Abstract MP90: Carotid Arterial Stiffness is Associated with An Increased Risk of Incident Cerebral Microbleeds in Older People: the Age, Gene/Environment Susceptibility-Reykjavik Study

Introduction: Cerebral microbleeds (CMBs) resulting from cerebral amyloid angiopathy are predominantly located in lobar regions, whereas those from hypertension are in deep and infratentorial regions. Although age and high blood pressure are major risk factors for CMBs, the underlying mechanisms remain unclear; arterial stiffness may be important. Hypothesis: We hypothesized that carotid arterial stiffness, would be associated with incident CMBs. Given the spatial distributions of the underlying arteriopathies in which hypertensive arteriopathy typically affects the small perforating end-arteries of the deep structures, we further hypothesized that the associations would be more robust for deep CMBs attributed to hypertensive arteriopathy. Methods: In the prospective, population-based Age, Gene/Environment Susceptibility-Reykjavik Study, 2,512 participants aged 66-97 years underwent a baseline brain MRI examination and carotid ultrasound in 2002-2006, and returned for a repeat brain MRI in 2007-2011. Common carotid arterial stiffness was assessed using a standardized protocol and expressed as carotid arterial strain (CAS), distensibility coefficient (DC) and Young’s elastic modulus (YEM). Log-binomial regression was applied to relate carotid arterial stiffness parameters to CMBs incidence. Results: During a mean follow-up of 5.2 years, 463 people (18.4%) developed new CMBs, of whom 292 had CMBs restricted to lobar regions and 171 had CMBs in a deep or infratentorial region. After adjusting for age, sex and brain MRI interval, all arterial stiffness parameters were each significantly associated with incident CMBs (Risk ratio [RR] per SD decrease in CAS, 1.11 [95%CI, 1.02-1.21]; RR per SD decrease in natural log-transformed DC, 1.14[1.05-1.23]; RR per SD decrease in natural log-transformed YEM, 1.13[1.04-1.22]) and deep CMBs (RR, 1.17[1.00-1.36]; 1.24[1.07-1.43]; 1.22[1.06-1.41] respectively) but not with lobar CMBs. When further adjusted for baseline vascular risk factors including blood pressure and use of blood pressure lowering drugs, the presence of carotid plaque, prevalent CMBs, subcortical infarcts and white matter hyperintensities, the associations persisted. Conclusion: Our findings support the hypothesis that localized increases in carotid arterial stiffness may contribute to the development of CMBs, especially those occuring in a deep location.

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Carotid Arterial Stiffness and Cardiometabolic Profiles in Women with Fibromyalgia

Biomedicines ◽

10.3390/biomedicines9121786 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1786

Author(s):

Yunkyung Kim ◽

Geun-Tae Kim ◽

Jihun Kang

Keyword(s):

Risk Factors ◽

Arterial Stiffness ◽

Central Obesity ◽

Cardiometabolic Risk ◽

Statistical Significance ◽

Cardiometabolic Risk Factors ◽

Control Group ◽

Increased Risk ◽

Carotid Arterial ◽

High Triglyceride

Background: The present study aimed to evaluate the association between FM and cardiometabolic risk factors and carotid arterial stiffness in FM patients. Methods: The cardiometabolic risk profile was defined based on the Adult Treatment Panel III panel. Carotid intimal media thickness (cIMT) and arterial stiffness were assessed using high-resolution ultrasonography. Multivariate logistic analysis was performed to estimate the association between FM and cardiometabolic risk factors. We used a general linear regression to compare the cIMT and carotid beta-index between the participants with and without FM. Pearson’s coefficient was calculated to evaluate the potential correlation between cardiometabolic risk profiles, cIMT, and arterial stiffening in FM. Results: FM participants showed a higher risk of central obesity (odds ratio [OR] = 3.21, 95% confidence interval [CI] 1.49, 6.91), high triglyceride (OR = 4.73, 95% CI 2.29, 9.79), and impaired fasting glucose (IFG) (OR = 4.27, 95% CI 2.07, 8.81) compared to the control group. The FM group exhibited higher beta-index values than the control group (p = 0.003). Although IFG and triglyceride glucose index showed a tendency to correlate with the beta-index, statistical significance was not observed. Conclusions: FM was associated with an increased risk of central obesity, high triglyceride levels, and IFG. Furthermore, advanced arterial stiffness of the carotid artery was observed in FM, which might be correlated with insulin resistance.

