Elevated Aortic Pulse Wave Velocity Relates to Longitudinal Gray and White Matter Changes

Abstract

Objective: To determine whether baseline aortic stiffness, measured by aortic pulse wave velocity (PWV), relates to longitudinal cerebral gray or white matter changes among older adults. Baseline cardiac magnetic resonance imaging will be used to assess aortic PWV while brain magnetic resonance imaging will be used to assess gray matter and white matter hyperintensity (WMH) volumes at baseline, 18 months, 3 years, 5 years, and 7 years. Approach and Results: Aortic PWV (m/s) was quantified from cardiac magnetic resonance. Multimodal 3T brain magnetic resonance imaging included T 1 -weighted imaging for quantifying gray matter volumes and T 2 -weighted fluid-attenuated inversion recovery imaging for quantifying WMHs. Mixed-effects regression models related baseline aortic PWV to longitudinal gray matter volumes (total, frontal, parietal, temporal, occipital, hippocampal, and inferior lateral ventricle) and WMH volumes (total, frontal, parietal, temporal, and occipital) adjusting for age, sex, race/ethnicity, education, cognitive diagnosis, Framingham stroke risk profile, APOE (apolipoprotein E)-ε4 carrier status, and intracranial volume. Two hundred seventy-eight participants (73±7 years, 58% male, 87% self-identified as non-Hispanic White, 159 with normal cognition, and 119 with mild cognitive impairment) from the Vanderbilt Memory & Aging Project (n=335) were followed on average for 4.9±1.6 years with PWV measurements occurring from September 2012 to November 2014 and longitudinal brain magnetic resonance imaging measurements occurring from September 2012 to June 2021. Higher baseline aortic PWV was related to greater decrease in hippocampal (β=−3.6 [mm 3 /y]/[m/s]; [95% CI, −7.2 to −0.02] P =0.049) and occipital lobe (β=−34.2 [mm 3 /y]/[m/s]; [95% CI, −67.8 to −0.55] P =0.046) gray matter volume over time. Higher baseline aortic PWV was related to greater increase in WMH volume over time in the temporal lobe (β=17.0 [mm 3 /y]/[m/s]; [95% CI, 7.2–26.9] P <0.001). All associations may be driven by outliers. Conclusions: In older adults, higher baseline aortic PWV related to greater decrease in gray matter volume and greater increase in WMHs over time. Because of unmet cerebral metabolic demands and microvascular remodeling, arterial stiffening may preferentially affect certain highly active brain regions like the temporal lobes. These same regions are affected early in the course of Alzheimer disease.

The association between kidney function, cognitive function, and structural brain abnormalities in community-dwelling individuals aged 50+ is mediated by age and biomarkers of cardiovascular disease

“…These are highly metabolically demanding regions that rely on oxygen supply, as reported by previous studies on vascular stiffness in cognition. 36 The characteristics and congruence of the determinants of eGFR are further evidence for our hypothesis that vascular dysfunction is the primary process underlying kidney disease and the development of cognitive decline, in people with relatively preserved kidney function.…”

Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta‐Analysis

“…Of the 13 longitudinal studies 36 , 37 , 122 , 129 , 159 , 164 , 170 , 174 , 175 , 180 , 184 , 189 , 191 included in the systematic review, 11 of the 13 reported significant associations between arterial stiffness and cSVD. The average follow‐up time was 7.0 years from baseline (range 2–21.5 years).…”

Aortic Characteristic Impedance and Suspected Mild Cognitive Impairment in a Community‐Based Healthy Population

“…The Ikaria study showed aortic distensibility measured at a level 3 cm above the aortic valve using 2‐dimensional echocardiography was better in subjects with higher MMSE score (≥24) than those with lower MMSE score in an older population (mean age, 75 years). 38 In the Vanderbilt Memory and Aging Project, higher baseline aortic arch PWV measured by magnetic resonance imaging were associated with greater gray matter volume loss and greater increased white matter hyperintensities, 39 which played a crucial role of cognitive impairment. In the Age, Gene/Environment Susceptibility–Reykjavik Study, Zc was obtained in a random subset of participants.…”