Scientists discover early links between cardiovascular risk and brain metabolism

The links between cardiovascular disease and cognitive impairment begin years before the first clinical symptoms of any condition occur. In a study conducted at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) in partnership with Santander Bank and neuropsychologists at the Barcelonaβeta Brain Research Center (BBRC, the research center of the Fundación Pasqual Maragall), the researchers found a link between brain identified. metabolism, cardiovascular risk and atherosclerosis during middle age, years before the first onset of symptoms.

The report, published in the Journal of the American College of Cardiology (JACC), is important because it suggests that intervention in a changeable condition (cardiovascular disease) can prevent the development of dementia, a disease for which there is currently no cure.

Dr. Valentín Fuster, principal director of CNIC and Mount Sinai Heart, chief physician of Mount Sinai Hospital and a lead author of the study, said: “Although everyone knows how important it is to look after ourselves and control cardiovascular risk factors. To avoid a heart attack, the association of the same risk factors with cognitive decline may increase awareness of the need to acquire healthy habits from the earliest stage of life. ‘

In addition, the results provide even more support for the importance of implementing primary cardiovascular prevention strategies in middle age as a valuable therapeutic approach to slow or even stop brain changes that may contribute to future cognitive decline.

Cognitive impairment

The advanced stages of vascular disease and dementia often occur together, but so far this connection has not been documented in earlier stages. The CNIC-coordinated study, led by dr. Marta Cortés Canteli, shows that atherosclerosis and cardiovascular risk factors in middle age, years before clinical signs appear, already show an association with low metabolism in brain regions involved in the future development of dementia, especially Alzheimer’s disease.

The advanced stages of neurodegenerative and vascular disease often occur together, and in recent years research has established a close link between cognitive decline and a number of cardiovascular risk factors, including high blood pressure, obesity, and high cholesterol.

Using advanced positron emission tomography (PET) imaging, the research team quantified brain metabolism in more than 500 participants in the PESA-CNIC-Santander study. The participants had a mean age of 50 years and had no symptoms, but already had evidence of atherosclerosis in their veins.

PESA-CNIC-Santander, led by dr. Valentín Fuster, is a prospective study of more than 4000 asymptomatic participants of middle age who have been fully evaluated since 2010 on the presence and progression of subclinical atherosclerosis.

The new study reveals a link between increased risk for a cardiovascular event and low brain metabolism. “When the brain’s metabolism decreases, the brain’s ability to deal with adverse events can be compromised. Depending on the affected brain area, it can lead to a number of different problems,” said Dr. Cortés Canteli, a CNIC investigator and fellow Miguel Servet.

Cardiovascular risk

“We found that higher cardiovascular risk in apparently healthy middle-aged individuals was associated with lower brain metabolism in parietotemporal regions involved in spatial and semantic memory and different types of learning,” said Dr Cortés Canteli. Dr Juan Domingo Gispert, Head of the Neuroimaging Group at the BBRC, noted that ‘the brain areas that show a low metabolism in participants with a higher cardiovascular risk are the same areas that are affected by Alzheimer’s disease, which suggests that these individuals may have a higher vulnerability than normal to this disease. ‘

“We think that cardiovascular risk factors that affect the large vessels that carry blood from the heart to the brain also affect the small vessels in the brain,” said Dr. Fuster said.

The authors say the study is by far the largest of its kind in a healthy middle-aged population and may indicate a paradigm shift in understanding the link between vascular and brain diseases.

Among the modifiable cardiovascular risk factors most closely associated with a reduction in brain metabolism, the researchers saw the greatest effect with hypertension. “We found that the same risk factors that damage the heart and large arteries, and especially high blood pressure, are closely related to the decline in brain metabolism years before the onset of symptoms,” said Dr. Fuster said.

Atherosclerotic plaques

The research team also found that a higher number of plaques in the carotid arteries, which transport blood to the brain, are associated with lower brain metabolism in areas of the limbic system and the parietal lobe, both of which are closely linked to the development of Alzheimer’s. disease.

“The next step will be to determine whether individuals with subclinical atherosclerosis of the carotid arteries and low brain metabolism at age 50 experience cognitive decline ten years later,” said Dr. Cortés Canteli said.

Dr Juan Domingo Gispert noted that ‘there is ample evidence linking cardiovascular risk factors and Alzheimer’s disease. If we can gain a more precise understanding of this connection in symptoms of disease, we can design new strategies to prevent Alzheimer’s, consistent with the success of current strategies to prevent cardiovascular disease. ‘

These results will be an important stimulus for the implementation of early intervention strategies to reduce the incidence of cognitive decline with age.

Provided by Centro Nacional de Investigaciones Cardiovasculares Carlos III (FSP)