From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.).
Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.).
Hypertension. 2020 Jun;75(6):1607-1614. doi: 10.1161/HYPERTENSIONAHA.119.14307. Epub 2020 Apr 10.
The mechanisms underlying cognitive impairment are incompletely understood but may include arterial stiffness and microvascular dysfunction. In the population-based Maastricht Study, we investigated the association between arterial stiffness and cognitive performance, and whether any such association was mediated by microvascular dysfunction. We included cross-sectional data of 2544 participants (age, 59.7 years; 51.0% men; 26.0% type 2 diabetes mellitus). We used carotid-femoral pulse wave velocity and carotid distensibility coefficient as measures of aortic and carotid stiffness, respectively. We calculated a composite score of microvascular dysfunction based on magnetic resonance imaging features of cerebral small vessel disease, flicker light-induced retinal arteriolar and venular dilation response, albuminuria, and plasma biomarkers of microvascular dysfunction (sICAM-1 [soluble intercellular adhesion molecule-1], sVCAM-1 [soluble vascular adhesion molecule-1], sE-selectin [soluble E-selectin], and vWF [von Willebrand factor]). Cognitive domains assessed were memory, processing speed, and executive function. A cognitive function score was calculated as the average of these domains. Higher aortic stiffness (per m/s) was associated with lower cognitive function (β, -0.018 SD [95% CI, -0.036 to -0.000]) independent of age, sex, education, and cardiovascular risk factors, but higher carotid stiffness was not. Higher aortic stiffness (per m/s) was associated with a higher microvascular dysfunction score (β, 0.034 SD [95% CI, 0.014 to 0.053]), and a higher microvascular dysfunction score (per SD) was associated with lower cognitive function (β, -0.089 SD [95% CI, -0.124 to -0.053]). Microvascular dysfunction significantly explained 16.2% of the total effect of aortic stiffness on cognitive function. The present study showed that aortic stiffness, but not carotid stiffness, is independently associated with worse cognitive performance, and that this association is in part explained by microvascular dysfunction.
认知障碍的机制尚不完全清楚，但可能包括动脉僵硬和微血管功能障碍。在基于人群的马斯特里赫特研究中，我们研究了动脉僵硬与认知表现之间的关系，以及这种关系是否通过微血管功能障碍来介导。我们纳入了 2544 名参与者的横断面数据（年龄 59.7 岁；51.0%为男性；26.0%患有 2 型糖尿病）。我们分别使用颈股脉搏波速度和颈动脉扩张系数作为主动脉和颈动脉僵硬的测量指标。我们根据脑小血管病的磁共振成像特征、闪烁光诱导的视网膜小动脉和小静脉扩张反应、白蛋白尿和微血管功能障碍的血浆生物标志物（可溶性细胞间黏附分子-1[sICAM-1]、可溶性血管细胞黏附分子-1[sVCAM-1]、可溶性 E 选择素[sE-选择素]和血管性血友病因子[vWF]）计算微血管功能障碍的综合评分。评估的认知域包括记忆、处理速度和执行功能。计算这些域的平均作为认知功能评分。动脉僵硬每增加 1m/s（per m/s）与认知功能降低相关（β，-0.018 标准差[95%置信区间，-0.036 至-0.000]），独立于年龄、性别、教育程度和心血管危险因素，但颈动脉僵硬的增加则不然。动脉僵硬每增加 1m/s（per m/s）与微血管功能障碍评分升高相关（β，0.034 标准差[95%置信区间，0.014 至 0.053]），微血管功能障碍评分每升高 1 个标准差（per SD）与认知功能降低相关（β，-0.089 标准差[95%置信区间，-0.124 至-0.053]）。微血管功能障碍显著解释了动脉僵硬对认知功能总效应的 16.2%。本研究表明，主动脉僵硬，而不是颈动脉僵硬，与认知表现较差独立相关，而这种关联部分是由微血管功能障碍解释的。
