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Cardiovascular risk factors and cerebral atrophy in a middle-aged cohort

From the Department of Neurology (Dr. Knopman), Mayo Clinic, Rochester, MN; Department of Medicine (Dr. Mosley), University of Mississippi Medical Center, Jackson; Department of Biostatistics (Dr. Catellier), University of North Carolina, Chapel Hill; and the Bloomberg School of Public Health (Dr. Sharrett), The Johns Hopkins Medical Institutions, Baltimore, MD.

Address correspondence and reprint requests to Dr. David Knopman, Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905; e-mail: knopman{at}mayo.edu

Background: Because cardiovascular (CV) risk factors have been associated with declines in cognitive functions and late life dementia, CV risk factors should also be associated with brain atrophy.

Objective: To study the association of CV risk factors with ventricular size (VS) and sulcal size (SS) in the middle-aged and young-elderly Atherosclerosis Risk in Communities (ARIC) Study cohort.

Methods: Cerebral MRI was performed on 1,812 individuals (aged 50 to 73 [mean 62.3] years, 60% women, 50% African American) with no history of stroke or TIA from the ARIC cohort at study sites in Forsyth County, NC, and Jackson, MS. Neuroradiologists rated VS and SS using a semiquantitative, 10-point scale by visual comparison with a standardized reference atlas. CV risk factors were assessed approximately 6 years prior to the MR scan. The authors performed multivariate analyses to assess the independent relationship between CV risk factors and the two measures of brain atrophy.

Results: Logistic regression models controlling for age, sex, race, and alcohol use found that the association between diabetes and VS is as follows: OR = 1.63, 95% CI: 1.19 to 2.24; p = 0.003. Increasing levels of fasting blood glucose also showed an association with greater VS (OR = 1.07, 95% CI: 1.03 to 1.10; p = 0.001, for each 10 mg/dL of blood glucose). No other CV risk factors were associated with greater VS or SS.

Conclusions: In this middle-aged and young-elderly cohort, diabetes mellitus was associated with greater ventricular size. Mechanisms for deterioration of brain structural integrity may include microvascular, amyloidogenic, or other not-yet-defined effects of diabetes mellitus.

The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022. This work was also supported by grant R01- HL70825.

Disclosure: The authors report no conflicts of interest.

Received February 18, 2005. Accepted in final form June 9, 2005.

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