Association of Low Systolic Blood Pressure with Postmortem Amyloid-β and Tau

2020 ◽  
Vol 78 (4) ◽  
pp. 1755-1764
Author(s):  
Shahram Oveisgharan ◽  
Ana W. Capuano ◽  
Alifiya Kapasi ◽  
Aron S. Buchman ◽  
Julie A. Schneider ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Amyloid Β ◽  
Vascular Risk Factors ◽  
Risk Scores ◽  
Vascular Risk ◽  
Community Based ◽  
Cardiovascular Risk Score ◽  
Linear Regressions

Background: Vascular mechanisms may contribute to the accumulation of AD pathology. Objective: We examined whether the burden of vascular risk factors proximate to death is associated with amyloid-β and tau levels or modified their known association. Methods: We examined the brains of 1, 585 participants from two longitudinal community-based studies of older adults. Amyloid-β and tau were quantified by postmortem examination. The burden of vascular risk factors was summarized by calculating the Framingham general cardiovascular risk score (FRS) proximate to death. Using linear regressions, we examined the association of the FRS with the amyloid-β and tau levels and examined if the FRS modified the association of the amyloid-β with tau. Results: On average, participants were nearly 90 years old and two-thirds were women. The FRS was not associated with amyloid-β (Spearman r  = –0.00, p  = 0.918) or tau (r = 0.01, p = 0.701). However, the FRS as a whole (estimate = –0.022, SE = 0.008, p = 0.009), and specifically the systolic blood pressure (SBP) component (estimate = –0.033, SE = 0.012, p = 0.009), modified the association of the amyloid-β with tau. Further analysis showed that the association between amyloid-β and tau was stronger at lower levels of SBP. Conclusion: Late-life vascular risk scores were not related to postmortem levels of amyloid-β or tau. However, lower levels of vascular risk scores and SBP were associated with a stronger association between amyloid-β and tau. These data suggest that vascular risk factors may modify the relation of AD pathology markers to one another.

scholarly journals Detrimental effect of systemic vascular risk factors on brain hemodynamic function assessed with MRI

2018 ◽  
Vol 31 (3) ◽  
pp. 253-261 ◽  
Author(s):  
Kevin S King ◽  
Min Sheng ◽  
Peiying Liu ◽  
Christopher D Maroules ◽  
Craig D Rubin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Metabolic Rate ◽  
Systolic Blood Pressure ◽  
Vascular Risk Factors ◽  
Oxygen Extraction Fraction ◽  
Vascular Risk ◽  
High Systolic Blood Pressure ◽  
Cerebral Metabolic Rate ◽  
Vascular Insufficiency

Background and purpose Vascular risk factors have been associated with decreased cerebral blood flow (CBF) but this is etiologically nonspecific and may result from vascular insufficiency or a response to decreased brain metabolic activity. We apply new MRI techniques to measure oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen consumption (CMRO2), hypothesizing that decreased CBF related to these vascular risk factors will be associated with increased OEF, confirming a primary vascular insufficiency. Methods 3T MRI was obtained on 70 community-based participants in this IRB-approved study with informed consent, with previous assessment of systolic blood pressure, hypertension medication, elevated serum triglycerides, low serum HDL, and diabetes mellitus. CBF was measured using phase contrast adjusted for brain volume (ml/100 g/min), OEF (%) was obtained from T2-Relaxation-Under-Spin-Tagging (TRUST), and CMRO2 (μmol/100 g/min) was derived using the Fick principle. Stepwise linear regression identified optimal predictors of CBF with age, sex, and hematocrit included for adjustment. This predictive model was then evaluated against OEF and CMRO2. Results Hypertriglyceridemia was associated with low CBF and high OEF. High systolic blood pressure was associated with high CBF and low OEF, which was primarily attributable to those with pressures above 160 mmHg. Neither risk factor was associated with significant differences in cerebral metabolic rate. Conclusion Low CBF related to hypertriglyceridemia was accompanied by high OEF with no significant difference in CMRO2, confirming subclinical vascular insufficiency. High CBF related to high systolic blood pressure likely reflected limitations of autoregulation at higher blood pressures.