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Abstract P327: Risk Factors for Prehypertension in the Community

Circulation ◽

10.1161/circ.127.suppl_12.ap327 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Lisa Rafalson ◽

Richard P Donahue ◽

Saverio Stranges

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

New York ◽

Weight Gain ◽

Waist Circumference ◽

General Population ◽

Population Based ◽

Health Study ◽

Increased Risk

Background: Prehypertension is an increasingly highly prevalent condition in the general population, and is associated with an increased risk for coronary heart disease and stroke. However, evidence from population-based studies of the risk factors for prehypertension is scant. We sought to examine the predictors of progression from normotension to prehypertension in a community-based population from Western New York. Methods: We conducted a longitudinal analysis, over six years of follow-up, among 569 men and women (51.8 years, 96% White, 70% female) who were free of prehypertension, hypertension, cardiovascular disease and type 2 diabetes at the baseline examination, in the Western New York Health Study (WNYHS). Incident prehypertension at follow-up was defined as systolic blood pressure of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg. Results: In bivariate analyses, there were several correlates of incident prehypertension, including age, BMI and waist circumference, impaired fasting glucose (IFG), uric acid, and baseline blood pressure levels. After multivariate adjustment, IFG at baseline odds ratio (OR):1.69, 95%CI:1.06-2.67) and weight gain since age 25 (OR: 1.28, 1.11-1.58 per 10 lb. increase) were the strongest significant predictors of prehypertension at follow-up. Neither waist circumference nor current BMI were predictor variables in models when they were substituted for weight gain. Conclusions: Results from this study suggest early dysregulation of glucose metabolism and weight gain over the lifespan are likely to represent important risk factors for prehypertension in the general population.

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Abstract 19220: Hepatic Steatosis is Independently Associated With an Increased Vascular Stiffness in Overweight Subjects

Circulation ◽

10.1161/circ.132.suppl_3.19220 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Inge v Munckhof ◽

Tessa Brand ◽

Marinette v Graaf ◽

Leo Joosten ◽

Mihai Netea ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Arterial Stiffness ◽

Cardiovascular Risk Factors ◽

Hepatic Steatosis ◽

Vascular Stiffness ◽

Alcoholic Fatty Liver ◽

Increased Risk ◽

Overweight Subjects

Introduction: The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased dramatically during the past decades, affecting 50-75 % of the obese subjects. Subjects with NAFLD have an increased risk of cardiovascular diseases. We investigated whether an increase in hepatic steatosis is independently associated with an increase in vascular stiffness. Methods: We recruited a subcohort of the Nijmegen Biomedical Study, a large population based cohort, including 112 subjects, BMI > 27 kg/m2, aged 55-81 years. The amount of liver fat was quantified by MR spectroscopy. Arterial stiffness was assessed by measurement of the carotid-femoral pulse wave velocity (PWV). The association between the hepatic steatosis and vascular stiffness was investigated by linear regression analysis with and without adjustment for the conventional cardiovascular risk factors. Results: In univariate analysis, hepatic steasosis was found to be correlated with PWV (r = 0.267; p = 0.005). After adjustment for age, sex, heart rate, alcohol use, and BMI still a significant positive association was present with a standardized beta of 0,298 (p=0.004). Even after adjustment for conventional cardiovascular risk factors including mean arterial pressure, blood pressure lowering and anti-diabetic drugs, hepatic steatosis remained independently associated with PWV ( standardized beta 0.269, p = 0.019). Conclusions: In a group of overweight subjects hepatic steatosis is associated with arterial stiffness. This association is independent of blood pressure, use of antihypertensives and the other traditional cardiovascular risk factors.

