Department of Psychology, Nanyang Technological University, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
School of Social Sciences, Singapore Management University, Singapore, Singapore.
Int J Cardiol. 2024 Jul 15;407:132037. doi: 10.1016/j.ijcard.2024.132037. Epub 2024 Apr 9.
White matter hyperintensities (WMHs) represent diffuse small vessel disease implicating the cardiac, systemic, and cerebral vasculatures. As the brain may be the end-organ of cumulative vascular disease, and higher education is protective of both cardiovascular and brain health, we aim to clarify their intertwining relationships.
We evaluated participants (mean age = 64) from the UK Biobank with neuroimaging measures of WMHs, left ventricular ejection fraction (LVEF) quantified using cardiovascular MRI, and arterial stiffness index (ASI) quantified using finger photoplethysmography. We used multiple regression to evaluate the basic, independent, and interactive relationships of LVEF status (n = 27,512) and ASI (n = 33,584) with WMHs. Moderated mediation analysis was used to determine whether the relationship between LVEF status and WMH was mediated by ASI and moderated by education.
Abnormal LVEF (β = -0.082, p < 0.001) and higher ASI (β = 0.02, p < 0.001) were associated with greater WMHs separately and independently, but not interactively. Moderated mediation analyses revealed that the relationship between abnormal LVEF and WMH was mediated by ASI, for individuals with lower education (β = -0.004, p < 0.001). Abnormal LVEF was associated with lower cortical thickness in 16 predominantly frontotemporal and select parietal regions (FDR, q < 0.05).
Cardiovascular dysfunction is associated with regional cerebral atrophy and may precipitate cerebrovascular disease via stiffening of systemic vasculatures, particularly for individuals with lower education. Integrative approaches to study biophysiological vascular systems can elucidate the complex interplay between biological and social determinants of brain and cerebrovascular health.
脑白质高信号（WMH）代表弥漫性小血管疾病，涉及心脏、全身和脑脉管系统。由于大脑可能是累积性血管疾病的终末器官，而高等教育对心血管和大脑健康都有保护作用，因此我们旨在阐明它们之间的相互关系。
我们评估了 UK Biobank 中具有脑白质高信号神经影像学测量值、使用心血管 MRI 量化的左心室射血分数（LVEF）和使用指端光体积描记法量化的动脉僵硬度指数（ASI）的参与者（平均年龄 64 岁）。我们使用多元回归来评估 LVEF 状态（n=27512）和 ASI（n=33584）与 WMH 之间的基本、独立和交互关系。中介调节分析用于确定 LVEF 状态与 WMH 之间的关系是否通过 ASI 介导，并受教育程度调节。
异常的 LVEF（β=-0.082，p<0.001）和较高的 ASI（β=0.02，p<0.001）分别与 WMH 独立且独立相关，但无交互作用。中介调节分析表明，对于教育程度较低的个体，LVEF 异常与 WMH 之间的关系通过 ASI 介导（β=-0.004，p<0.001）。异常的 LVEF 与 16 个主要位于额颞叶和部分顶叶的区域的皮质厚度降低相关（FDR，q<0.05）。
心血管功能障碍与区域性脑萎缩相关，并且可能通过全身脉管系统的僵硬来引发脑血管疾病，尤其是对于教育程度较低的个体。综合方法研究生物物理血管系统可以阐明大脑和脑血管健康的生物和社会决定因素之间的复杂相互作用。