Abstract 3358: Sex Differences in Vascular Risk Factors in a Multi-ethnic, Medically Underserved Stroke Population

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Daphne Antillon ◽  
Natalie Valle ◽  
Kaiwen Lin ◽  
Waimei Tai ◽  
Mary Ann Gallup ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Sex Differences ◽  
Alcohol Abuse ◽  
Vascular Risk Factors ◽  
Medically Underserved ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Low Hdl ◽  
History Of

Background: Recent nationally representative studies of stroke patients have revealed that vascular risk factors are not as aggressively controlled in women compared to men. Medically underserved minority populations are at particularly high risk for poor control of vascular risk factors; however, little is known about sex differences in this population. Methods: Sex-specific vascular risk factors and admission medications were assessed for 440 consecutive ischemic stroke patients (39% female) admitted to a safety-net public hospital in Los Angeles County. Multivariate logistic regression was used to determine sex differences in vascular risk factors, adjusting for age and race. Results: The mean age was 58.9 (SE 10.6) years, 58% were Hispanic, 7% were white, 13% were black, 20% were Asian, and 1% were Native American. Stroke classification (using modified TOAST) revealed the following distribution: 35% small vessel, 20% large vessel, 7% cardioembolic, 23% cryptogenic, 13% >1 possible etiology, and 3% other mechanisms (e.g. drug use). Women had higher mean glycosylated hemoglobin levels than men (8.0% vs 7.4%, p<0.01) and were more likely than men to have a history of type 2 diabetes (49% vs. 40% male, p=0.04), systolic blood pressure > 140 mm Hg (72% vs. 62%, p=0.03), total cholesterol > 200 mg/dL (46% vs. 36%, p=0.04), and low HDL levels (<40 mg/dL for men and <50 mg/dL for women)(83% vs. 79%, p <0.01). Men were more likely than women to have a previous history of stroke (19% vs. 13%, p = 0.05), smoking (49% vs 19%, p<0.01), and alcohol abuse (28% vs. 7%, p<0.01). After adjustment for race and age, women were more likely than men to have total cholesterol > 200 mg/dL (OR 1.56, 95% CI 1.05-2.31), BMI ≥ 30 kg/m 2 (OR 1.55, 95% CI 1.03-2.34), systolic blood pressure >140 mm Hg (OR 1.46, 95% CI 0.96-2.22), low HDL (1.26, 95% CI 0.76-2.08), and triglyceride level > 150 mg/dL (OR 1.09, 95% CI 0.74-1.63); however, the latter 3 were not significant. After adjustment for race and age, men were more likely than women to have a history of smoking (OR 4.54, 95% CI 2.78-7.14) and alcohol abuse (OR 5.56, 95% CI 2.86-11.11). Conclusions: In this multi-ethnic population with inadequate access to care, women are more likely than men to have obesity, hypertension, and dyslipidemia while men are more likely than women to smoke or abuse alcohol. Larger studies are necessary to validate these findings. In the meantime, interventions aimed at reducing the incidence of metabolic syndrome components among women and smoking and alcohol abuse among men in underserved communities are likely warranted.

scholarly journals Differing Pattern of Ambulatory Blood Pressure in Very Elderly Men Expresses Dynamics in Atherosclerotic Load in the Senescence

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Arkadiusz Siennicki-Lantz ◽  
Sölve Elmståhl
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Measurement ◽  
Ankle Brachial Index ◽  
The Elderly ◽  
Population Based ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Pressure Development

