动脉僵硬度与痴呆病理：动脉粥样硬化风险社区研究（ARIC）-正电子发射断层扫描（PET）研究。
Arterial stiffness and dementia pathology: Atherosclerosis Risk in Communities (ARIC)-PET Study.
机构信息
From the Departments of Internal Medicine (T.M.H., S.C.) and Radiology (A.M.), and Division of Public Health Sciences (L.E.W.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (G.H., P.P.), University of North Carolina at Chapel Hill; Departments of Radiology (D.W., Y.Z.) and Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson.
出版信息
Neurology. 2018 Apr 3;90(14):e1248-e1256. doi: 10.1212/WNL.0000000000005259. Epub 2018 Mar 16.
OBJECTIVE
Arterial stiffness has been associated with evidence of cerebral small vessel disease (cSVD) and fibrillar β-amyloid (Aβ) deposition in the brain. These complex relationships have not been examined in racially and cognitively diverse cohorts.
METHODS
The Atherosclerosis Risk in Communities (ARIC)-Neurocognitive Study collected detailed cognitive testing for adjudication of dementia and mild cognitive impairment (MCI), brain MRI, and arterial stiffness by pulse wave velocity (PWV, carotid-femoral [cfPWV] and heart-carotid [hcPWV]). The ARIC-PET ancillary study added Aβ imaging using florbetapir ([F]-AV-45) to obtain standardized uptake volume ratios and defined global Aβ-positivity as standardized uptake volume ratio >1.2. One-SD increase in PWV was related to brain volume, MRI-defined cSVD (e.g., cerebral microbleeds and white matter hyperintensity), and cortical Aβ deposition adjusted for age, body mass index, sex, race, and ε4 status. We examined the cross-sectional relationships including interactions by race, ε4 status, and cognition.
RESULTS
Among the 320 ARIC-PET participants (76 [5] years, 45% black, 27% MCI), greater central stiffness (hcPWV) was associated with greater Aβ deposition (odds ratio [OR] = 1.31, 95% confidence interval [CI] 1.01-1.71). Greater central stiffness (cfPWV) was significantly associated with having lower brain volumes in Alzheimer disease-susceptible regions (in mm, β = -1.5 [0.7 SD], = 0.03) and high white matter hyperintensity burden (OR = 1.6, 95% CI 1.2-2.1). Furthermore, cfPWV was associated with a higher odds of concomitant high white matter hyperintensity and Aβ-positive scans (OR = 1.4, 95% CI 1.1-2.1). These associations were strongest among individuals with MCI and did not differ by race or ε4 status.
CONCLUSIONS
Arterial stiffness, measured by PWV, is an emerging risk factor for dementia through its repeated relationships with cognition, cSVD, and Aβ deposition.
目的
动脉僵硬度与脑小血管疾病（cSVD）的证据以及脑内纤维状β-淀粉样蛋白（Aβ）沉积有关。这些复杂的关系尚未在种族和认知多样化的队列中进行检查。
方法
社区动脉粥样硬化风险（ARIC）-神经认知研究收集了详细的认知测试结果，以确定痴呆和轻度认知障碍（MCI）的诊断、脑 MRI 和动脉僵硬度（通过脉搏波速度（PWV）、颈股动脉 PWV（cfPWV）和心颈动脉 PWV（hcPWV）测量）。ARIC-PET 辅助研究使用 florbetapir([F]-AV-45) 进行了 Aβ 成像，以获得标准化摄取值比值，并将全球 Aβ 阳性定义为标准化摄取值比值＞1.2。PWV 每增加一个标准差与脑容量、MRI 定义的 cSVD（如脑微出血和脑白质高信号）以及皮质 Aβ 沉积有关，这些因素均经过年龄、体重指数、性别、种族和 ε4 状态的调整。我们检查了包括种族、ε4 状态和认知在内的交互作用的横断面关系。
结果
在 320 名 ARIC-PET 参与者（76±5 岁，45%为黑人，27%为 MCI）中，中央僵硬度（hcPWV）越大，Aβ 沉积越多（比值比 [OR] = 1.31，95%置信区间 [CI] 1.01-1.71）。中央僵硬度（cfPWV）越大，与阿尔茨海默病易感区域的脑容量越低（以毫米计，β=-1.5[0.7 标准差]， =0.03）和高脑白质高信号负荷（OR=1.6，95%CI 1.2-2.1）显著相关。此外，cfPWV 与同时存在高脑白质高信号和 Aβ 阳性扫描的可能性较高相关（OR=1.4，95%CI 1.1-2.1）。这些关联在 MCI 患者中最强，且与种族或 ε4 状态无关。
结论
通过与认知、cSVD 和 Aβ 沉积的反复关系，脉搏波速度（PWV）测量的动脉僵硬度是痴呆的一个新的危险因素。
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