Angela L Jefferson1, Alexa S Beiser2, Jayandra J Himali2, Sudha Seshadri2, Christopher J O'Donnell2, Warren J Manning2, Philip A Wolf2, Rhoda Au2, Emelia J Benjamin2. 1. From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. angela.jefferson@vanderbilt.edu. 2. From Vanderbilt Memory & Alzheimer's Center, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (A.L.J.); Departments of Neurology (A.S.B., J.J.H., S.S., P.A.W., R.A.) and Medicine (E.J.B.), Boston University School of Medicine, Boston, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (A.S.B., J.J.H., S.S., C.J.O., P.A.W., R.A., E.J.B.); Departments of Epidemiology (E.J.B.) and Biostatistics (A.S.B.), Boston University School of Public Health, Boston, MA; and Departments of Medicine (Cardiovascular Division) (W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: Cross-sectional epidemiological and clinical research suggests that lower cardiac index is associated with abnormal brain aging, including smaller brain volumes, increased white matter hyperintensities, and worse cognitive performances. Lower systemic blood flow may have implications for dementia among older adults. METHODS AND RESULTS: A total of 1039 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, and dementia formed our sample (age, 69±6 years; 53% women). Multivariable-adjusted proportional hazard models adjusting for Framingham Stroke Risk Profile score (age, sex, systolic blood pressure, antihypertensive medication, diabetes mellitus, cigarette smoking, cardiovascular disease history, atrial fibrillation), education, and apolipoprotein E4 status related cardiac magnetic resonance imaging-assessed cardiac index (cardiac output divided by body surface area) to incident all-cause dementia and Alzheimer disease (AD). Over the median 7.7-year follow-up period, 32 participants developed dementia, including 26 cases of AD. Each 1-SD unit decrease in cardiac index increased the relative risk of both dementia (hazard ratio [HR]=1.66; 95% confidence interval [CI], 1.11-2.47; P=0.013) and AD (HR=1.65; 95% CI, 1.07-2.54; P=0.022). Compared with individuals with normal cardiac index, individuals with clinically low cardiac index had a higher relative risk of dementia (HR=2.07; 95% CI, 1.02-4.19; P=0.044). If participants with clinically prevalent cardiovascular disease and atrial fibrillation were excluded (n=184), individuals with clinically low cardiac index had a higher relative risk of both dementia (HR=2.92; 95% CI, 1.34-6.36; P=0.007) and AD (HR=2.87; 95% CI, 1.21-6.80; P=0.016) compared with individuals with normal cardiac index. CONCLUSION: Lower cardiac index is associated with an increased risk for the development of dementia and AD.
BACKGROUND: Cross-sectional epidemiological and clinical research suggests that lower cardiac index is associated with abnormal brain aging, including smaller brain volumes, increased white matter hyperintensities, and worse cognitive performances. Lower systemic blood flow may have implications for dementia among older adults. METHODS AND RESULTS: A total of 1039 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, and dementia formed our sample (age, 69±6 years; 53% women). Multivariable-adjusted proportional hazard models adjusting for Framingham Stroke Risk Profile score (age, sex, systolic blood pressure, antihypertensive medication, diabetes mellitus, cigarette smoking, cardiovascular disease history, atrial fibrillation), education, and apolipoprotein E4 status related cardiac magnetic resonance imaging-assessed cardiac index (cardiac output divided by body surface area) to incident all-cause dementia and Alzheimer disease (AD). Over the median 7.7-year follow-up period, 32 participants developed dementia, including 26 cases of AD. Each 1-SD unit decrease in cardiac index increased the relative risk of both dementia (hazard ratio [HR]=1.66; 95% confidence interval [CI], 1.11-2.47; P=0.013) and AD (HR=1.65; 95% CI, 1.07-2.54; P=0.022). Compared with individuals with normal cardiac index, individuals with clinically low cardiac index had a higher relative risk of dementia (HR=2.07; 95% CI, 1.02-4.19; P=0.044). If participants with clinically prevalent cardiovascular disease and atrial fibrillation were excluded (n=184), individuals with clinically low cardiac index had a higher relative risk of both dementia (HR=2.92; 95% CI, 1.34-6.36; P=0.007) and AD (HR=2.87; 95% CI, 1.21-6.80; P=0.016) compared with individuals with normal cardiac index. CONCLUSION: Lower cardiac index is associated with an increased risk for the development of dementia and AD.
Authors: Sarah E Vermeer; Niels D Prins; Tom den Heijer; Albert Hofman; Peter J Koudstaal; Monique M B Breteler Journal: N Engl J Med Date: 2003-03-27 Impact factor: 91.245
Authors: M Shibata; S Yamada; S R Kumar; M Calero; J Bading; B Frangione; D M Holtzman; C A Miller; D K Strickland; J Ghiso; B V Zlokovic Journal: J Clin Invest Date: 2000-12 Impact factor: 14.808
Authors: Edouard Fonck; Georg G Feigl; Jean Fasel; Daniel Sage; Michael Unser; Daniel A Rüfenacht; Nikolaos Stergiopulos Journal: Stroke Date: 2009-05-28 Impact factor: 7.914
Authors: Tom Jeerakathil; Philip A Wolf; Alexa Beiser; Joseph Massaro; Sudha Seshadri; Ralph B D'Agostino; Charles DeCarli Journal: Stroke Date: 2004-06-24 Impact factor: 7.914
Authors: Thomas Polak; Martin J Herrmann; Laura D Müller; Julia B M Zeller; Andrea Katzorke; Matthias Fischer; Fabian Spielmann; Erik Weinmann; Leif Hommers; Martin Lauer; Andreas J Fallgatter; Jürgen Deckert Journal: J Neural Transm (Vienna) Date: 2017-09-01 Impact factor: 3.575
Authors: Ariane Marelli; Steven P Miller; Bradley Scott Marino; Angela L Jefferson; Jane W Newburger Journal: Circulation Date: 2016-05-17 Impact factor: 29.690
Authors: Kasper Adelborg; Erzsébet Horváth-Puhó; Anne Ording; Lars Pedersen; Henrik Toft Sørensen; Victor W Henderson Journal: Eur J Heart Fail Date: 2016-09-09 Impact factor: 15.534