To assess an impact of vascular risk factors on ambulatory blood pressure measurement (ABPM) in the elderly, we followed up a population-based cohort of men from 68 until 82 years, when 104 survivors underwent ABPM.Results. At age 68, hypertension and high clinic blood pressure (CBP) did not predict ABPM level. Smoking and low ankle-brachial index (ABI) predicted higher ABPM variability and pulse pressure (PP), but not absolute ABPM values. At age 82, hypertension, high or increasing CBP, strongly positively correlated with all variables of ABPM. Carotid stenosis, low or declining ABI during followup, correlated with higher nocturnal ABPM and PP.Concluding. Hypertension and vascular risk factors in a cohort of 68-year-old men do not result in higher ABPM at age 82, possibly due to inflection point in their pressure development. Higher ABPM reflects instead an increasing CBP and aggravating atherosclerosis during the preceding decade in that part of the cohort with previously favorable risk factor status.

scholarly journals Aerobic exercise interventions reduce blood pressure in patients after stroke or transient ischaemic attack: a systematic review and meta-analysis

2018 ◽  
Vol 53 (24) ◽  
pp. 1515-1525 ◽  
Author(s):  
Cheng Wang ◽  
Jessica Redgrave ◽  
Mohsen Shafizadeh ◽  
Arshad Majid ◽  
Karen Kilner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Blood Pressure ◽  
Transient Ischaemic Attack ◽  
Meta Analysis ◽  
Vascular Risk Factors ◽  
Cochrane Library ◽  
Vascular Risk ◽  
Exercise Interventions ◽  
Ischaemic Attack

ObjectiveSecondary vascular risk reduction is critical to preventing recurrent stroke. We aimed to evaluate the effect of exercise interventions on vascular risk factors and recurrent ischaemic events after stroke or transient ischaemic attack (TIA).DesignIntervention systematic review and meta-analysis.Data sourcesOVID MEDLINE, PubMed, The Cochrane Library, Web of Science, The National Institute for Health and Care Excellence, TRIP Database, CINAHL, PsycINFO, SCOPUS, UK Clinical Trials Gateway and the China National Knowledge Infrastructure were searched from 1966 to October 2017.Eligibility criteriaRandomised controlled trials evaluating aerobic or resistance exercise interventions on vascular risk factors and recurrent ischaemic events among patients with stroke or TIA, compared with control.ResultsTwenty studies (n=1031) were included. Exercise interventions resulted in significant reductions in systolic blood pressure (SBP) −4.30 mm Hg (95% CI −6.77 to −1.83) and diastolic blood pressure −2.58 mm Hg (95% CI −4.7 to −0.46) compared with control. Reduction in SBP was most pronounced among studies initiating exercise within 6 months of stroke or TIA (−8.46 mm Hg, 95% CI −12.18 to −4.75 vs −2.33 mm Hg, 95% CI −3.94 to −0.72), and in those incorporating an educational component (−7.81 mm Hg, 95% CI −14.34 to −1.28 vs −2.78 mm Hg, 95% CI −4.33 to −1.23). Exercise was also associated with reductions in total cholesterol (−0.27 mmol/L, 95% CI −0.54 to 0.00), but not fasting glucose or body mass index. One trial reported reductions in secondary vascular events with exercise, but was insufficiently powered.SummaryExercise interventions can result in clinically meaningful blood pressure reductions, particularly if initiated early and alongside education.

scholarly journals Stroke, vascular risk factors and depression

2001 ◽  
Vol 178 (1) ◽  
pp. 23-28 ◽  
Author(s):  
R. Stewart ◽  
M. Prince ◽  
M. Richards ◽  
C. Brayne ◽  
A. Mann
Keyword(s):  
Risk Factors ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Geriatric Depression ◽  
Community Based ◽  
Blood Tests ◽  
Mediating Factor ◽  
The Uk

BackgroundStroke, hypertension and diabetes are common in older Caribbean-born populations in the UK who may be at risk of depression secondary to vascular disease.AimsWe examined the association between stroke, vascular risk factors and depression in a community-based Caribbean-born population aged 55–75 years.MethodVascular risk factors were identified by interview, examination and blood tests. Depression was categorised using the Geriatric Depression Scale. Disablement was assessed as a potential mediating factor.ResultsPhysical illness and disablement were strongly associated with depression, independent of disablement. Previous stroke was associated with depression, independent of disablement. No vascular risk factors were associated with depression.ConclusionsThe risk of depression associated with stroke was not explained by disablement. However, the hypothesis that vascular risk factors are important in the genesis of depression was not supported.