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Space and location of cerebral microbleeds, cognitive decline, and dementia in the community

Neurology ◽

10.1212/wnl.0000000000003983 ◽

2017 ◽

Vol 88 (22) ◽

pp. 2089-2097 ◽

Cited By ~ 47

Author(s):

Jie Ding ◽

Sigurður Sigurðsson ◽

Pálmi V. Jónsson ◽

Gudny Eiriksdottir ◽

Osorio Meirelles ◽

...

Keyword(s):

Older People ◽

Cognitive Decline ◽

Verbal Memory ◽

Brain Mri ◽

Population Based ◽

Cerebral Microbleeds ◽

Cognitive Testing ◽

Amyloid Angiopathy ◽

Linear Regression Models ◽

Microvascular Damage

Objective:To assess the association of the number and anatomic location of cerebral microbleeds (CMBs), visible indicators of microvascular damage on MRI, with incident cognitive disease in the general population of older people.Methods:In the longitudinal population-based Age, Gene/Environment Susceptibility (AGES)–Reykjavik Study, 2,602 participants 66 to 93 years of age and free of prevalent dementia underwent brain MRI and cognitive testing of verbal memory, processing speed, and executive function at baseline and a mean of 5.2 years later. Adjudicated incident dementia cases were diagnosed according to international guidelines.Results:In the multiple linear regression models adjusted for demographic, genetic, cardiovascular risk, and other cerebrovascular MRI markers, the presence of CMBs located in deep or mixed (deep and lobar) areas was associated with a greater decline in all 3 cognitive domains. Mixed CMBs were the strongest correlate for decline in memory and speed. Compared to those with no CMBs, participants with ≥3 CMBs had a steeper decline in a composite measure of global cognitive function, memory, and speed. Among those with ≥3 deep or mixed CMBs, associations were strongest for memory; the association with speed was strongest in those having ≥3 strictly lobar CMBs. People with ≥3 CMBs, regardless of their locations, had a higher incidence of all-cause dementia and vascular dementia.Conclusions:Mixed or a higher load of CMBs, with some specificity for location, is associated with accelerated cognitive decline in older people. These findings suggest a role for hypertensive vasculopathy and the combined effect of hypertensive and cerebral amyloid angiopathy in the pathogenesis of cognitive deterioration.

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The effect of known cardiovascular risk factors on carotid-femoral pulse wave velocity in school-aged children: a population based twin study

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174414000282 ◽

2014 ◽

Vol 5 (4) ◽

pp. 307-313 ◽

Cited By ~ 5

Author(s):

K. McCloskey ◽

C. Sun ◽

A. Pezic ◽

J. Cochrane ◽

R. Morley ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Cardiovascular Risk Factors ◽

Pulse Wave ◽

Monozygotic Twins ◽

Population Based

Childhood cardiovascular risk factors affect vascular function long before overt cardiovascular disease. Twin studies provide a unique opportunity to examine the influence of shared genetic and environmental influences on childhood cardiovascular function. We examined the relationship between birth parameters, markers of adiposity, insulin resistance, lipid profile and blood pressure and carotid–femoral pulse wave velocity (PWV), a validated non-invasive measure of arterial stiffness in a healthy cohort of school-aged twin children.PWV was performed on a population-based birth cohort of 147 twin pairs aged 7–11 years. Fasting blood samples, blood pressure and adiposity measures were collected concurrently. Mixed linear regression models were used to account for twin clustering, within- and between-twin pair associations.There were positive associations between both markers of higher adiposity, insulin resistance, elevated triglycerides and PWV, which remained significant after accounting for twin birth-set clustering. There was a positive association between both diastolic and mean arterial blood pressure and PWV in within-pair analysis in dizygotic, but not monozygotic twins, indicating genetic differences evident in dizygotic not monozygotic twins may affect these associations.Increased blood pressure, triglycerides and other metabolic markers are associated with increased PWV in school-aged twins. These results support both the genetic and environmental contribution to higher PWV, as a marker of arterial stiffness, and reiterate the importance of preventing metabolic syndrome from childhood.

