Optimization of cardiovascular health metrics associated with better cerebrovascular structure and function in young adults

1. In this cross-sectional study, young adults with a greater number of modifiable cardiovascular (CV) risk factors at recommended levels was associated with higher cerebral vessel density and caliber and higher cerebral blood flow.

2. Greater optimization of these CV risk factors were also associated with decreased white matter hyperintensities.

Evidence Rating: 2 (Good)

Study Rundown: It is well-known that cardiovascular (CV) risk is closely intertwined with cerebrovascular injury and cognitive decline in older adults. However, while experimental studies with older adults have demonstrated that poor CV health results in pathological brain remodeling, such as vessel rarefaction, lower vessel caliber, and lower cerebral blood flow, there is little data on whether these morphologic changes are evident in young adults. In this cross-sectional study, optimization of modifiable CV factors in young adults was correlated with improved cerebrovascular structures by MRI, including higher cerebral vessel density and caliber as well as higher cerebral blood flow. In addition, patients with better CV risk factor optimization had fewer white matter hyperintensities.

While this study does suggest an association between CV and cerebrovascular structure begins even in early adulthood, this study has multiple limitations. First, the study recruited a small number of patients at a single site, therefore increasing the risk of bias and type 1 error as well as making correlations with individual risk factors difficult to attain statistically. Second, the sample was not population-based due to mixed passive and active recruitment strategies and may not be generalizable in terms of prevalence. Third, the cross-sectional nature of the study limits conclusions about causality.

Click to read the study in JAMA

Relevant Reading: Neuroimaging and neuropathology indices of cerebrovascular disease burden.

In-Depth [cross-sectional study]: A total of 125 participants completed the brain MRI protocol and CV risk assessment study measures (average age 24.7 ± 5 years, 49% women), with a mean score of modifiable CV risk factors at recommended levels of 6 ± 1.4. Multivariable models were completed to correlate CV risk with cerebrovascular morphology and white matter hyperintensity. For each additional, beneficial modifiable risk factor, vessel density was greater by 0.3 vessels/cm³ (CI₉₅ 0.1 to 0.5), vessel caliber was greater by 8 micrometers (CI₉₅ 3 to13 micrometers), and white matter hyperintensities were fewer by 1.6 lesions (CI₉₅ 0.5 to 3.0). Cerebral blood flow varied with vessel density and was 2.5 ml/100 g per minute (CI₉₅ 0.16 to 4.89) higher for each healthier modifiable CV risk factor.

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