scholarly journals Associations between vascular risk factors and subsequent Alzheimer’s disease in older adults

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Hyewon Lee ◽  
Kiwon Kim ◽  
Yeong Chan Lee ◽  
Soyeon Kim ◽  
Hong-Hee Won ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Blood Pressure ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Clinical Guidelines ◽  
Density Lipoprotein ◽  
Vascular Risk Factors ◽  
Lipoprotein Cholesterol ◽  
Vascular Risk

Abstract Background The clinical guidelines related to the primary prevention of Alzheimer’s disease (AD) have focused on the management of vascular risk factors. However, the link between vascular risk factors and AD in older adults remains unclear. This study aimed to determine the association between vascular risk factors and subsequent AD in 178,586 older adults (age ≥ 65 years). Methods Participants were recruited from 2009 through 2010 and followed up for 6 years. We assessed various vascular risk factors (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], fasting glucose [FG], systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], and body mass index [BMI]) and their association with AD incidence, categorizing each vascular factor using current clinical guidelines. Results AD was observed in 6.0% of participants at follow-up. All lipid profiles (TC, LDL-C, HDL-C and TG) were positively associated with the risk of AD. SBP and PP were in negative associations with AD, and DBP was positively associated with AD. BMI exhibited a negative association with AD incidence. We found no significant association between FG and AD risk. The sex difference was observed to have effects on vascular risk factors. Conclusions In this study, we comprehensively investigated the association between eight vascular risk factors and the risk of incident AD. Our findings suggest that multiple vascular risk factors are related to the development of AD in older adults. These results can help inform future guidelines for reducing AD risk.

scholarly journals Sugar-sweetened beverages, vascular risk factors and events: a systematic literature review

2014 ◽  
Vol 18 (7) ◽  
pp. 1145-1154 ◽  
Author(s):  
Amelie Keller ◽  
Berit L Heitmann ◽  
Nanna Olsen
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Blood Sugar ◽  
Blood Lipid ◽  
Vascular Risk Factors ◽  
Current Evidence ◽  
Vascular Risk ◽  
Vascular Events ◽  
Sugar Sweetened Beverages ◽  
Sweetened Beverages

AbstractObjectiveA high intake of sugar-sweetened beverages (SSB) has been linked to weight gain, obesity and type 2 diabetes; however, the influence on CVD risk remains unclear. Therefore, our objective was to summarize current evidence for an association between SSB consumption and cardiovascular risk factors and events.DesignThe article search was performed in August 2013. Two independent researchers performed the article search and selection, data extraction and quality assessment. Eligible studies reported the intake of SSB and one of the following outcomes: change in blood pressure, blood lipid or blood sugar, or CVD events such as stroke or myocardial infarction. Only intervention and longitudinal studies were included.SubjectsOnly studies in adults (aged 18+ years old) were considered.ResultsTwo of four prospective studies found clear direct associations between SSB consumption and CHD, while two of three studies, including both men and women, found direct associations between SSB consumption and stroke; however, the association was significant among women only. All included studies examining vascular risk factors found direct associations between SSB consumption and change in blood pressure, blood lipid or blood sugar.ConclusionsThe reviewed studies generally showed that SSB intake was related to vascular risk factors, whereas associations with vascular events were less consistent. Due to a limited number of published papers, especially regarding vascular events, the strength of the evidence is still limited and hence more studies are needed before firm conclusions can be made.

