From the Department of Psychiatry and Behavioral Sciences (X.J., K.Y.), University of California San Francisco; Department of Epidemiology (C.E.L.), School of Public Health, University of Alabama at Birmingham; Department of Preventive Medicine (N.B.A.), Northwestern University Feinberg School of Medicine, Chicago, IL; Kaiser Permanente Division of Research (S.S.), Oakland, CA; Department of Epidemiology and Biostatistics (K.Y.), University of California San Francisco; Department of Neurology (K.Y.), University of California; and San Francisco VA Health Care System (K.Y.).
Neurology. 2023 Apr 4;100(14):e1454-e1463. doi: 10.1212/WNL.0000000000206825. Epub 2023 Jan 25.
To understand the role of premature (defined as ≤ 60 years) cardiovascular disease (CVD) in brain health earlier in life, we examined the associations of premature CVD with midlife cognition and white matter health.
We studied a prospective cohort in the Coronary Artery Risk Development in Young Adults study, who were 18-30 years at baseline (1985-1986) and followed up to 30 years when 5 cognitive tests measuring different domains were administered. A subset (656 participants) had brain MRI measures of white matter hyperintensity (WMH) and white matter integrity. A premature CVD event was adjudicated based on medical records of coronary heart disease, stroke/TIA, congestive heart failure, carotid artery disease, and peripheral artery disease. We conducted linear regression to determine the associations of nonfatal premature CVD with cognitive performance (z-standardized), cognitive decline, and MRI measures.
Among 3,146 participants, the mean age (57% women and 48% Black) was 55.1 ± 3.6 years, with 5% (n = 147) having premature CVD. Adjusting for demographics, education, literacy, income, depressive symptoms, physical activity, diet, and , premature CVD was associated with lower cognition in 4 of 5 domains: global cognition (-0.22, 95% CI -0.37 to -0.08), verbal memory (-0.28, 95% CI -0.44 to -0.12), processing speed (-0.46, 95% CI -0.62 to -0.31), and executive function (-0.38, 95% CI -0.55 to -0.22). Premature CVD was associated with greater WMH (total, temporal, and parietal lobes) and higher white matter mean diffusivity (total and temporal lobes) after adjustment for covariates. These associations remained significant after adjusting for cardiovascular risk factors (CVRFs) and excluding those with stroke/TIA. Premature CVD was also associated with accelerated cognitive decline over 5 years (adjusted OR 3.07, 95% CI 1.65-5.71).
Premature CVD is associated with worse midlife cognition and white matter health, which is not entirely driven by stroke/TIA and even independent of CVRFs. Preventing CVD in early adulthood may delay the onset of cognitive decline and promote brain health over the life course.
为了更早地了解过早（定义为≤60 岁）心血管疾病（CVD）在大脑健康中的作用，我们研究了过早 CVD 与中年认知和白质健康的关系。
我们研究了冠状动脉风险发展中的年轻成年人研究中的一个前瞻性队列，这些人在基线时（1985-1986 年）为 18-30 岁，并随访 30 年，在此期间进行了 5 项测量不同领域的认知测试。一部分（656 名参与者）有脑 MRI 测量的白质高信号（WMH）和白质完整性。非致命性过早 CVD 的事件是根据冠心病、中风/TIA、充血性心力衰竭、颈动脉疾病和外周动脉疾病的病历裁定的。我们进行了线性回归，以确定非致命性过早 CVD 与认知表现（标准化 z 值）、认知衰退和 MRI 测量之间的关系。
在 3146 名参与者中，平均年龄（57%为女性，48%为黑人）为 55.1±3.6 岁，5%（n=147）有过早 CVD。调整人口统计学、教育、读写能力、收入、抑郁症状、身体活动、饮食等因素后，过早 CVD 与以下 4 个认知领域的认知能力下降有关：总体认知（-0.22，95%置信区间-0.37 至-0.08）、言语记忆（-0.28，95%置信区间-0.44 至-0.12）、处理速度（-0.46，95%置信区间-0.62 至-0.31）和执行功能（-0.38，95%置信区间-0.55 至-0.22）。在调整协变量后，过早 CVD 与更高的 WMH（总、颞叶和顶叶）和更高的白质平均弥散度（总叶和颞叶）有关。在调整心血管危险因素（CVRFs）并排除中风/TIA 后，这些关联仍然显著。过早 CVD 也与 5 年内认知衰退加速有关（调整后的 OR 3.07，95%置信区间 1.65-5.71）。
过早 CVD 与中年认知和白质健康状况较差有关，这不仅仅是由中风/TIA 引起的，甚至与 CVRFs 无关。在成年早期预防 CVD 可能会延迟认知衰退的发生，并促进整个生命过程中的大脑健康。
