Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Bioingeniería, Biomateriales y Nanomedicina, Madrid, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
J Am Coll Cardiol. 2021 Feb 23;77(7):888-898. doi: 10.1016/j.jacc.2020.12.027.
Atherosclerosis has been linked to cognitive decline in late life; however, the impact of cardiovascular risk factors (CVRFs) and subclinical atherosclerosis on brain metabolism at earlier stages remains unexplored.
This study sought to determine the association between brain metabolism, subclinical atherosclerosis, and CVRFs in middle-aged asymptomatic individuals.
This study included 547 asymptomatic middle-aged participants (50 ± 4 years, 82% men) from the PESA (Progression of Early Subclinical Atherosclerosis) study with evidence of subclinical atherosclerosis. Participants underwent F-fluorodeoxyglucose (FDG)-positron emission tomography. Global brain FDG uptake and voxel-wise analyses were used to evaluate the associations of cerebral metabolism with CVRFs and atherosclerotic plaque burden in carotids and femorals assessed by 3-dimensional vascular ultrasound.
Global FDG uptake showed an inverse correlation with 30-year Framingham Risk Score (FRS) (β = -0.15, p < 0.001). This association was mainly driven by the presence of hypertension (d = 0.36, p < 0.001). Carotid plaque burden was inversely associated with global brain FDG uptake (β = -0.16, p < 0.001), even after adjusting for 30-year FRS. Voxel-wise approaches revealed that the brain areas most strongly affected by hypometabolism in association with 30-year FRS, hypertension, and carotid plaque burden were parietotemporal regions (angular, supramarginal, and inferior/middle temporal gyri) and the cingulate gyrus.
In asymptomatic middle-aged individuals, cardiovascular risk is associated with brain hypometabolism, with hypertension being the modifiable CVRF showing the strongest association. Subclinical carotid plaque burden is also linked to reduced brain metabolism independently of CVRFs. Cerebral areas showing hypometabolism include those known to be affected in dementia. These data reinforce the need to control CVRFs early in life in order to potentially reduce the brain's midlife vulnerability to future cognitive dysfunction.
动脉粥样硬化与晚年认知能力下降有关；然而，心血管风险因素（CVRFs）和亚临床动脉粥样硬化对早期大脑代谢的影响仍未得到探索。
本研究旨在确定中年无症状个体的大脑代谢、亚临床动脉粥样硬化与 CVRFs 之间的关系。
本研究纳入了来自 PESA（早期亚临床动脉粥样硬化进展）研究的 547 名无症状中年参与者（50±4 岁，82%为男性），这些参与者有亚临床动脉粥样硬化的证据。参与者接受 F-氟脱氧葡萄糖（FDG）-正电子发射断层扫描。使用全局脑 FDG 摄取和体素分析来评估大脑代谢与 CVRFs 以及通过三维血管超声评估的颈动脉和股动脉粥样硬化斑块负担之间的关系。
全局 FDG 摄取与 30 年Framingham 风险评分（FRS）呈负相关（β=-0.15，p<0.001）。这种关联主要是由高血压的存在驱动的（d=0.36，p<0.001）。颈动脉斑块负担与全局脑 FDG 摄取呈负相关（β=-0.16，p<0.001），即使在调整了 30 年 FRS 后也是如此。体素分析显示，与 30 年 FRS、高血压和颈动脉斑块负担相关的大脑代谢最受影响的区域是顶颞叶区域（角回、缘上回和颞下回/中回）和扣带回。
在无症状的中年个体中，心血管风险与脑代谢低下有关，高血压是与大脑代谢低下关联最强的可改变的 CVRF。亚临床颈动脉斑块负担与 CVRFs 无关，也与大脑代谢降低有关。表现出代谢低下的脑区包括已知在痴呆中受影响的脑区。这些数据强化了需要在生命早期控制 CVRFs，以潜在地降低大脑在中年期对未来认知功能障碍的脆弱性。
