Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

Abstract

BackgroundThe American Heart Association Life's Simple 7 metric defines ideal cardiovascular health (CVH) on 7 factors: smoking, diet, physical activity, body mass index, blood sugar, blood pressure, and cholesterol. This metric has been used to define optimal brain health, but data relative to subclinical imaging biomarkers of brain aging are lacking. This study examines the association between Life's Simple 7 with white matter hyperintensity volume, silent brain infarcts, and cerebral volume.Methods and ResultsA subsample of stroke‐free participants from the population‐based Northern Manhattan Study underwent brain magnetic resonance imaging an average of 7 years after baseline. Linear and logistic regression models were constructed to estimate associations between the number of ideal CVH metrics achieved with imaging biomarkers of brain aging, adjusting for sociodemographics. Among 1031 participants (mean age at magnetic resonance imaging=72±8, 40% men, 19% black, 16% white, and 65% Hispanic), no one had ideal status in all 7 factors, 1% had ideal status in 6 factors, 18% in 4 to 5 factors, 30% in 3 factors, 33% in 2 factors, and 18% in 0 to 1 factors. The number of ideal CVH factors achieved was inversely associated with white matter hyperintensity volume (beta per factor=−0.047; P=0.04) and silent brain infarct (odds ratio per factor=0.84; 95% confidence interval=0.72–0.97) and positively associated with cerebral volume (beta per factor=0.300; P=0.002).ConclusionsAn increasing ideal CVH score was associated with less white matter hyperintensity volume and silent brain infarcts and greater cerebral volumes, supporting the Life's Simple 7 metric as a useful measure to quantify optimal brain health. Monitoring and promoting achievement of Life's Simple 7 ideal CVH factors may improve subclinical and clinical brain health outcomes.

Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study

“…We found no association with cardiovascular health, which is consistent with some but not all previous studies 1032 33 35 The large heterogeneity in population settings (mean age ranged from young adulthood to older age), as well as the type of brain imaging analysis, might explain inconsistent findings. Further investigations are thus needed to confirm specific brain correlates of cardiovascular health.…”

“…26 32 33 Cardiovascular health has been shown to be associated with whole brain volume,10 32 although findings on specific markers are less consistent 1026 32 33 White matter hyperintensities, particularly in the deep white matter, are usually interpreted as “microvascular changes” that are associated with vascular risk in general 34. We found no association with cardiovascular health, which is consistent with some but not all previous studies 10…”

“…Few studies, mostly cross sectional, have examined the association between cardiovascular health and brain imaging 1026 32 33 Cardiovascular health has been shown to be associated with whole brain volume,10 32 although findings on specific markers are less consistent 1026 32 33 White matter hyperintensities, particularly in the deep white matter, are usually interpreted as “microvascular changes” that are associated with vascular risk in general 34.…”

Poor cardiovascular health status among Chinese women

“…The extremely low ideal CVHS (1%) and high poor CVHS (90%) among CWP with a mean age of 44 years seen in our study are very alarming, although our observed ideal CVHS is somewhat better than that reported in previous studies [ 15 , 16 ]. The younger age, medical education and health care profession in CWP may explain the differences regarding the number of subjects with ≥ 2 risk factors and CVHS healthy factor score between CWP and NPC.…”

Cardiovascular health metrics from mid- to late-life and risk of dementia: A population-based cohort study in Finland

“…The poor levels (as risk factors) of CVH metrics, especially occurring from midlife, are supposed to contribute mainly to macro-and microvascular lesions and neurodegenerative process in the brain, e.g., oxidative stress, inflammation, atherosclerosis, hypoxia, cerebral small vessel lesions, and advanced glycation end products [36]. Optimal or ideal levels of CVH metrics (e.g., no smoking, physical activity, and normal blood glucose) are associated with less burden of cerebrovascular damage [37], which then leads to fewer white matter lesions and brain infarcts as well as less severe neurodegeneration [2,38]. The optimal brain health resulting from optimal CVH profiles may in turn contribute to the lower risk of cognitive impairment [39] and cognitive decline [17,18], and thus lead to a lower risk of dementia.…”