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Li H, Wang M, Qian F, Wu Z, Liu W, Wang A, Guo X. Association between untreated and treated blood pressure levels and cognitive decline in community-dwelling middle-aged and older adults in China: a longitudinal study. Alzheimers Res Ther 2024; 16:104. [PMID: 38730505 PMCID: PMC11083800 DOI: 10.1186/s13195-024-01467-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Optimal blood pressure (BP) levels to reduce the long-term risk of cognitive decline remains controversial. We aimed to investigate the association between BP and anti-hypertensive treatment status with cognitive decline in older adults. METHODS This study used data from the China Health and Retirement Longitudinal Study. Cognitive function was assessed at year 2011, 2013, 2015, and 2018. Global cognitive Z-score was calculated as the average score of episodic memory and mental intactness. BP were measured at the first and second wave. Pulse pressure (PP) was calculated as systolic BP (SBP) minus diastolic BP. Cumulative BP was calculated as the area under the curve using BP measurements from 2011 to 2013. Linear mixed models were used to assess the longitudinal association between BP-related measurements and cognitive decline. RESULTS We included 11,671 participants (47.3% men and mean age 58.6 years). Individual with BP > 140/90 mm Hg or taking anti-hypertensive medication were independently associated with accelerated cognitive decline (β=-0.014, 95% CI: -0.020 to -0.007). Individuals with anti-hypertensive medication use, but with controlled SBP to less than 120 mm Hg did not have a significantly increased risk of cognitive decline compared with normotension (β=-0.003, 95% CI: -0.021 to 0.014). Individuals on anti-hypertensive treatment with PP of more than 70 mm Hg had a significantly higher risk of cognitive decline (β=-0.033, 95% CI: -0.045 to -0.020). Regardless of anti-hypertensive treatment status, both elevated baseline and cumulative SBP and PP were found to be independently associated with accelerated cognitive decline. CONCLUSIONS Cumulatively elevated SBP, PP and uncontrolled BP were associated with subsequent cognitive decline. Effectively controlling BP with anti-hypertensive treatment may be able to preserve cognitive decline in older adults.
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Affiliation(s)
- Haibin Li
- Department of Cardiac Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China.
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
| | - Man Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Frank Qian
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Zhiyuan Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Weida Liu
- State Key Laboratory for Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Xiuhua Guo
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
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Yang R, Jiang H, Xing Z, Ding H, Yin Z, Fu L, Tai S. Cumulative blood pressure predicts risk of stroke in individuals with type 2 diabetes. Diabetes Metab Syndr 2024; 18:102988. [PMID: 38513321 DOI: 10.1016/j.dsx.2024.102988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/06/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
AIMS To determine whether cumulative blood pressure (BP) could predict stroke in individuals with type 2 diabetes (T2D). METHODS BP levels at baseline and the initial three visits were obtained from individuals participating in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial who had not experienced a stroke. Cumulative elevations in BP were assessed by adding the weighted mean BP values at various time intervals. The association of cumulative BP with stroke was evaluated by a multivariate-adjusted Cox proportional hazard model analysis. RESULTS Overall, 8282 participants were included (62.10% males and 37.90% females; mean age, 62.73 years). With a median follow-up period of 6.36 years, 324 (3.91%) and 305 (3.68%) patients had any and nonfatal stroke events, respectively. Only baseline systolic BP (SBP) independently predicted any stroke after adjustment for potential confounders, whereas cumulative SBP and pulse pressure independently predicted elevated stroke events. A strong dose-response relationship between cumulative BP and stroke was identified, and conventional risk factors combined with cumulative SBP improved prediction efficiency. CONCLUSION Cumulative SBP independently predicts stroke in individuals with T2D and provides an incremental predictive value for stroke compared with baseline BP assessments. TRIAL REGISTRATION URL: http://www. CLINICALTRIALS gov. Unique identifier: NCT00000620).
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Affiliation(s)
- Rukai Yang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hejun Jiang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huiqing Ding
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhiyi Yin
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liyao Fu
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - Shi Tai
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China.
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Yang Z, Wen J, Abdulkadir A, Cui Y, Erus G, Mamourian E, Melhem R, Srinivasan D, Govindarajan ST, Chen J, Habes M, Masters CL, Maruff P, Fripp J, Ferrucci L, Albert MS, Johnson SC, Morris JC, LaMontagne P, Marcus DS, Benzinger TLS, Wolk DA, Shen L, Bao J, Resnick SM, Shou H, Nasrallah IM, Davatzikos C. Gene-SGAN: discovering disease subtypes with imaging and genetic signatures via multi-view weakly-supervised deep clustering. Nat Commun 2024; 15:354. [PMID: 38191573 PMCID: PMC10774282 DOI: 10.1038/s41467-023-44271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
Disease heterogeneity has been a critical challenge for precision diagnosis and treatment, especially in neurologic and neuropsychiatric diseases. Many diseases can display multiple distinct brain phenotypes across individuals, potentially reflecting disease subtypes that can be captured using MRI and machine learning methods. However, biological interpretability and treatment relevance are limited if the derived subtypes are not associated with genetic drivers or susceptibility factors. Herein, we describe Gene-SGAN - a multi-view, weakly-supervised deep clustering method - which dissects disease heterogeneity by jointly considering phenotypic and genetic data, thereby conferring genetic correlations to the disease subtypes and associated endophenotypic signatures. We first validate the generalizability, interpretability, and robustness of Gene-SGAN in semi-synthetic experiments. We then demonstrate its application to real multi-site datasets from 28,858 individuals, deriving subtypes of Alzheimer's disease and brain endophenotypes associated with hypertension, from MRI and single nucleotide polymorphism data. Derived brain phenotypes displayed significant differences in neuroanatomical patterns, genetic determinants, biological and clinical biomarkers, indicating potentially distinct underlying neuropathologic processes, genetic drivers, and susceptibility factors. Overall, Gene-SGAN is broadly applicable to disease subtyping and endophenotype discovery, and is herein tested on disease-related, genetically-associated neuroimaging phenotypes.