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Abstract T P418: The Association Of Cognitive Decline With Cerebral Microbleeds Appearance And Its Risk Factors: 9 Years Follow-up Study

Stroke ◽

10.1161/str.46.suppl_1.tp418 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Tomonori Nakagawa ◽

Keiichi Onoda ◽

Hiroyuki Takayoshi ◽

Shingo Mitaki ◽

Hiroaki Oguro ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cognitive Function ◽

Cognitive Functions ◽

Small Vessel Disease ◽

Brain Mri ◽

Cerebral Microbleeds ◽

Brain Hemorrhage ◽

Function Tests

Aims: Cumulative evidence indicates that the presence of cerebral microbleeds (CMB) is a highly strong risk factor for future brain hemorrhage. Our recent longitudinal study demonstrated the odds ratio of CMB for future brain hemorrhage was 50.2 (95% CI, 16.7 to 150.9). Since small vessel disease underlies CMB as a histopathological basis, the control of hypertension is supposed to be essential for preventing the occurrence of CMB. It remains unknown whether new appearance of CBM affects cognitive functions. We performed a longitudinal cohort study to clarify risk factors accounting for the appearance of CMB and its effects on cognitive functions. Methods: In this study we followed up 97 healthy subjects (mean age 63 y.o. at the entry), who had undertaken brain MRI 9 years ago in our brain check-up system. No subjects had neurological symptoms at the first and second check-up. We assessed the changes of CMB in MRI and risk factors for the appearance or increase of asymptomatic lesions were examined. Cognitive function tests (a concise version of WAIS-R) were also performed at the entry and follow-up time. Age was used as a covariate in all statistics. Results: During the 9-year follow-up period, we observed new appearance of CMB in 19 subjects (19.6 %: worsening group). The worsening group showed significantly higher values of systolic blood pressure at the time of entry compared to the no-change group (p=140) is 4.21 (p<0.05). In addition, the worsening group showed significant deterioration in cognitive function tests (p<0.05). Conclusions: The present study demonstrates that the optimal control of blood pressure are critical for prevention of CMB appearance, which would contribute to prevention of future cognitive deterioration in addition to brain hemorrhage.

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Innumerable cerebral microbleeds in hepatitis B virus-related decompensated liver cirrhosis: a case report

BMC Neurology ◽

10.1186/s12883-021-02291-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chi Hyuk Oh ◽

Jin San Lee

Keyword(s):

Liver Cirrhosis ◽

Hepatic Encephalopathy ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Brain Mri ◽

Cerebral Microbleeds ◽

Amyloid Angiopathy ◽

Decompensated Liver Cirrhosis ◽

B Virus ◽

The Brain

Abstract Background Cerebral microbleeds (CMBs) are small, rounded, dark-signal lesions on brain MRI that represent cerebral hemosiderin deposits resulting from prior microhemorrhages and are neuroimaging biomarkers of cerebral amyloid angiopathy (CAA). Here, we report a case of innumerable CMBs in a patient with hepatic encephalopathy underlying decompensated liver cirrhosis. Case presentation An 83-year-old woman diagnosed with hepatitis B virus-related liver cirrhosis 40 years before was referred to our neurology clinic for progressive disorientation of time and place, personality changes, and confusion with somnolence over 2 weeks. Based on the laboratory, neuroimaging, and electrophysiological findings, we diagnosed the patient with hepatic encephalopathy, and her symptoms recovered within 12 h after proper medical management. Brain MRI showed innumerable CMBs in the bilateral frontal, parietal, temporal, and occipital lobes. Since the distribution of CMBs in the patient was mainly corticosubcortical and predominantly in the posterior cortical regions, and the apolipoprotein E genotype was ε4/ε4, we speculated that CAA and hepatic encephalopathy coexisted in this patient. Conclusions We suggest that severe liver dysfunction associated with long-term decompensated liver cirrhosis may be related to an increased number of CMBs in the brain. Our findings indicate that decompensated liver cirrhosis may be a risk factor for the development of CMBs and corroborate a link between the liver and the brain.

