The sooner we start to control cardiovascular risk factors, the better for our brain

2023-08-31 18:45:10

Cardiovascular diseases and dementia coexist in advanced stages on many occasions; however, there are few longitudinal studies in people in their mid-50s that have evaluated the interaction between atherosclerosis and its risk factors on brain health.

Now, a study carried out at the National Center for Cardiovascular Research (CNIC) in Spain provides new data on this relationship and confirms the relevance of controlling traditional cardiovascular risk factors, such as hypertension, cholesterol, diabetes, smoking or a sedentary lifestyle, not only for take care of cardiovascular health, but also to prevent diseases such as Alzheimer’s.

The CNIC research shows that atherosclerosis (the accumulation of fatty plaques in the arteries) and its associated risk factors, in addition to being the main causes of cardiovascular disease, are also implicated in brain alterations typical of Alzheimer’s disease, the most common cause of dementia.

The information is very relevant because, says Dr. Valentín Fuster, General Director of the CNIC and one of the main authors of the study, it opens the possibility of intervening on a modifiable disorder, such as cardiovascular diseases, to prevent the development of dementia, for which there is no treatment for many patients. “The sooner we start to control cardiovascular risk factors, the better it is for our brains,” says Dr. Fuster.

Likewise, the Director of the CNIC underlines, “despite the fact that we all know the importance of taking care of ourselves and controlling cardiovascular risk factors to avoid a heart attack, the fact that they are related to a deterioration in brain health may lead to a greater awareness of the need to acquire healthy habits in the younger phases of life”.

Research team members. (Photo: CNIC)

In 2021, CNIC researchers discovered that the presence of cardiovascular risk factors and subclinical atherosclerosis -before symptoms appear- in the carotid arteries, which supply blood to the brain, in apparently healthy 50-year-old individuals who participate in the PESA-CNIC-Santander study, was associated with lower brain glucose metabolism (Cortés-Canteli & Gispert et al. JACC. 2021). Brain glucose metabolism is considered an indicator of brain health.

The PESA-CNIC-Santander, directed by Dr. Fuster, is a prospective study that includes more than 4,000 asymptomatic middle-aged participants in which the presence and development of subclinical atherosclerosis has been exhaustively evaluated since 2010.

Dr. Valentín Fuster’s team, led by Dr. Marta Cortés Canteli and Dr. Juan Domingo Gispert, has followed these individuals for 5 years and found that those who maintain a high cardiovascular risk throughout this time, suffer an even greater decrease in brain metabolism measured through imaging techniques such as positron emission tomography (PET).

“We have detected a cerebral metabolic decline three times greater than that of people who remain at low cardiovascular risk,” says Catarina Tristão-Pereira, the first signatory of the study and an INPhINIT fellow from Fundación La Caixa.

Glucose is the main source of energy for neurons and other brain cells. “If brain glucose consumption decreases over several years, it can limit the brain’s ability to deal with neurodegenerative or cerebrovascular diseases in the future,” says Dr. Gispert, an expert in Neuroimaging at the CNIC and the Barcelona-beta Research Center.

In fact, in collaboration with doctors Henrik Zetterberg and Kaj Blennow from the University of Gothenburg (Sweden), world experts in the determination of new biomarkers in blood, CNIC researchers discovered that this metabolic decline was partly due to the already existing neuronal damage in these individuals. “This data is particularly relevant since the death of neurons is an irreversible process,” remarks Dr. Cortés Canteli, a neuroscientist at the CNIC and a Miguel Servet researcher at the Fundación Jiménez Díaz Health Research Institute.

In addition, the CNIC team discovered that the progression of subclinical atherosclerosis in the carotids during these 5 years was related to a decrease in metabolism in brain regions vulnerable to Alzheimer’s disease, in addition to the effect of the cardiovascular risk factors themselves. . “These results corroborate that imaging detection of subclinical atherosclerosis provides highly relevant information”, adds Dr. Fuster, Principal Investigator of the PESA study. “The relationship between the brain and the heart is a fascinating subject and with this study we have seen that it starts much earlier than previously thought,” he continues.

The researchers conclude that in light of these results, “carotid screening has great potential to identify people vulnerable to future brain abnormalities and cognitive decline.” Thus, they write, “this work could have important implications for clinical practice as it supports the implementation of primary cardiovascular prevention strategies early in life as a valuable approach to healthy brain longevity.”

“Although we still do not know the impact that this decrease in brain metabolism can have on cognitive function, having already detected neuronal damage does indicate that the sooner we start to control cardiovascular risk factors, the better it will be for our brain,” concludes Dr. Cortés Canteli.

The study is titled “Longitudinal interplay between subclinical atherosclerosis, cardiovascular risk factors, and cerebral glucose metabolism in midlife: results from the PESA prospective cohort study. And it has been published in the academic journal The Lancet Healthy Longevity.

Researchers from the CIBER for Cardiovascular Diseases (CIBERCV), the CIBER for Fragility and Healthy Aging (CIBERFES) and the CIBER for Bioengineering, Biomaterials and Nanomedicine (CIBERBBN) in Spain have also participated in the study. (Source: CNIC)