Association of Cumulative Blood Pressure With Cognitive Decline, Dementia, and Mortality

Li, Chenglong; Zhu, Yidan; Ma, Yanjun; Hua, Rong; Zhong, Bao‐Liang; Xie, Weixin

doi:10.1016/j.jacc.2022.01.045

Cited by 98 publications

(96 citation statements)

References 31 publications

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“…The TyG index was calculated as: ln (fasting TG [mg/dL] × FBG [mg/dL]/2) [ 11 ]. As previously described [ 19 , 21 , 27 , 28 ], the cumulative TyG index was defined as the summation of the average TyG index for each pair of consecutive examinations multiplied by the time between these two consecutive visits, in years:…”

Section: Methodsmentioning

confidence: 99%

Association of the cumulative triglyceride-glucose index with major adverse cardiovascular events in patients with type 2 diabetes

Tai

Zhang

et al. 2022

Cardiovasc Diabetol

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Background The triglyceride-glucose (TyG) index is a reliable surrogate marker of insulin resistance and is associated with major adverse cardiovascular events (MACEs) in patients with type 2 diabetes mellitus (T2DM). However, the long-term effect of the TyG index on the incidence of MACEs remains unclear. We aimed to investigate the association between the cumulative TyG index and the risk of MACEs in patients with T2DM. Methods This post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial assessed patients’ (T2DM > 3 months) cumulative TyG index and MACE data from the study database. Five fasting blood glucose and triglyceride measurements, at baseline and the first four visits, were taken from 5695 participants who had not experienced MACEs. Cumulative exposure to the TyG index was calculated as the weighted sum of the mean TyG index value for each time interval (value × time). Multivariable-adjusted Cox proportional hazard models and restricted cubic spline analysis were used to determine the association between the cumulative TyG index and MACEs. The incremental predictive value of the cumulative TyG index was further assessed. Results Over a median follow-up of 5.09 years, 673 (11.82%) MACEs occurred, including 256 (4.50%) cardiovascular disease (CVD) deaths, 288 (5.06%) non-fatal myocardial infarctions (MIs), and 197 (3.46%) strokes. The risk of developing MACEs increased with the cumulative TyG index quartile. After adjusting for multiple potential confounders, the hazard ratios for the very high cumulative TyG index group versus the low group were 1.59 (95% confidence interval [CI], 1.17–2.16), 1.97 (95% CI 1.19–3.26), and 1.66 (95% CI 1.02–2.70) for overall MACEs, CVD death, and non-fatal MI, respectively. Restricted cubic spline analysis also showed a cumulative increase in the risk of MACEs with an increase in the magnitude of the cumulative TyG index. The addition of the cumulative TyG index to a conventional risk model for MACEs improved the C-statistics, net reclassification improvement value, and integrated discrimination improvement value. Conclusions In patients with T2DM, the cumulative TyG index independently predicts the incidence of MACEs, and monitoring the long-term TyG index may assist with optimized-for-risk stratification and outcome prediction for MACEs. Trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620.

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Section: Methodsmentioning

confidence: 99%

Association of the cumulative triglyceride-glucose index with major adverse cardiovascular events in patients with type 2 diabetes

Tai

Zhang

et al. 2022

Cardiovasc Diabetol

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“…One could thus consider posterior WMH to be a structural correlate that underlies the common observations that vascular disease, in particular hypertension, lowers the threshold for all-cause dementia development in face of pre-existing AD pathology. [4][5][6] As posterior WMH dominance could also relate to cerebrovascular deposition of Aβ, i.e. cerebral amyloid angiopathy (CAA), a condition that highly overlaps with AD pathology (for review see 33,34 ), we visually inspected susceptibilityweighted sequences of all MRIs.…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesised that a history of hypertension and an abnormal build-up of Aβ relate positively to the likelihood of developing WMH, but that both conditions display distinct spatial effects: hypertension on deep and periventricular frontal regions and Aβ on deep and periventricular posterior regions, as discussed in the literature. 1,[4][5][6][7][8][9] We used a 2×2 ANCOVA model in CAT12 to examine the relationship between WMH probability (outcome) and hypertension and Aβ (factors) at a voxel level.…”

Section: Voxel-and Roi-based Wmh Analysis and Mediation Modelsmentioning

confidence: 99%

“…2,3 Alterations to the functioning of cerebral micro-vessels -also known as cerebral small vessel disease (CSVD)-caused, for instance, by long-term exposure to cardiovascular risk factors (hypertension particularly) have been assumed to drive WMH formation. [4][5][6] Nonetheless, recent studies demonstrating elevated global and posterior WMH in patients along the Alzheimer's disease (AD) spectrum with minimal vascular pathology (for review see 1,[7][8][9] ) call into question the assumption that any "AD-related" WMH solely reflect a vascular contribution. This viewpoint has also been challenged by studies reporting a more "AD-like" WMH pattern in Aβ positive subjective cognitive decline (SCD), mild cognitive impairment (MCI) or AD.…”

Section: Introductionmentioning

confidence: 99%

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Arterial hypertension and β-amyloid accumulation have spatially overlapping effects on posterior white matter hyperintensity volume: A cross-sectional study

