低心排血量与新发痴呆症和阿尔茨海默病相关：弗雷明汉心脏研究
Low cardiac index is associated with incident dementia and Alzheimer disease: the Framingham Heart Study.
作者信息
Jefferson Angela L, Beiser Alexa S, Himali Jayandra J, Seshadri Sudha, O'Donnell Christopher J, Manning Warren J, Wolf Philip A, Au Rhoda, Benjamin Emelia J
机构信息
From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
出版信息
Circulation. 2015 Apr 14;131(15):1333-9. doi: 10.1161/CIRCULATIONAHA.114.012438. Epub 2015 Feb 19.
BACKGROUND
Cross-sectional epidemiological and clinical research suggests that lower cardiac index is associated with abnormal brain aging, including smaller brain volumes, increased white matter hyperintensities, and worse cognitive performances. Lower systemic blood flow may have implications for dementia among older adults.
METHODS AND RESULTS
A total of 1039 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, and dementia formed our sample (age, 69±6 years; 53% women). Multivariable-adjusted proportional hazard models adjusting for Framingham Stroke Risk Profile score (age, sex, systolic blood pressure, antihypertensive medication, diabetes mellitus, cigarette smoking, cardiovascular disease history, atrial fibrillation), education, and apolipoprotein E4 status related cardiac magnetic resonance imaging-assessed cardiac index (cardiac output divided by body surface area) to incident all-cause dementia and Alzheimer disease (AD). Over the median 7.7-year follow-up period, 32 participants developed dementia, including 26 cases of AD. Each 1-SD unit decrease in cardiac index increased the relative risk of both dementia (hazard ratio [HR]=1.66; 95% confidence interval [CI], 1.11-2.47; P=0.013) and AD (HR=1.65; 95% CI, 1.07-2.54; P=0.022). Compared with individuals with normal cardiac index, individuals with clinically low cardiac index had a higher relative risk of dementia (HR=2.07; 95% CI, 1.02-4.19; P=0.044). If participants with clinically prevalent cardiovascular disease and atrial fibrillation were excluded (n=184), individuals with clinically low cardiac index had a higher relative risk of both dementia (HR=2.92; 95% CI, 1.34-6.36; P=0.007) and AD (HR=2.87; 95% CI, 1.21-6.80; P=0.016) compared with individuals with normal cardiac index.
CONCLUSION
Lower cardiac index is associated with an increased risk for the development of dementia and AD.
背景
横断面流行病学和临床研究表明，较低的心指数与大脑异常老化有关，包括脑容量减小、白质高信号增加以及认知表现变差。较低的全身血流量可能对老年人的痴呆症产生影响。
方法和结果
共有1039名无临床中风、短暂性脑缺血发作和痴呆症的弗雷明汉后代队列参与者构成了我们的样本（年龄69±6岁；53%为女性）。多变量调整的比例风险模型对弗雷明汉中风风险概况评分（年龄、性别、收缩压、抗高血压药物、糖尿病、吸烟、心血管疾病史、心房颤动）、教育程度和载脂蛋白E4状态进行了调整，将心脏磁共振成像评估的心指数（心输出量除以体表面积）与全因痴呆症和阿尔茨海默病（AD）的发病情况相关联。在中位7.7年的随访期内，32名参与者患上了痴呆症，其中包括26例AD。心指数每降低1个标准差单位，痴呆症（风险比[HR]=1.66；95%置信区间[CI]为1.11 - 2.47；P=0.013）和AD（HR=1.65；95%CI为1.07 - 2.54；P=0.022）的相对风险都会增加。与心指数正常的个体相比，临床心指数较低的个体患痴呆症的相对风险更高（HR=2.07；95%CI为1.02 - 4.19；P=0.044）。如果排除临床普遍存在心血管疾病和心房颤动的参与者（n = 184），与心指数正常的个体相比，临床心指数较低的个体患痴呆症（HR=2.92；95%CI为1.34 - 6.36；P=0.007）和AD（HR=2.87；95%CI为1.21 - 6.80；P=0.016）的相对风险更高。
结论
较低的心指数与痴呆症和AD发病风险增加有关。
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