Vascular risk factors and cerebrovascular pathologic changes on autopsy: The 90+ Study.

INTRODUCTION

Cerebrovascular pathologic changes (CVPC) are prevalent and associated with dementia in those ≥ 90 years. However, CVPC associations to traditional risk factors (hypertension, diabetes, and hyperlipidemia) are variable. We hypothesized that neither traditional risk factors nor related medications would be associated with CVPC presence.

METHODS

In autopsy volunteers from The 90+ Study, odds ratios (OR) of CVPC presence to self-reported vascular risk factors and cardiovascular medication classes were calculated using logistic regressions adjusted for age of death, sex, and education.

RESULTS

In 267 participants (mean age at death 98 (±3.5) years; 75% female), CVPC presence was not related to traditional risk factors. Lower odds of atherosclerosis with diuretics [OR 0.55] and lower odds of cerebral amyloid angiopathy (CAA) with B-blocker [OR 0.57] or vasodilator [OR 0.40] use were observed.

DISCUSSION

Our findings suggest that vascular risk factors are not risk factors for CVPC at this age, medications have mitigated risks, or survival bias obscures associations.

HIGHLIGHTS

Cardiovascular risk factors are thought to contribute to cerebrovascular diseases. Risk factors were generally not associated with cerebrovascular changes. Lower odds of certain cerebrovascular changes were associated with antihypertensive use.