Bernal

Schreiber

Ostendorf

et al. 2022

Preprint

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ImportancePosterior white matter hyperintensities (WMH) in subjects across the Alzheimer’s disease (AD) spectrum with minimal vascular pathology suggests that amyloid pathology —not just arterial hypertension— impacts WMH, adversely influencing cognition.ObjectiveTo characterise the effects of AD pathology, namely β-amyloid (Aβ) and hypertension on WMH and cognition.DesignCross-sectional and longitudinalSettingMulticentreParticipantsWe analysed data from subjects with normal cognition (NC), subjective cognitive decline (SCD), and mild cognitive impairment (MCI) enrolled in the ongoing observational multicentre DZNE Longitudinal Cognitive Impairment and Dementia Study. We focused on participants with available magnetic resonance imaging (MRI), cerebrospinal fluid biomarkers, and cognitive and hypertension information. We conducted analyses between 02.2022 and 06.2022.Intervention(s) (for clinical trials) or Exposure(s) (for observational studies)NAMain Outcomes and MeasuresSpatial distribution and volume of MRI WMH in relation to Aß42/40 levels and arterial hypertension. Mediation of the relationship between Aβ positivity and hypertension on cognition by the regional WMH volume.ResultsWe included 355 participants (median age 70.3 [IQR 66.0-74.4] years; 168 female; 121 NC, 154 SCD, 80 MCI). Hypertension and Aβ positivity were positively associated (pFTR<0.05) with WMH volume, with large spatial overlap in the occipital lobes (regression coefficient ± standard error; hypertension: 0.49±0.14; Aβ: 0.41±0.15), parietal lobes (hypertension: 0.62±0.23; Aβ: 0.61±0.24), corona radiata (hypertension: 0.55±0.19; Aβ: 0.61±0.24), optic radiation (hypertension: 0.64±0.19; Aβ: 0.50±0.20) and splenium (hypertension: 0.38±0.13; Aβ: 0.39±0.13). Global and occipital WMH volumes were strongly associated cognitive changes over a three-year period, estimated with preclinical Alzheimer’s cognitive composite 5 (PACC5) (global: 2.18±0.61, pFDR<0.01; occipital: 3.31±0.75, pFDR<0.01), regardless of Aβ and hypertension status. The association between Aβ positivity and baseline cognitive performance (direct-memory: -0.42±0.08, pFDR<0.01; executive: - 0.28±0.28, pFDR<0.01) was partially mediated by WMH in the corona radiata (indirect-memory: -0.04±0.02, pFDR<0.05; executive: -0.04±0.02, pFDR<0.01) and splenium (indirect-memory: -0.02±0.02, pFDR<0.01; executive: -0.04±0.02, pFDR<0.01). Evidence supporting hypertension affected cognition was insufficient (direct-memory: 0.03±0.07, pFDR=0.683; executive: -0.05±0.07, pFDR=0.499; PACC5 change: 0.01±0.02, pFDR =0.588).Conclusions and RelevancePosterior white matter is susceptible to vascular disease and Aβ accumulation. Its deterioration is involved in the association between Aβ and cognitive dysfunction. Posterior WMH could be a promising target to tackle the downstream damage related to the interacting and potentiating effect of these two pathologies.Trial RegistrationGerman Clinical Trials Register (DRKS00007966, 04/05/2015)Key PointsQuestionIs the spatial distribution and volume of cerebral white matter hyperintensities (WMH) related to arterial hypertension, amyloid pathology, and cognition?FindingsIn this cross-sectional and longitudinal cohort study, WMH increased with hypertension and amyloid, with a spatial overlap in occipital and parietal lobes. Amyloid is involved in the relationship between WMH in corona radiata and splenium on cognitive performance. Global, occipital, and frontal WMH were strongly associated cognitive performance and worsening, regardless of hypertension and amyloid status.MeaningPosterior white matter is susceptible to vascular disease and amyloid pathology; its damage plays a role in the effect of amyloid pathology on cognition.

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“…The cumulative data from the ELSA and Health and Retirement Study that used the same tests for the evaluation of cognitive function included almost 17,000 participants with a median age of 62 and 65 years, respectively, during a median follow-up of 8 years and found that long-term cumulative BP was related to subsequent cognitive decline, dementia risk, and all-cause mortality in cognitively healthy adults aged >50 years [ 5 ]. The authors adjusted the models for a large number of demographic and clinical characteristics, including comorbidities and therapy.…”

mentioning

confidence: 99%

Hypertensive and cognitive function: did we come to a dead end?

Tadić

Cuspidi

2022

Hypertens Res

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Association of Cumulative Blood Pressure With Cognitive Decline, Dementia, and Mortality

Cited by 98 publications

References 31 publications

Association of the cumulative triglyceride-glucose index with major adverse cardiovascular events in patients with type 2 diabetes

Association of the cumulative triglyceride-glucose index with major adverse cardiovascular events in patients with type 2 diabetes

Arterial hypertension and β-amyloid accumulation have spatially overlapping effects on posterior white matter hyperintensity volume: A cross-sectional study

Hypertensive and cognitive function: did we come to a dead end?

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