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Geographical profiles of cardiovascular risk and the risk factors in China: data from a nationwide population-based screening project

European Heart Journal ◽

10.1093/ehjci/ehaa946.2826 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C.Q Wu ◽

X Li ◽

J.P Lu ◽

B.W Chen ◽

Y.C Li ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Blood Pressure ◽

Population Based ◽

Staple Food ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Food Factor ◽

Rural And Urban ◽

Activity Factor

Abstract Background In China, an abundance of cardiovascular risk factors has contributed to the increasing prevalence of cardiovascular diseases (CVD), which caused almost 4 million deaths per year. However, comprehensive evidence on the geographical profiles of cardiovascular disease risk in China is lacking, as findings in prior studies have been limited to relatively small sample sizes, had incomplete regional coverage, or focused on a narrow risk factor spectrum. Purpose To compare the population CVD risk among different regions across China, and to describe the geographical distributions of CVD risk factors and their clusters throughout the nation. Methods In a nationwide population-based screening project covering 252 counties of China, standardized measurements were conducted to collect information on 12 major CVD risk factors. Individuals of high CVD risk were identified as those with previous CVD, or with a predicted 10-year risk of CVD greater than 10% according to the WHO risk prediction charts. We applied factor analysis to generate “clusters” that characterized the clustering of these risk factors, then explored their relationship with the local ambient temperature and per capital GDP. Results Among 983476 participants included, 9.2% were of high CVD risk, with a range of 1.6% to 23.6% across counties. Among the seven regions in China, the rate was relatively high in the Northeast (11.8%) and North China (10.4%), while low in the South China (7.2%) and Northwest (7.8%). We identified 6 clusters underlying CVD risk factors, including Obesity factor, Blood pressure factor, Staple food factor, Non-staple food factor, Smoking and alcohol factor, and Metabolic and physical activity factor (Figure). We found high risk regions were facing different leading challenges, like obesity and blood pressure for the North China, while unhealthy non-staple food for the Northeast. The South China, as the region with the lowest CVD risk, still had the highest prevalence of unhealthy staple food. Lower annual average ambient temperature was associated with higher risk in Blood pressure factor, Obesity factor and Non-staple food factor, but lower risk in Staple food factor and Metabolic and physical activity factor (p<0.001 for all), consistently between rural and urban. Higher per capital GDP was associated with lower risk in Non-staple food factor in urban and higher risk in Metabolic and physical activity factor in rural (p<0.05 for both). The correlation between per capital GDP and Smoking and alcohol factor differed significantly between in rural and urban regions (p=0.042). Conclusions The geographical profile of CVD risk in China is complex - population risk levels varied substantially across regions, which were contributed by different risk factors. China needs geographically targeted intervention strategies considering environmental and socio-economic factors to control CVD risk and reduce the burden related to CVD. Geographical disparity of risk clusters Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science

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Elevation of pulse pressure in middle age is associated with the risk of dementia: data from a population-based cohort

European Heart Journal ◽

10.1093/ehjci/ehaa946.2738 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Kim ◽

H Jung ◽

P.S Yang ◽

H.T Yu ◽

T.H Kim ◽

...

