BACKGROUND Vascular risk factors, particularly hypertension, are important contributors to accelerated brain aging. We sought to quantify vascular risk factor risks over adulthood and assess the empirical evidence for risk thresholds. METHODS We used SBP (systolic blood pressure) and diastolic blood pressure, total cholesterol, fasting blood glucose, and body mass index measurements collected from participants in the CARDIA study (Coronary Artery Risk Development in Young Adults) at 2- to 5-year intervals through year 30. The Montreal Cognitive Assessment and domain-specific cognitive tests were performed at year 30. White matter hyperintensity volume was measured by magnetic resonance imaging. We used a 2-step method to fit longitudinal vascular risk factor exposures to optimized spline functions with mixed-effects models, then used the participant-specific random effects that characterized individual exposures over time in cross-sectional models adjusted for sex, race, age, and education to study effects on midlife brain health. RESULTS Change in SBP up to 33 years of age was negatively associated with Montreal Cognitive Assessment scores (-0.29 Montreal Cognitive Assessment Z score per mm Hg/y change [95% CI, -0.49 to -0.09]; P=0.005), with similar effects for SBP changes from 33 to 49 years of age (-0.08 [95% CI, -0.16 to 0.01]; P=0.08). We observed comparable, significant associations between SBP exposure during those ages, midlife performance on specific cognitive domains, and volume of white matter hyperintensity (all P<0.05). SBP ≤111 mm Hg was the estimated threshold below which no harmful association with midlife cognitive performance was identified. CONCLUSIONS SBP in early adulthood is the vascular risk factor most strongly associated with midlife cognitive performance and white matter hyperintensity burden, with SBP 111 mm Hg suggested as a harm threshold.

中文翻译：

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年轻至中年血管风险对大脑健康的影响和阈值。


背景技术血管危险因素，特别是高血压，是加速大脑老化的重要因素。我们试图量化成年期的血管危险因素风险并评估风险阈值的经验证据。方法 我们使用了 CARDIA 研究（年轻人冠状动脉风险发展）参与者每隔 2 至 5 年收集的 SBP（收缩压）和舒张压、总胆固醇、空腹血糖和体重指数测量值到第 30 年。第 30 年进行蒙特利尔认知评估和特定领域认知测试。通过磁共振成像测量白质高信号体积。我们使用两步法将纵向血管危险因素暴露与混合效应模型的优化样条函数进行拟合，然后使用参与者特定的随机效应，该效应描述了在针对性别、种族、年龄进行调整的横截面模型中随着时间的推移个体暴露的特征，以及研究对中年大脑健康影响的教育。结果 33 岁以下 SBP 变化与蒙特利尔认知评估分数呈负相关（每 mm Hg/y 变化 -0.29 蒙特利尔认知评估 Z 分数 [95% CI，-0.49 至 -0.09]；P=0.005）， 33 岁至 49 岁期间 SBP 变化也有类似的影响（-0.08 [95% CI，-0.16 至 0.01]；P=0.08）。我们观察到这些年龄段的 SBP 暴露、中年特定认知领域的表现以及白质高信号量之间存在可比较的显着关联（所有 P<0.05）。 SBP ≤111 mm Hg 是估计阈值，低于该阈值则不会发现与中年认知能力存在有害关联。 结论 成年早期的 SBP 是与中年认知表现和白质高信号负担最密切相关的血管危险因素，建议将 SBP 111 mm Hg 作为危害阈值。