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Affiliation(s)
- Zhijian Yang
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Graduate Group in Applied Mathematics and Computational Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Junhao Wen
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Laboratory of AI and Biomedical Science (LABS), Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Ahmed Abdulkadir
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Yuhan Cui
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Guray Erus
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Mamourian
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Randa Melhem
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dhivya Srinivasan
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sindhuja T Govindarajan
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jiong Chen
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamad Habes
- Biggs Alzheimer's Institute, University of Texas San Antonio Health Science Center, San Antonio, TX, USA
| | - Colin L Masters
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul Maruff
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jurgen Fripp
- CSIRO Health and Biosecurity, Australian e-Health Research Centre CSIRO, Brisbane, QLD, Australia
| | - Luigi Ferrucci
- Translational Gerontology Branch, Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, MedStar Harbor Hospital, 3001 S. Hanover Street, Baltimore, MD, USA
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John C Morris
- Knight Alzheimer Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Pamela LaMontagne
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel S Marcus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tammie L S Benzinger
- Knight Alzheimer Disease Research Center, Washington University in St. Louis, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Li Shen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jingxuan Bao
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD, USA
| | - Haochang Shou
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ilya M Nasrallah
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christos Davatzikos
- Artificial Intelligence in Biomedical Imaging Laboratory (AIBIL), Center for and Data Science for Integrated Diagnostics (AI2D), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Cheng Y, Deng H, Ling Y, Lin W, Liang Z, Chen Y, Fang X, Liao H, Liu Y, Wei H, Liu F, Jiang J, Wu S, Xue Y, Wu Z. Higher Cumulative Blood Pressure in Midlife Predicts an Increased Risk of Atrial Fibrillation: Evidence From the Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2023; 12:e030409. [PMID: 38084710 PMCID: PMC10863776 DOI: 10.1161/jaha.123.030409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Elevated blood pressure (BP) is reportedly associated with an increased risk of atrial fibrillation (AF). However, the association between cumulative BP exposure in midlife and incident AF in mid-to-late life remains unclear. METHODS AND RESULTS Participants enrolled in the ARIC (Atherosclerosis Risk in Communities) study with 4 consecutive BP measurements and no prevalent AF at baseline were included. Cumulative BP was calculated as the area under the curve from visit 1 to visit 4. Incident AF was identified by study visit ECGs, hospital discharge codes, or death certificates. A total of 9892 participants were included (44.6% men and mean age 62.9±5.7 years at visit 4) with 1550 (15.7%) individuals who developed new-onset AF during an average follow-up of 15.4 years. The incidence rates of AF per 1000 person-years across the 4 quartiles of cumulative systolic BP were 7.9, 9.2, 12.5, and 16.9, respectively. After multivariable adjustment, the hazard ratios for incident AF among participants in the highest quartile of cumulative systolic BP, pulse pressure, and mean arterial pressure were 1.48 (95% CI, 1.27-1.72), 1.81 (95% CI, 1.53-2.13), and 1.22 (95% CI, 1.05-1.41), respectively, compared with those in the lowest quartile. The addition of cumulative systolic BP or pulse pressure slightly improved the ability to predict new-onset AF. CONCLUSIONS Higher exposure to cumulative systolic BP, pulse pressure, and mean arterial pressure was significantly associated with increased risk of incident AF.
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Affiliation(s)
- Yun‐Jiu Cheng
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Hai Deng
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Yun Ling
- Department of Cardiovascular SurgeryShanghai East Hospital Affiliated to Tongji University School of MedicineShanghaiChina
| | - Wei‐Dong Lin
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Zhuomin Liang
- Department of Cardiology, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases (Sun Yat‐sen University)GuangzhouChina
| | - Yili Chen
- Department of Cardiology, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases (Sun Yat‐sen University)GuangzhouChina
| | - Xian‐Hong Fang
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Hong‐Tao Liao
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Yang Liu
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Hui‐Qiang Wei
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Fang‐Zhou Liu
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Jun‐Rong Jiang
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Shu‐Lin Wu
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Yu‐Mei Xue
- Department of Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Zexuan Wu
- Department of Cardiology, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases (Sun Yat‐sen University)GuangzhouChina
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Liu P, Li J, Yang L, Zhang Z, Zhao H, Zhao N, Ou W, Zhang Y, Chen S, Wang G, Zhang X, Wu S, Yang X. Association between cumulative uric acid to high-density lipoprotein cholesterol ratio and the incidence and progression of chronic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1269580. [PMID: 38155948 PMCID: PMC10753577 DOI: 10.3389/fendo.2023.1269580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Objective The ratio of uric acid to high-density lipoprotein cholesterol (UHR) was related to the risk of chronic kidney disease (CKD), we aimed to investigate the association of cumulative UHR (cumUHR) with incidence and progression of CKD. Methods Our study included a total of 49,913 participants (mean age 52.57 years, 77% males) from the Kailuan Study conducted between 2006 and 2018. Participants who completed three consecutive physical examinations were included. Cumulative UHR (cumUHR) was computed as the summed average UHR between two consecutive physical examinations, multiplied by the time between the two examinations. Participants were then categorized into four groups based on cumUHR quartiles. Subsequently, participants were further divided into a CKD group and a non-CKD group. The associations between cumUHR and CKD and it's progression were assessed by Cox proportional hazards regression models. The cumulative incidence of endpoint events was compared between the cumUHR groups using the log-rank test. The C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to assess the predictive performance of cumUHR. Results After a mean follow-up of 8.0 ± 1.7 years, there were 4843 cases of new-onset CKD, 2504 of low eGFR, and 2617 of proteinuria in the non-CKD group. Within the CKD group, there were 1952 cases of decline in eGFR category, 1465 of >30% decline in eGFR, and 2100 of increased proteinuria. In the non-CKD group, the adjusted hazard ratios (HRs) and confidence intervals (CIs) in the fourth quartile were 1.484 (1.362-1.617), 1.643 (1.457-1.852), and 1.324 (1.179-1.486) for new-onset CKD, low eGFR, and proteinuria, respectively. In the CKD group, the adjusted HRs in the fourth quartile were 1.337 (1.164-1.534), 1.428 (1.216-1.677), and 1.446 (1.267-1.651) for decline in eGFR category, >30% decline in eGFR, and increase in proteinuria, respectively. In addition, we separately added a single UHR measurement and cumUHR to the CKD base prediction model and the CKD progression base prediction model, and found that the models added cumUHR had the highest predictive value. Conclusion High cumUHR exposure was an independent risk factor for the incidence and progression of CKD, and it was a better predictor than a single UHR measurement.
