endothelial dysfunction may be associated with cognitive decline or white matter hyperintensities (WMH) independently of blood pressure level. We aimed to investigate, using an integrative approach, the relative contributions of structural and functional vascular factors to the degree of cognitive impairment (primary outcome) and the severity of WMH (secondary outcome) in elderly hypertensive patients with subjective memory complaints, a group prone to dementia.
A prospective, dedicated, cross-sectional population of 198 elderly hypertensive patients (mean age 69.3+/-6.2 years) with subjective memory complaints underwent a full set of cognitive function assessments, brain MRI with semiquantification of WMH, carotid ultrasonography, carotid-femoral pulse wave velocity, brachial endothelial function, and plasma von Willebrand Factor measurements.
After adjustment for the usual cardiovascular risk factors, increased arterial stiffness (as assessed by pulse wave velocity) was significantly and independently associated with memory impairment in men. The severity of WMH was independently associated with increased carotid intima media thickness and stiffness (as assessed by augmentation index) as well as with increased age and plasma levels of von Willebrand Factor, a biomarker of endothelial dysfunction.
Our data suggest that vascular abnormalities, independently of blood pressure levels, may play a role in the setting of subjective memory complaints as well as of WMH in elderly hypertensive patients. Arterial thickness and stiffness as well as endothelial function should be assessed simultaneously and may represent additional targets for the prevention of subjective memory complaints and WMH.
动脉僵硬度增加、动脉壁增厚以及内皮功能障碍可能与认知功能减退或白质高信号（WMH）相关，且独立于血压水平。我们旨在采用综合方法，研究在有主观记忆障碍主诉的老年高血压患者（这是一个易患痴呆症的群体）中，血管结构和功能因素对认知障碍程度（主要结局）和WMH严重程度（次要结局）的相对贡献。
对198例有主观记忆障碍主诉的老年高血压患者（平均年龄69.3±6.2岁）进行前瞻性、专门的横断面研究，这些患者接受了全套认知功能评估、脑MRI检查并对WMH进行半定量分析、颈动脉超声检查、颈股脉搏波速度测量、肱动脉内皮功能检测以及血浆血管性血友病因子测量。
在对常见心血管危险因素进行校正后，动脉僵硬度增加（通过脉搏波速度评估）与男性记忆障碍显著且独立相关。WMH的严重程度与颈动脉内膜中层厚度增加、僵硬度增加（通过增强指数评估）以及年龄增加和血管性血友病因子血浆水平升高独立相关，血管性血友病因子是内皮功能障碍的生物标志物。
我们的数据表明，血管异常独立于血压水平，可能在老年高血压患者主观记忆障碍以及WMH的发生中起作用。应同时评估动脉厚度和僵硬度以及内皮功能，它们可能是预防主观记忆障碍和WMH的额外靶点。