Abstract T P315: Wake-up Intracerebral Hemorrhage Is Not Different From Intracerebral Hemorrhage With Known Onset Time

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Joan Martí-Fàbregas ◽  
Luis Prats ◽  
Alejandro Martínez-Domeño ◽  
Rebeca Marín ◽  
Francesca Casoni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Scale Score ◽  
Neurological Deficit ◽  
Onset Time ◽  
Vascular Risk Factors ◽  
Neurological Deterioration ◽  
Vascular Risk ◽  
Nihss Score

Background: The frequency of wake-up Intracerebral Hemorrhage (WU-ICH) is uncertain. It is also unknown whether there are clinical, radiological and prognostic differences between WU-ICH and non-WU-ICH. We assessed the hypothesis that both types of ICH do not differ. Methods: This is a multicentre (n=6 tertiary hospitals) registry of consecutive patients with ICH. We collected the following variables: Time of onset. WU onset was defined as stroke detected on awakening, independently of the time of the day; Demographics (age, sex); Traditional vascular risk factors; Severity of the neurological deficit at admission (NIHSS score and/or Glasgow coma scale score -GCS-); Neurological deterioration (decrease in >1 point in GCS and/or increase in >3 points in NIHSS score); Etiology; Neuroimaging at admission (location, secondary intraventricular hemorrhage, hematoma volume); Blood pressure, blood glucose, platelet count and INR at admission; and Outcome (modified Rankin scale score -mRS- at discharge and at 3 months; favourable outcome when mRS ≤ 2). Patients were treated according to national guidelines of ICH. Comparison between groups was achieved with Student’s t-test, Chi-square test and Mann-Whitney’s U test. Results: We included a total of 270 patients, whose mean age was 70.2 ± 14.4 years, and 60% of them were men. WU-ICH was diagnosed in 49 (18%) patients. We found no significant differences between groups in demographics, frequency of vascular risk factors, severity of the neurological deficit, etiology, blood pressure, blood analysis and neuroradiological findings. Patients with WU-ICH had a lower frequency of neurological deterioration when assessed by the NIHSS scale (p= 0.04) but not by the GCS scale. The outcome at discharge and at 3-months was equivalent between groups. Conclusions: In conclusion, 18% of ICHs are detected on awakening. Patients with wake-up ICH do not differ from patients with known onset time either in most clinical and radiological variables or in the long-term prognosis. WU-ICH patients may have a lower likelihood of neurological worsening within the acute stage.

Management of vascular risk factors and co-morbidities in secondary stroke prevention

ESC CardioMed ◽  
2018 ◽  
pp. 971-975
Author(s):  
Martin O’Donnell ◽  
Cliona Small
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Ischaemic Stroke ◽  
Stroke Prevention ◽  
Alcohol Intake ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Vascular Events ◽  
Lifestyle Risk

Medical approaches to reducing the risk of recurrent stroke following ischaemic stroke or transient ischaemic attack, and other major vascular events, involves a targeted modification of vascular risk factors, including lifestyle factors (e.g. physical inactivity, smoking, and diet), hypertension, and hyperlipidaemia and glycaemic control. The INTERSTROKE study reported that ten potentially modifiable vascular risk factors were associated with about 90% of the population attributable risk for stroke. Modification of lifestyle risk factors remains a cornerstone of stroke prevention, and includes promoting increased physical activity, smoking cessation, adopting healthier dietary patterns, weight reduction in those who are overweight/obese, and avoiding high alcohol intake (and heavy episode alcohol intake). All patients with blood pressure levels greater than or equal to 140/90 mmHg should be treated with antihypertensive therapy (although some suggest a lower threshold in patients with non-cardioembolic stroke), with a recent trial suggesting that patients with small vessel ischaemic stroke may benefit from lowering blood pressure to less than 130/90 mmHg. Statin therapy in patients with elevated low-density lipoprotein is associated with a reduction in major vascular events after ischaemic stroke, with a more aggressive strategy adopted in patients with ischaemic stroke due to large vessel atherosclerosis. While sleep apnoea is a risk factor for stroke, treatment with continuous positive airway pressure did not reduce the risk of stroke in a recent, large clinical trial. The optimal approach to achieve high rates of vascular risk factor targets following stroke has not been identified, but evaluations of community-based interventions are ongoing.

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