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Affiliation(s)
- Peipei Liu
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Junjuan Li
- Department of Nephrology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Ling Yang
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Zihao Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Hua Zhao
- Hebei Key Laboratory for Chronic Diseases, Tangshan Key Laboratory for Preclinical and Basic Research on Chronic Diseases, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei, China
| | - Naihui Zhao
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Wenli Ou
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Yinggen Zhang
- Department of Nuclear Medicine, Kailuan General Hospital, Tangshan, Hebei, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Xiaofu Zhang
- Hebei Key Laboratory for Chronic Diseases, Tangshan Key Laboratory for Preclinical and Basic Research on Chronic Diseases, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Xiuhong Yang
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
- Hebei Key Laboratory for Chronic Diseases, Tangshan Key Laboratory for Preclinical and Basic Research on Chronic Diseases, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei, China
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Kim H, Alvin Ang TF, Thomas RJ, Lyons MJ, Au R. Long-term blood pressure patterns in midlife and dementia in later life: Findings from the Framingham Heart Study. Alzheimers Dement 2023; 19:4357-4366. [PMID: 37394941 PMCID: PMC10597747 DOI: 10.1002/alz.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Long-term blood pressure (BP) measures, such as visit-to-visit BP variability (BPV) and cumulative BP, are strong indicators of cardiovascular risks. This study modeled up to 20 years of BP patterns representative of midlife by using BPV and cumulative BP, then examined their associations with development of dementia in later life. METHODS For 3201 individuals from the Framingham Heart Study, multivariate logistic regression analyses were performed to examine the association between long-term BP patterns during midlife and the development of dementia (ages ≥ 65). RESULTS After adjusting for covariates, every quartile increase in midlife cumulative BP was associated with a sequential increase in the risk of developing dementia (e.g., highest quartile of cumulative systolic blood pressure had approximately 2.5-fold increased risk of all-cause dementia). BPV was not significantly associated with dementia. DISCUSSION Findings suggest that cumulative BP over the course of midlife predicts risk of dementia in later life. HIGHLIGHTS Long-term blood pressure (BP) patterns are strong indicators of vascular risks. Cumulative BP and BP variability (BPV) were used to reflect BP patterns across midlife. High cumulative BP in midlife is associated with increased dementia risk. Visit-to-visit BPV was not associated with the onset of dementia.
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Affiliation(s)
- Hyun Kim
- Dept. of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave # 2, Boston, MA 02215, USA
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
| | - Ting Fang Alvin Ang
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
| | - Robert J. Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue Shapiro 7 Boston, MA 02215
| | - Michael J. Lyons
- Dept. of Psychological & Brain Sciences, Boston University, 900 Commonwealth Ave # 2, Boston, MA 02215, USA
| | - Rhoda Au
- Framingham Heart Study, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 E. Concord St Housman (R), Boston MA 02118
- Dept. of Neurology, Medicine and Alzheimer’s Disease Research Center, Boston University School of Medicine, 72 E. Concord St, Boston MA 02118
- Dept. of Epidemiology, Boston University School of Public Health, 715 Albany St.Boston, MA 02118
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Cui F, Ouyang ZQ, Zeng YZ, Ling BB, Shi L, Zhu Y, Gu HY, Jiang WL, Zhou T, Sun XJ, Han D, Lu Y. Effects of hypertension on subcortical nucleus morphological alternations in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2023; 14:1201281. [PMID: 37780620 PMCID: PMC10534025 DOI: 10.3389/fendo.2023.1201281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives Type 2 diabetes mellitus(T2DM) and hypertension(HTN) are common comorbidities, and known to affect the brain. However, little is known about the effects of the coexisting HTN on brain in T2DM patients. So we aim to investigate the impact of HTN on the subcortical nucleus morphological alternations in T2DM patients. Materials & methods This work was registered by the clinicaltrials.gov (grant number NCT03564431). We recruited a total of 92 participants, comprising 36 only T2DM patients, 28 T2DM patients with HTN(T2DMH) and 28 healthy controls(HCs) in our study. All clinical indicators were assessed and brain image data was collected for each participant. Voxel-based morphometry(VBM), automatic volume and vertex-based shape analyses were used to determine the subcortical nucleus alternations from each participant's 3D-T1 brain images and evaluate the relationship between the alternations and clinical indicators. Results T2DMH patients exhibited volumetric reduction and morphological alterations in thalamus compared to T2DM patients, whereas T2DM patients did not demonstrate any significant subcortical alterations compared to HCs. Furthermore, negative correlations have been found between thalamic alternations and the duration of HTN in T2DMH patients. Conclusion Our results revealed that HTN may exacerbate subcortical nucleus alternations in T2DM patients, which highlighted the importance of HTN management in T2DM patients to prevent further damage to the brain health.
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Affiliation(s)
- Feng Cui
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Qiang Ouyang
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yi-Zhen Zeng
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Bing-Bing Ling
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Li Shi
- Department of Endocrinology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yun Zhu
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - He-Yi Gu
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wan-Lin Jiang
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ting Zhou
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xue-Jin Sun
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Dan Han
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yi Lu
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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8
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Tang X, Chen Y, Tan H, Fang J, Yu D, Chen C, Li X, Hu Z, Ding L, Zhang Y. Micro- and macro-changes in early-stage type 2 diabetes mellitus without cognitive impairment: a diffusion tensor imaging (DTI) and surface-based morphometry (SBM) study. Front Neurol 2023; 14:1115634. [PMID: 37475732 PMCID: PMC10354865 DOI: 10.3389/fneur.2023.1115634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/26/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction Brain structure and function changes are considered major brain damages in type 2 diabetes mellitus (T2DM), which likely has a close relationship with cognitive impairment. Many previous studies have shown by using brain structural and functional magnetic resonance imaging (MRI) methods that brain white and gray matter are damaged in T2DM, leading to cognitive impairment. Researches neglected patients of T2DM without cognitive dysfunction might also have brain changes. Methods In this study, subjects with early stage T2DM with no cognitive dysfunction were enrolled to detect brain damages using the tract-based spatial statistics analysis (TBSS) method to demonstrate white matter (WM) micro changes and surface-based morphometry (SBM) method to assess cerebral cortex macro changes. Results The whole-brain TBSS analysis revealed that there were no statistically significant changes in fractional anisotropy (FA) and mean diffusivity (MD), but the FA declined in some area of cerebral WM (p < 0.1). The SBM results showed no changes in cortical thickness (CT), cortical volume (CV), surface area (SA), and cortical sulcal curve (CSC) between these two groups, but pial local gyration index (LGI) was decreased in the precuneus (-log10, p = -3.327). Discussion In conclusion, early stage T2DM patients without cognitive impairment had brain micro and macro structural damages, suggesting the potential use of MRI as an imaging marker to detect brain changes in early stage T2DM, which could not be observed and assessed clinically.
