Summary: A new study reports lifestyle choices, such as smoking or drinking alcohol during early adulthood, can increase the risk of developing dementia or having a stroke later in life.
Source: University of Oxford.
Researchers from the University of Oxford, in collaboration with researchers from Canada and the Universities of Bristol and London, have used advanced magnetic resonance imaging to investigate whether factors such as blood pressure, fitness, smoking and alcohol intake during young adult life are associated with changes in the blood vessels inside the brain.
The British Heart Foundation and Wellcome Trust funded study, which took place at the Cardiovascular Clinical Research Facility at Oxford’s John Radcliffe Hospital, involved 125 young adults between the ages of 18 and 40 years.
Participants with healthier cardiovascular risk profiles, such as those with optimal blood pressure who are following the UK’s Chief Medical Officers’ public health guidelines for exercise participation and lower alcohol intake were found to have higher density of blood vessels in the brain as well as higher brain blood flow and fewer white matter hyperintensity lesions; which have been associated with a higher risk of stroke and dementia in later life.
Profesor Paul Leeson, Professor of Cardiovascular Medicine at the University of Oxford, who led the research commented: ‘We have known for some time that lifestyle during young adult life is relevant to the health of the heart. This new research is exciting because we have been able to show that similar factors may also be impacting on the health of the brain, decades earlier than previously anticipated.’
Dr Wilby Williamson, Sports and Exercise Medicine Physician and Clinical Research Fellow in Cardiovascular Medicine at the University of Oxford, who helped deliver the study and is a co-author commented: ‘Young adult cardiovascular health is often a neglected area. This study is a first step towards personalized risk assessment so we can better inform people about steps to improve their future brain health.’
Dr Charlie Foster, Chair of the UK Chief Medical Officers Expert Committee for Physical activity commented: ‘This study suggests regular exercise, sensible drinking, not smoking, and keeping blood pressure at healthy levels can have wide spread benefits for both heart and brain disease and that Health choices have real impact and benefits at any age.’
‘It also demonstrates the power and utility of medical imaging to better understand how specific risk factors relate to early brain changes’, commented study co-author Dr Adam Lewandowski, who is a British Heart Foundation Research Fellow and University Research Lecturer at the University of Oxford.
Professor Jeremy Pearson, associate medical director at the British Heart Foundation, said: ‘The risk of heart disease and stroke is known to be affected by external factors from early childhood onwards even though clinical events usually occur only in later life.
‘This study in healthy young adults shows clearly that there are already detectable changes in blood vessels in the brain likely to increase risk of subsequent stroke in those with the highest level of modifiable risk factors such as smoking and high BMI.
‘It strengthens the evidence that leading a lifestyle to keep your heart healthy is important throughout life.’
Dr Foster, Dr Lewandowski, Dr Williamson and Professor Paul Leeson are currently using the advanced imaging techniques available in Oxford in a trial in young adults with higher blood pressure. The study will help determine the best ways to change lifestyle to improve brain and heart health.
Source: University of Oxford
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Original Research: Abstract for “Association of Cardiovascular Risk Factors With MRI Indices of Cerebrovascular Structure and Function and White Matter Hyperintensities in Young Adults” by Wilby Williamson, MSc, MRCP; Adam J. Lewandowski, DPhil; Nils D. Forkert, PhD; Ludovica Griffanti, PhD; Thomas W. Okell, DPhil; Jill Betts, DPhil; Henry Boardman, MRCP, DPhil; Timo Siepmann, MD; David McKean, MD; Odaro Huckstep, MSc; Jane M. Francis, DCR(R); Stefan Neubauer, MD, FRCP; Renzo Phellan, MSc; Mark Jenkinson, DPhil; Aiden Doherty, PhD; Helen Dawes, PhD; Eleni Frangou, MSc (Res); Christina Malamateniou, PhD; Charlie Foster, PhD; and Paul Leeson, PhD, FRCP in JAMA. Published August 21 2018.
Association of Cardiovascular Risk Factors With MRI Indices of Cerebrovascular Structure and Function and White Matter Hyperintensities in Young Adults
Risk of stroke and brain atrophy in later life relate to levels of cardiovascular risk in early adulthood. However, it is unknown whether cerebrovascular changes are present in young adults.
To examine relationships between modifiable cardiovascular risk factors and cerebrovascular structure, function, and white matter integrity in young adults.
Design, Setting, and Participants
A cross-sectional observational study of 125 young adults (aged 18-40 years) without clinical evidence of cerebrovascular disease. Data collection was completed between August 2014 and May 2016 at the University of Oxford, United Kingdom. Final data collection was completed on May 31, 2016.
The number of modifiable cardiovascular risk factors at recommended levels, based on the following criteria: body mass index (BMI) <25; highest tertile of cardiovascular fitness and/or physical activity; alcohol consumption <8 drinks/week; nonsmoker for >6 months; blood pressure on awake ambulatory monitoring <130/80 mm Hg; a nonhypertensive diastolic response to exercise (peak diastolic blood pressure <90 mm Hg); total cholesterol <200 mg/dL; and fasting glucose <100mg/dL. Each risk factor at the recommended level was assigned a value of 1, and participants were categorized from 0-8, according to the number of risk factors at recommended levels, with higher numbers indicating healthier risk categories.
Main Outcomes and Measures
Cerebral vessel density, caliber and tortuosity, brain white matter hyperintensity lesion count. In a subgroup (n = 52), brain blood arrival time and cerebral blood flow assessed by brain magnetic resonance imaging (MRI).
A total of 125 participants, mean (SD) age 25 (5) years, 49% women, with a mean (SD) score of 6.0 (1.4) modifiable cardiovascular risk factors at recommended levels, completed the cardiovascular risk assessment and brain MRI protocol. Cardiovascular risk factors were correlated with cerebrovascular morphology and white matter hyperintensity count in multivariable models. For each additional modifiable risk factor categorized as healthy, vessel density was greater by 0.3 vessels/cm3 (95% CI, 0.1-0.5; P = .003), vessel caliber was greater by 8 μm (95% CI, 3-13; P = .01), and white matter hyperintensity lesions were fewer by 1.6 lesions (95% CI, −3.0 to −0.5; P = .006). Among the 52 participants with available data, cerebral blood flow varied with vessel density and was 2.5 mL/100 g/min higher for each healthier category of a modifiable risk factor (95% CI, 0.16-4.89; P = .03).
Conclusions and Relevance
In this preliminary study involving young adults without clinical evidence of cerebrovascular disease, a greater number of modifiable cardiovascular risk factors at recommended levels was associated with higher cerebral vessel density and caliber, higher cerebral blood flow, and fewer white matter hyperintensities. Further research is needed to verify these findings and determine their clinical importance.