Keyword(s):

Blood Pressure ◽

Pulse Pressure ◽

Middle Age ◽

Population Based ◽

Entire Cohort ◽

Incident Dementia ◽

Increased Risk ◽

Diagnosis Of Dementia ◽

History Of ◽

The Mean

Abstract Aims Pulse pressure (PP) is a well-known risk factor for cardiovascular disease. However, the association between the PP and dementia is not well identified. This study aimed to determine the effect of PP on the risk of dementia development in different age subgroups using a longitudinal, population-based, and stroke-free cohort from the general population. Methods The association of PP with the development of incident dementia was assessed from January 1, 2005, to December 31, 2013, in 433,154 participants without a history of dementia or stroke from the Korea National Health Insurance Service-Health Screening cohort. The diagnosis of dementia was defined using the 10th revision of the International Classification of Disease codes. Results The mean age of the cohort was 55.7±9.2 years, 45.7% were women. Hypertension was 23.6%. The mean systolic and diastolic blood pressure of the entire cohort were 125.9±16.6 and 78.4±10.7 mmHg, respectively. Mean PP was 47.5±10.9 mmHg. In the middle-age group (40 to 50 year-old), increasing of 10 mmHg of PP was associated with incident dementia after adjusting mean blood pressure and clinical variables with a hazard ratio (HR) of 1.21 (95% confidence interval [CI]: 1.19–1.23, p<0.001). The association was still significant even after censoring for stroke (HR: 1.16, 95% CI: 1.08–1.22, p<0.001). In the older population, elevation of PP was not associated with dementia development (HR: 0.98, 95% CI: 0.95–1.01, p=0.247) Conclusion PP was associated with increased risk of dementia only in middle-aged population beyond that of mean arterial pressure. Funding Acknowledgement Type of funding source: None

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Systemic sclerosis portends increased risk of conduction and rhythm abnormalities at diagnosis and during disease course: A US population-based cohort

Journal of Scleroderma and Related Disorders ◽

10.1177/23971983211034074 ◽

2021 ◽

pp. 239719832110340

Author(s):

Yasser A Radwan ◽

Reto D Kurmann ◽

Avneek S Sandhu ◽

Edward A El-Am ◽

Cynthia S Crowson ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Systemic Sclerosis ◽

Confidence Interval ◽

Cumulative Incidence ◽

Disease Onset ◽

Population Based ◽

Hazard Ratio ◽

Conduction Disorders ◽

Increased Risk

Objectives: To study the incidence, risk factors, and outcomes of conduction and rhythm disorders in a population-based cohort of patients with systemic sclerosis versus nonsystemic sclerosis comparators. Methods: An incident cohort of patients with systemic sclerosis (1980–2016) from Olmsted County, MN, was compared to age- and sex-matched nonsystemic sclerosis subjects (1:2). Electrocardiograms, Holter electrocardiograms, and a need for cardiac interventions were reviewed to determine the occurrence of any conduction or rhythm abnormalities. Results: Seventy-eight incident systemic sclerosis cases and 156 comparators were identified (mean age 56 years, 91% female). The prevalence of any conduction disorder before systemic sclerosis diagnosis compared to nonsystemic sclerosis subjects was 15% versus 7% ( p = 0.06), and any rhythm disorder was 18% versus 13% ( p = 0.33). During a median follow-up of 10.5 years in patients with systemic sclerosis and 13.0 years in nonsystemic sclerosis comparators, conduction disorders developed in 25 patients with systemic sclerosis with cumulative incidence of 20.5% (95% confidence interval: 12.4%–34.1%) versus 28 nonsystemic sclerosis patients with cumulative incidence of 10.4% (95% confidence interval: 6.2%–17.4%) (hazard ratio: 2.57; 95% confidence interval: 1.48–4.45), while rhythm disorders developed in 27 patients with systemic sclerosis with cumulative incidence of 27.3% (95% confidence interval: 17.9%–41.6%) versus 43 nonsystemic sclerosis patients with cumulative incidence of 18.0% (95% confidence interval: 12.3%–26.4%) (hazard ratio: 1.62; 95% confidence interval: 1.00–2.64). Age, pulmonary hypertension, and smoking were identified as risk factors. Conclusion: Patients with systemic sclerosis have an increased risk of conduction and rhythm disorders both at disease onset and over time, compared to nonsystemic sclerosis patients. These findings warrant increased vigilance and screening for electrocardiogram abnormalities in systemic sclerosis patients with pulmonary hypertension.

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