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Affiliation(s)
- Xiangyong Tang
- Department of Medical Imaging, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, China
| | - Yanzi Chen
- Department of Medical Imaging, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, China
| | - Hui Tan
- Department of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Jinzhi Fang
- Department of Medical Imaging, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, China
| | - Dafei Yu
- Department of Medical Imaging, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, China
| | - Cuimei Chen
- Department of Medical Imaging, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, China
| | - Xiao Li
- Department of Medical Imaging, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, China
| | - Ziqi Hu
- Department of Medical Imaging, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, China
| | - Ling Ding
- Department of Medical Imaging, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, China
| | - Yuzhong Zhang
- Department of Medical Imaging, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, China
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9
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Jiang R, Calhoun VD, Noble S, Sui J, Liang Q, Qi S, Scheinost D. A functional connectome signature of blood pressure in >30 000 participants from the UK biobank. Cardiovasc Res 2023; 119:1427-1440. [PMID: 35875865 PMCID: PMC10262183 DOI: 10.1093/cvr/cvac116] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Elevated blood pressure (BP) is a prevalent modifiable risk factor for cardiovascular diseases and contributes to cognitive decline in late life. Despite the fact that functional changes may precede irreversible structural damage and emerge in an ongoing manner, studies have been predominantly informed by brain structure and group-level inferences. Here, we aim to delineate neurobiological correlates of BP at an individual level using machine learning and functional connectivity. METHODS AND RESULTS Based on whole-brain functional connectivity from the UK Biobank, we built a machine learning model to identify neural representations for individuals' past (∼8.9 years before scanning, N = 35 882), current (N = 31 367), and future (∼2.4 years follow-up, N = 3 138) BP levels within a repeated cross-validation framework. We examined the impact of multiple potential covariates, as well as assessed these models' generalizability across various contexts.The predictive models achieved significant correlations between predicted and actual systolic/diastolic BP and pulse pressure while controlling for multiple confounders. Predictions for participants not on antihypertensive medication were more accurate than for currently medicated patients. Moreover, the models demonstrated robust generalizability across contexts in terms of ethnicities, imaging centres, medication status, participant visits, gender, age, and body mass index. The identified connectivity patterns primarily involved the cerebellum, prefrontal, anterior insula, anterior cingulate cortex, supramarginal gyrus, and precuneus, which are key regions of the central autonomic network, and involved in cognition processing and susceptible to neurodegeneration in Alzheimer's disease. Results also showed more involvement of default mode and frontoparietal networks in predicting future BP levels and in medicated participants. CONCLUSION This study, based on the largest neuroimaging sample currently available and using machine learning, identifies brain signatures underlying BP, providing evidence for meaningful BP-associated neural representations in connectivity profiles.
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Affiliation(s)
- Rongtao Jiang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Emory University and Georgia State University, Atlanta, GA 30303, USA
| | - Stephanie Noble
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA
| | - Jing Sui
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Emory University and Georgia State University, Atlanta, GA 30303, USA
| | - Qinghao Liang
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Shile Qi
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Emory University and Georgia State University, Atlanta, GA 30303, USA
| | - Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520, USA
- Department of Statistics & Data Science, Yale University, New Haven, CT 06520, USA
- Child Study Center, Yale School of Medicine, New Haven, CT 06510, USA
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10
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Chen CH, Khnaijer MK, Beaudin AE, McCreary CR, Gee M, Saad F, Frayne R, Ismail Z, Pike GB, Camicioli R, Smith EE. Subcortical volumes in cerebral amyloid angiopathy compared with Alzheimer's disease and controls. Front Neurosci 2023; 17:1139196. [PMID: 37139517 PMCID: PMC10149850 DOI: 10.3389/fnins.2023.1139196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background Previous reports have suggested that patients with cerebral amyloid angiopathy (CAA) may harbor smaller white matter, basal ganglia, and cerebellar volumes compared to age-matched healthy controls (HC) or patients with Alzheimer's disease (AD). We investigated whether CAA is associated with subcortical atrophy. Methods The study was based on the multi-site Functional Assessment of Vascular Reactivity cohort and included 78 probable CAA (diagnosed according to the Boston criteria v2.0), 33 AD, and 70 HC. Cerebral and cerebellar volumes were extracted from brain 3D T1-weighted MRI using FreeSurfer (v6.0). Subcortical volumes, including total white matter, thalamus, basal ganglia, and cerebellum were reported as proportion (%) of estimated total intracranial volume. White matter integrity was quantified by the peak width of skeletonized mean diffusivity. Results Participants in the CAA group were older (74.0 ± 7.0, female 44%) than the AD (69.7 ± 7.5, female 42%) and HC (68.8 ± 7.8, female 69%) groups. CAA participants had the highest white matter hyperintensity volume and worse white matter integrity of the three groups. After adjusting for age, sex, and study site, CAA participants had smaller putamen volumes (mean differences, -0.024% of intracranial volume; 95% confidence intervals, -0.041% to -0.006%; p = 0.005) than the HCs but not AD participants (-0.003%; -0.024 to 0.018%; p = 0.94). Other subcortical volumes including subcortical white matter, thalamus, caudate, globus pallidus, cerebellar cortex or cerebellar white matter were comparable between all three groups. Conclusion In contrast to prior studies, we did not find substantial atrophy of subcortical volumes in CAA compared to AD or HCs, except for the putamen. Differences between studies may reflect heterogeneity in CAA presenting syndromes or severity.
