Aging Research Center, NVS, Karolinska Institute, Stockholm, Sweden.
Dement Geriatr Cogn Disord. 2011;31(2):119-25. doi: 10.1159/000323810. Epub 2011 Jan 27.
BACKGROUND/AIMS: This study investigated the relation of midlife blood pressure, total cholesterol, body mass index (BMI), their changes over time, apolipoprotein E, and white matter lesions (WML).
Participants of the Cardiovascular Risk Factors, Aging and Incidence of Dementia study were derived from random, population-based samples previously surveyed in 1972, 1977, 1982 or 1987. In 1998, 1,449 (73%) individuals aged 65-79 years were re-examined (average follow-up 21 years). A subpopulation (n = 112) was scanned with a 1.5-tesla MRI scanner in 1998, and WML were assessed from fluid-attenuated inversion recovery images using a semi-quantitative visual rating scale.
Risk of late-life WML was related to midlife overweight (relative risk = 2.53; 95% CI = 1.70-2.89), obesity (2.94; 2.44-3.03), and hypertension (2.73; 1.81-3.08), even after adjustments for several confounding factors. Elevated BMI (>25) (2.26; 1.42-2.62) and hypertension (3.14; 1.83-3.40) from midlife to late life also increased the risk of WML. In addition, an association with WML was seen for decreasing blood pressure (hypertension at midlife but not at late life) (3.25; 2.46-3.41), even after controlling for antihypertensive treatment. Lipid-lowering drugs had a protective effect against WML (0.13; 0.02-0.59).
These results indicate that early and sustained vascular risk factor control is associated with a lower likelihood of having more severe WML in late life.
背景/目的：本研究探讨了中年血压、总胆固醇、体重指数（BMI）及其随时间的变化、载脂蛋白 E 和脑白质病变（WML）之间的关系。
心血管风险因素、衰老和痴呆发病率研究的参与者来自于之前于 1972 年、1977 年、1982 年或 1987 年进行的随机、基于人群的样本。1998 年，对 1449 名（73%）年龄在 65-79 岁的个体进行了重新检查（平均随访 21 年）。1998 年，对一个亚人群（n=112）使用 1.5 特斯拉 MRI 扫描仪进行了扫描，并使用半定量视觉评分量表从液体衰减反转恢复图像中评估 WML。
晚年 WML 的发病风险与中年超重（相对风险=2.53；95%置信区间=1.70-2.89）、肥胖（2.94；2.44-3.03）和高血压（2.73；1.81-3.08）相关，即使在调整了几个混杂因素后也是如此。从中年到晚年，BMI 升高（>25）（2.26；1.42-2.62）和高血压（3.14；1.83-3.40）也增加了 WML 的发病风险。此外，从中年到晚年血压下降（中年有高血压但晚年无高血压）（3.25；2.46-3.41）也与 WML 相关，即使在控制了降压治疗后也是如此。降脂药物对 WML 有保护作用（0.13；0.02-0.59）。
这些结果表明，早期和持续的血管危险因素控制与晚年更严重的 WML 发生可能性较低相关。