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Affiliation(s)
- Chih-Hao Chen
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mary Klir Khnaijer
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Andrew E. Beaudin
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Cheryl R. McCreary
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Myrlene Gee
- Division of Neurology, Department of Medicine and Neurosciences and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Feryal Saad
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Richard Frayne
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - G. Bruce Pike
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Richard Camicioli
- Division of Neurology, Department of Medicine and Neurosciences and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Eric E. Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- *Correspondence: Eric E. Smith,
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11
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Zhu Y, Li C, Wu T, Wang Y, Hua R, Ma Y, Xie W. Associations of cumulative depressive symptoms with subsequent cognitive decline and adverse health events: Two prospective cohort studies. J Affect Disord 2023; 320:91-97. [PMID: 36183825 DOI: 10.1016/j.jad.2022.09.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The course of depression is variable; however, few studies examined the relationship between long-term cumulative depressive symptoms and adverse health outcomes in the elderly. METHODS In this cohort study, we used data from the Health and Retirement Study (HRS) over 24 years and the English Longitudinal Study of Ageing (ELSA) over 16 years. Cumulative depressive symptoms were estimated by calculating the areas under the curve based on the Center for Epidemiological Research Depression scale assessed at four examinations. Outcomes include cognitive decline, incident dementia, cardiovascular disease (CVD), cancer, and all-cause mortality. RESULTS A total of 8284 American (mean age: 60.1 years; male: 35.4 %) and 4314 British (60.1 years; 42.4 %) were included in the analysis. The median follow-up was 16.1 years in the HRS and 9.9 years in the ELSA. Similar results were observed in two cohorts. Comparing with the first tertile of cumulative depressive symptoms, the third tertile experienced faster cognitive decline (p = 0.013 in the ELSA and p < 0.001 in the HRS), increased risk of dementia (both p < 0.001), CVD (both p < 0.001) and all-cause mortality (p = 0.002 in the HRS). Strong dose-response relationships were observed. We did not found clearly association between cumulative depressive symptoms and incident cancer. CONCLUSIONS This study suggests that long-term cumulative depressive symptoms were associated with subsequent faster cognitive decline and greater risks for dementia, CVD and all-cause mortality, but not cancer. These findings provide insights on potential effective strategy that may improve health in the elderly, future clinical trials are needed to determine causality.
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Affiliation(s)
- Yidan Zhu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Tao Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Yongqian Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Rong Hua
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Yanjun Ma
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China.
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12
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Li C, Zhu Y, Ma Y, Hua R, Zhong B, Xie W. Association of Cumulative Blood Pressure With Cognitive Decline, Dementia, and Mortality. J Am Coll Cardiol 2022; 79:1321-1335. [PMID: 35393012 DOI: 10.1016/j.jacc.2022.01.045] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Elevated blood pressure (BP) has been linked to impaired cognition and dementia in older adults. However, few studies have accounted for long-term cumulative BP exposure. OBJECTIVES The aim of this study was to test whether long-term cumulative BP was independently associated with subsequent cognitive decline, incident dementia, and all-cause mortality among cognitively healthy adults. METHODS This study used data from the HRS (Health and Retirement Study) and ELSA (English Longitudinal Study of Ageing). Cumulative BP was calculated as the area under the curve using measurements from wave 0 (1998-1999) to wave 4 (2008-2009) in ELSA and wave 8 (2006-2007) to wave 10 (2010-2011) in the HRS. Outcomes included cognitive decline, incident dementia, and all-cause mortality. RESULTS A total of 7,566 and 9,294 participants from ELSA and the HRS were included (44.8% and 40.2% men and median age 62.0 years [IQR: 55.0-70.0 years] and 65.0 years [IQR: 58.0-72.0 years], respectively). The median follow-up duration was 8.0 years (IQR: 4.0-8.0 years) and 8.0 years (IQR: 6.0-8.0 years), respectively. Elevated cumulative systolic BP and pulse pressure were independently associated with accelerated cognitive decline (P < 0.001 for both), elevated dementia risk (P < 0.001 for both), and all-cause mortality (P < 0.001 for both), while a significant inverse association was observed for diastolic BP. Strong dose-response relationships were identified, with similar results for the 2 cohorts. CONCLUSIONS Long-term cumulative BP was associated with subsequent cognitive decline, dementia risk, and all-cause mortality in cognitively healthy adults aged ≥50 years. Efforts are required to control long-term systolic BP and pulse pressure and to maintain adequate diastolic BP.
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Affiliation(s)
- Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Yidan Zhu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Yanjun Ma
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Rong Hua
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Baoliang Zhong
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China.
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13
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Tian X, Wang A, Zuo Y, Chen S, Zhang L, Zhao Y, Liu L, Wu S, Luo Y, Gao J. Time course of serum uric acid accumulation and the risk of diabetes mellitus. Nutr Diabetes 2022; 12:1. [PMID: 35013096 PMCID: PMC8748907 DOI: 10.1038/s41387-021-00179-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/25/2021] [Accepted: 10/26/2021] [Indexed: 01/14/2023] Open
Abstract
Background The impact of long-term serum uric acid (SUA) exposure and time course of SUA accumulation on diabetes mellitus (DM) is unknown. This study aimed to evaluate the association of cumulative SUA (cumSUA) exposure and its accumulation time course with risk of DM. Methods This prospective study included 46,434 participants without DM and underwent three examinations at 2006, 2008, and 2010. CumSUA from 2006 to 2010 was calculated, multiplying mean values between consecutive examinations by time intervals between visits. Time course of SUA accumulation was categorized as the slope of SUA versus time from 2006 to 2010, or by splitting the overall accumulation into an early (cumSUA06-08) and late accumulation (cumSUA08-10). Results During 6.99 years of follow-up, we identified 2971 incident DM cases. In the fully adjusted model, a higher risk of DM was observed in participants with the highest quartile of cumSUA (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.17–1.46), cumulative burden >0 (HR, 1.23; 95% CI, 1.08–1.40), and with 6 year of hyperuricemia exposure duration (HR, 1.25; 95% CI, 1.01–1.55). When considering the time course of SUA accumulation, participants with a negative slope (HR, 1.05; 95% CI, 1.01–1.12), or combined with cumSUA ≥ median and a negative slope had elevated risk of DM (HR, 1.58; 95% CI, 1.18–2.11). Conclusions Incident DM risk depends on cumulative exposure of SUA and time course of SUA accumulation. Early SUA accumulation resulted in a greater risk increase compared with later accumulation, emphasizing the importance of optimal SUA control early in life.
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Affiliation(s)
- Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China.
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Licheng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yuhan Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Lulu Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shouling Wu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
| | - Jingli Gao
- Department of Intensive Medicine, Kailuan Hospital, North China University of Science and Technology, Tangshan, China.
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14
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Li C, Ma Y, Hua R, Zheng F, Xie W. Long-Term Physical Activity Participation and Subsequent Incident Type 2 Diabetes Mellitus: A Population-Based Cohort Study. Front Endocrinol (Lausanne) 2021; 12:769549. [PMID: 34917029 PMCID: PMC8669796 DOI: 10.3389/fendo.2021.769549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background Uncertainty remains concerning association between long-term physical activity and incident type 2 diabetes mellitus (DM). We intended to evaluate physical activity participation over a 6-year span and assess association with subsequent 10-year incident DM risk, as well as examine mediation role by obesity. Methods A total of 9757 community-dwelling adults aged ≥ 50 years in England were included in the population-based cohort. Physical activity participation, including trajectories and cumulative participation were assessed using weighted Z score over a 6-year span from wave 1 (2002-2003) to wave 4 (2008-2009). Incident DM recorded over a 10-year span from wave 4 (2008-2009) to wave 9 (2018-2019) was outcome. Results 5 distinct activity trajectories were identified, including persistently low (N=3037, incident DM=282), initially low then improving (1868, 90), initially high then declining (325, 20), persistently moderate (2489, 170), and persistently high (2038, 108). Compared with persistently low, participants of initially low then improving, persistently moderate and high were associated with lower incident DM risk, with multivariable-adjusted hazard ratios (HR) of 0.41 (95% confidence interval [CI]: 0.32 to 0.53, P<0.001), 0.70 (95% CI: 0.56 to 0.89, P=0.004) and 0.49 (95% CI: 0.37 to 0.65, P <0.001), respectively. Elevated cumulative activity was also associated with lower DM risk, with each quintile increment in cumulative weighted Z score corresponding to HR of 0.76 (95% CI: 0.71 to 0.82, P <0.001). Mediation analysis found that body mass index, waist circumference and change in body mass index mediate 10% (P <0.001), 17% (P <0.001) and 9% (P <0.001) of the observed association between activity and incident DM, respectively. Conclusions For middle aged and older adults, both gradually improved and persistently active participation in physical activity were associated with subsequent lower risk of incident DM, with obesity playing a potential mediator. Strategies focusing on improving and maintaining active participation in physical activity might be beneficial from DM prevention perspective.
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Affiliation(s)
- Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Peking University Clinical Research Institute Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Yanjun Ma
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Peking University Clinical Research Institute Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Rong Hua
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Peking University Clinical Research Institute Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Fanfan Zheng
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Peking University Clinical Research Institute Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
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15
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Shang X, Hill E, Zhu Z, Liu J, Ge BZ, Wang W, He M. The Association of Age at Diagnosis of Hypertension With Brain Structure and Incident Dementia in the UK Biobank. Hypertension 2021; 78:1463-1474. [PMID: 34601962 DOI: 10.1161/hypertensionaha.121.17608] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (X.S., Z.Z., M.H.).,Guangdong Cardiovsacular Institute, Guangzhou, China (X.S., Z.Z.)
| | - Edward Hill
- Department of Medicine (Royal Melbourne Hospital) (E.H.), University of Melbourne, VIC, Australia.,Wicking Dementia Research and Education Centre, University of Tasmania, Australia (E.H.)
| | - Zhuoting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (X.S., Z.Z., M.H.).,Guangdong Cardiovsacular Institute, Guangzhou, China (X.S., Z.Z.)
| | - Jiahao Liu
- Melbourne School of Population and Global Health (J.L.), University of Melbourne, VIC, Australia
| | - B Zongyuan Ge
- Monash e-Research Center, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Center, Monash University, Melbourne, VIC, Australia (Z.G.)
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.W., M.H.)
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (X.S., Z.Z., M.H.).,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.W., M.H.).,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia (M.H.)
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16
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Jenkins LM, Kogan A, Malinab M, Ingo C, Sedaghat S, Bryan NR, Yaffe K, Parrish TB, Nemeth AJ, Lloyd-Jones DM, Launer LJ, Wang L, Sorond F. Blood pressure, executive function, and network connectivity in middle-aged adults at risk of dementia in late life. Proc Natl Acad Sci U S A 2021; 118:e2024265118. [PMID: 34493658 PMCID: PMC8449402 DOI: 10.1073/pnas.2024265118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
Midlife blood pressure is associated with structural brain changes, cognitive decline, and dementia in late life. However, the relationship between early adulthood blood pressure exposure, brain structure and function, and cognitive performance in midlife is not known. A better understanding of these relationships in the preclinical stage may advance our mechanistic understanding of vascular contributions to late-life cognitive decline and dementia and may provide early therapeutic targets. To identify resting-state functional connectivity of executive control networks (ECNs), a group independent components analysis was performed of functional MRI scans of 600 individuals from the Coronary Artery Risk Development in Young Adults longitudinal cohort study, with cumulative systolic blood pressure (cSBP) measured at nine visits over the preceding 30 y. Dual regression analysis investigated performance-related connectivity of ECNs in 578 individuals (mean age 55.5 ± 3.6 y, 323 female, 243 Black) with data from the Stroop color-word task of executive function. Greater connectivity of a left ECN to the bilateral anterior gyrus rectus, right posterior orbitofrontal cortex, and nucleus accumbens was associated with better executive control performance on the Stroop. Mediation analyses showed that while the relationship between cSBP and Stroop performance was mediated by white matter hyperintensities (WMH), resting-state connectivity of the ECN mediated the relationship between WMH and executive function. Increased connectivity of the left ECN to regions involved in reward processing appears to compensate for the deleterious effects of WMH on executive function in individuals across the burden of cumulative systolic blood pressure exposure in midlife.
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Affiliation(s)
- Lisanne M Jenkins
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611;
| | - Alexandr Kogan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Matthew Malinab
- Faculty of Applied Sciences, Simon Fraser University, Burnaby, BC, Canada, V5A 1S6
| | - Carson Ingo
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Sanaz Sedaghat
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Nick R Bryan
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19103
| | - Kristine Yaffe
- Weill Institute for Neurosciences, University of California, San Francisco, CA 94121
| | - Todd B Parrish
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- McCormick School of Engineering, Northwestern University, Chicago, IL 60208
| | - Alexander J Nemeth
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, Baltimore, MD 20814
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
| | - Farzaneh Sorond
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
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17
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Kim CS, Kim B, Choi HS, Bae EH, Ma SK, Han KD, Kim SW. Cumulative hypertension burden and risk of end-stage renal disease. Hypertens Res 2021; 44:1652-1661. [PMID: 34408283 DOI: 10.1038/s41440-021-00723-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/23/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022]
Abstract
Hypertension is the leading risk factor for end-stage renal disease (ESRD). However, the association between sustained exposure to increased blood pressure (BP) and ESRD is not well established. This study investigated whether the cumulative hypertension burden is a substantial risk factor for ESRD. The incidence of ESRD among 2,144,801 participants identified from the Korean National Health Insurance Service database who had documented BP assessment data in their annual health check-up data from between 2006 and 2010, was determined. Over a median follow-up of 7.2 years, ESRD was identified in 1758 participants. Hypertension burden was defined as the cumulative exposure to hypertension (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) during four consecutive follow-up periods and ranged from 0 to 4. The hypertension burden was as follows: 0 (n = 1,164,488), 77.6%; 1 (n = 292,377), 13.6%; 2 (n = 114,397), 5.3%; 3 (n = 52,671), 2.5%; and 4 (n = 20,886), 1.0%. Compared to the hypertension burden of 0, the adjusted hazard ratio for ESRD was 1.35, 1.54, 1.51, and 2.28 for hypertension burdens of 1, 2, 3, and 4, respectively. A positive dose-dependent relationship between hypertension burden and ESRD was found (P for interaction < 0.001). This association was maintained for sustained exposure to both systolic and diastolic hypertension burden. In conclusion, hypertension burden increases the risk of ESRD. Our study underlines the usefulness of a new assessment of the hypertension burden over a certain period for predicting the risk of ESRD in a large population-based cohort.
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Affiliation(s)
- Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. .,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
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18
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Tian X, Wang A, Wu S, Zuo Y, Chen S, Zhang L, Mo D, Luo Y. Cumulative Serum Uric Acid and Its Time Course Are Associated With Risk of Myocardial Infarction and All-Cause Mortality. J Am Heart Assoc 2021; 10:e020180. [PMID: 34120449 PMCID: PMC8403320 DOI: 10.1161/jaha.120.020180] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Serum uric acid (SUA) has been demonstrated as a risk factor for myocardial infarction (MI) and all-cause mortality; however, the impact of cumulative SUA (cumSUA) remains unclear. We aimed to investigate the association of cumSUA with MI risk and all-cause mortality, and to further explore the effects of SUA accumulation time course. Methods and Results The study enrolled 53 463 participants without a history of MI, and these participants underwent 3 examinations during 2006 to 2010. cumSUA from baseline to the third examination was calculated, multiplying mean values between consecutive examinations by time intervals between visits. Cox models estimated hazard ratios (HRs) and 95% CIs of MI and all-cause mortality for cumSUA quartiles, hyperuricemia exposure duration, and SUA accumulation time course. During a median follow-up of 7.04 years, 476 incident MIs and 2692 deaths occurred. In the fully adjusted model, a higher MI risk was observed in the highest cumSUA quartile (HR, 1.48; 95% CI, 1.10-1.99), in participants with longer hyperuricemia exposure duration (HR, 1.71; 95% CI, 1.06-2.73), and in participants with cumSUA≥median and a negative slope (HR, 1.58; 95% CI, 1.18-2.11). Similar associations persisted for all-cause mortality. Conclusions The risk of MI and all-cause mortality increased with higher cumSUA and was affected by the SUA accumulation time course. Early SUA accumulation contributed more to MI risk and all-cause mortality than later SUA accumulation with the same overall cumulative exposure, emphasizing the importance of optimal SUA control early in life.
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Affiliation(s)
- Xue Tian
- Department of Epidemiology and Health Statistics School of Public Health Capital Medical University Beijing China.,Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalCapital Medical University Beijing China.,Department of Neurology Beijing Tiantan HospitalCapital Medical University Beijing China
| | - Shouling Wu
- Department of Cardiology Kailuan Hospital North China University of Science and Technology Tangshan China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics School of Public Health Capital Medical University Beijing China.,Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing China
| | - Shuohua Chen
- Department of Cardiology Kailuan Hospital North China University of Science and Technology Tangshan China
| | - Licheng Zhang
- Department of Epidemiology and Health Statistics School of Public Health Capital Medical University Beijing China.,Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing China
| | - Dapeng Mo
- Department of Neurological Intervention Beijing Tiantan HospitalCapital Medical University Beijing China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics School of Public Health Capital Medical University Beijing China.,Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing China
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19
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Newby D, Winchester L, Sproviero W, Fernandes M, Wang D, Kormilitzin A, Launer LJ, Nevado-Holgado AJ. Associations Between Brain Volumes and Cognitive Tests with Hypertensive Burden in UK Biobank. J Alzheimers Dis 2021; 84:1373-1389. [PMID: 34690138 PMCID: PMC8673518 DOI: 10.3233/jad-210512] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Mid-life hypertension is an established risk factor for cognitive impairment and dementia and related to greater brain atrophy and poorer cognitive performance. Previous studies often have small sample sizes from older populations that lack utilizing multiple measures to define hypertension such as blood pressure, self-report information, and medication use; furthermore, the impact of the duration of hypertension is less extensively studied. OBJECTIVE To investigate the relationship between hypertension defined using multiple measures and length of hypertension with brain measure and cognition. METHODS Using participants from the UK Biobank MRI visit with blood pressure measurements (n = 31,513), we examined the cross-sectional relationships between hypertension and duration of hypertension with brain volumes and cognitive tests using generalized linear models adjusted for confounding. RESULTS Compared with normotensives, hypertensive participants had smaller brain volumes, larger white matter hyperintensities (WMH), and poorer performance on cognitive tests. For total brain, total grey, and hippocampal volumes, those with greatest duration of hypertension had the smallest brain volumes and the largest WMH, ventricular cerebrospinal fluid volumes. For other subcortical and white matter microstructural regions, there was no clear relationship. There were no significant associations between duration of hypertension and cognitive tests. CONCLUSION Our results show hypertension is associated with poorer brain and cognitive health however, the impact of duration since diagnosis warrants further investigation. This work adds further insights by using multiple measures defining hypertension and analysis on duration of hypertension which is a substantial advance on prior analyses-particularly those in UK Biobank which present otherwise similar analyses on smaller subsets.
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Affiliation(s)
- Danielle Newby
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Laura Winchester
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - William Sproviero
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Marco Fernandes
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | | | - Andrey Kormilitzin
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | | | - Alejo J. Nevado-Holgado
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, UK
- Akrivia Health, Oxford, UK
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20
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Mahinrad S, Shownkeen M, Sedaghat S, Yaffe K, Hausdorff JM, Lloyd-Jones DM, Gorelick PB, Sorond FA. Vascular health across young adulthood and midlife cerebral autoregulation, gait, and cognition. Alzheimers Dement 2020; 17:745-754. [PMID: 33283978 DOI: 10.1002/alz.12246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION To test the association of vascular health (VH) across young adulthood with midlife dynamic cerebral autoregulation (dCA), gait, and cognition; and to test whether dCA is a modifying factor. METHODS We studied 196 participants from the Coronary Artery Risk Development in Young Adults cohort who were followed over 30 years. VH was assessed at each visit according to American Heart Association recommendations. At year 30, dCA was measured using transcranial Doppler ultrasound and several gait and cognitive domains were assessed. RESULTS Worse VH from baseline through year 7, but not at year 30, was associated with less efficient dCA (all P < .05). Worse VH at all visits was associated with slower gait speed, and at year 7 with worse executive and global cognition (all P < .05). The association of baseline VH and midlife gait, but not cognition, was moderated by dCA (interaction P < .05). CONCLUSIONS VH as early as young adulthood may influence midlife brain health, and dCA may modify this relationship.
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Affiliation(s)
- Simin Mahinrad
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Meghana Shownkeen
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sanaz Sedaghat
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University, Chicago, Illinois, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Philip B Gorelick
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Farzaneh A Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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21
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Lamar M, Boots EA, Arfanakis K, Barnes LL, Schneider JA. Common Brain Structural Alterations Associated with Cardiovascular Disease Risk Factors and Alzheimer's Dementia: Future Directions and Implications. Neuropsychol Rev 2020; 30:546-57. [PMID: 33011894 DOI: 10.1007/s11065-020-09460-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/24/2020] [Indexed: 01/18/2023]
Abstract
Recent reports suggest declines in the age-specific risk of Alzheimer's dementia in higher income Western countries. At the same time, investigators believe that worldwide trends of increasing mid-life modifiable risk factors [e.g., cardiovascular disease (CVD) risk factors] coupled with the growth of the world's oldest age groups may nonetheless lead to an increase in Alzheimer's dementia. Thus, understanding the overlap in neuroanatomical profiles associated with CVD risk factors and AD may offer more relevant targets for investigating ways to reduce the growing dementia epidemic than current targets specific to isolated AD-related neuropathology. We hypothesized that a core group of common brain structural alterations exist between CVD risk factors and Alzheimer's dementia. Two co-authors conducted independent literature reviews in PubMed using search terms for CVD risk factor burden (separate searches for 'cardiovascular disease risk factors', 'hypertension', and 'Type 2 diabetes') and 'aging' or 'Alzheimer's dementia' with either 'grey matter volumes' or 'white matter'. Of studies that reported regionally localized results, we found support for our hypothesis, determining 23 regions commonly associated with both CVD risk factors and Alzheimer's dementia. Within this context, we outline future directions for research as well as larger cerebrovascular implications for these commonalities. Overall, this review supports previous as well as more recent calls for the consideration that both vascular and neurodegenerative factors contribute to the pathogenesis of dementia.
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22
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Mo J, Chen Z, Xu J, Wang A, Meng X, Zhao X, Li H, Wu S, Wang Y. The impact of the cumulative burden of LDL-c and hs-CRP on cardiovascular risk: a prospective, population-based study. Aging (Albany NY) 2020; 12:11990-12001. [PMID: 32544081 PMCID: PMC7343474 DOI: 10.18632/aging.103365] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
Background: This study aims to demonstrate the impact of the cumulative burden of low density lipoprotein-cholesterol (cumLDL-c) and high sensitivity C-reactive protein (cumhs-CRP) on cardiovascular risk. Results: During the 4.62 (±0.70) years of follow-up, 2,148 (5.92%) participants had MACE. Both of cumLDL-c and cumhs-CRP were independent risk factors for MACE. In participants without cumLDL-c during 2006-2013, the participants with cumhs-CRP had higher MACE risk during the subsequent 5 years, than those without cumhs-CRP (hazard ratio [HR]: 1.24, 95% confidence interval [CI]:1.04-1.47). In addition, cumhs-CRP correlated with MACE in a cumhs-CRP level-dependent pattern. Conclusion: This study validated the effects of residual inflammation risk in patients with low LDL-c Level in a general population, using long-term burdens of hs-CRP or LDL-c other than a single time-point level. Method: The Kailuan study is a prospective, population-based study began in 2006. These total 36,421 participants completed 4 measurements of hs-CRP and LDL-c biennially from 2006-2013. Cumhs-CRP or cumLDL-c levels were calculated as the number of interval years multiplied by the Δhs-CRP (more than 2.0 mg/L) or ΔLDL-c (more than 2.6 mmol/L). Outcomes measured during follow-up (2012-2017) were defined as major adverse cardiac events (MACE), including ischemic stroke, myocardial infarction, and all-cause mortality.
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Affiliation(s)
- Jinglin Mo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zimo Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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