Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort
Rebecca F. Gottesman,Marilyn S. Albert,Alvaro Alonso,Laura H. Coker,Josef Coresh,Sonia M. Davis,Jennifer A. Deal,Guy M. McKhann,Thomas H. Mosley,A. Richey Sharrett,Andrea L.C. Schneider,B. Gwen Windham,Lisa M. Wruck,David S. Knopman +13 more
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TLDR
Midlife vascular risk factors are associated with increased risk of dementia in black and white ARIC Study participants and further studies are needed to evaluate the mechanism of and opportunities for prevention of the cognitive sequelae of these risk factors in midlife.Abstract:
Importance Vascular risk factors have been associated with cognitive decline. Midlife exposure to these factors may be most important in conferring late-life risk of cognitive impairment. Objectives To examine Atherosclerosis Risk in Communities (ARIC) participants in midlife and to explore associations between midlife vascular risk factors and 25-year dementia incidence. Design, Setting, and Participants This prospective cohort investigation of the Atherosclerosis Risk in Communities (ARIC) Study was conducted from 1987-1989 through 2011-2013. The dates of this analysis were April 2015 through August 2016. The setting was ARIC field centers (Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and Minneapolis suburbs, Minnesota). The study comprised 15 744 participants (of whom 27.1% were black and 72.9% white) who were aged 44 to 66 years at baseline. Main Outcomes and Measures Demographic and vascular risk factors were measured at baseline (obesity, smoking, diabetes, prehypertension, hypertension, and hypercholesterolemia) as well as presence of the APOE e4 genotype. After the baseline visit, participants had 4 additional in-person visits, for a total of 5 in-person visits, hospitalization surveillance, telephone calls, and repeated cognitive evaluations. Most recently, in 2011-2013, through the ARIC Neurocognitive Study (ARIC-NCS), participants underwent a detailed neurocognitive battery, informant interviews, and adjudicated review to define dementia cases. Additional cases were identified through the Telephone Interview for Cognitive Status–Modified or informant interview, for participants not attending the ARIC-NCS visit, or by an International Classification of Diseases , Ninth Revision dementia code during a hospitalization. Fully adjusted Cox proportional hazards regression was used to evaluate associations of baseline vascular and demographic risk factors with dementia. Results In total, 1516 cases of dementia (57.0% female and 34.9% black, with a mean [SD] age at visit 1 of 57.4 [5.2] years) were identified among 15 744 participants. Black race (hazard ratio [HR], 1.36; 95% CI, 1.21-1.54), older age (HR, 8.06; 95% CI, 6.69-9.72 for participants aged 60-66 years), lower educational attainment (HR, 1.61; 95% CI, 1.28-2.03 for less than a high school education), and APOE e4 genotype (HR, 1.98; 95% CI, 1.78-2.21) were associated with increased risk of dementia, as were midlife smoking (HR, 1.41; 95% CI, 1.23-1.61), diabetes (HR, 1.77; 95% CI, 1.53-2.04), prehypertension (HR, 1.31; 95% CI, 1.14-1.51), and hypertension (HR, 1.39; 95% CI, 1.22-1.59). The HR for dementia for diabetes was almost as high as that for APOE e4 genotype. Conclusions and Relevance Midlife vascular risk factors are associated with increased risk of dementia in black and white ARIC Study participants. Further studies are needed to evaluate the mechanism of and opportunities for prevention of the cognitive sequelae of these risk factors in midlife.read more
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2018 ESC/ESH Guidelines for the management of arterial hypertension.
B. Williams,G. Mancia,Wilko Spiering,Agabiti Rosei E,M. Azizi,Michel Burnier,Denis Clement,A. Coca,de Simone G,A Dominiczak,T. Kahan,Felix Mahfoud,Josep Redon,L.M. Ruilope,Alberto Zanchetti,Mary Kerins,S.E. Kjeldsen,Reinhold Kreutz,S. Laurent,Lip Gyh.,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,R.E. Schmieder,Evgeny Shlyakhto,Constantinos Tsioufis,Aboyans,Ileana Desormais +27 more
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Salim S. Virani,Alvaro Alonso,Emelia J. Benjamin,Márcio Sommer Bittencourt,Clifton W. Callaway,April P. Carson,Alanna M. Chamberlain,Alex R. Chang,Susan Cheng,Francesca N. Delling,Luc Djoussé,Mitchell S.V. Elkind,Jane F. Ferguson,Myriam Fornage,Sadiya S. Khan,Brett M. Kissela,Kristen L. Knutson,Tak W. Kwan,Daniel T. Lackland,Tené T. Lewis,Judith H. Lichtman,Chris T. Longenecker,Matthew Shane Loop,Pamela L. Lutsey,Seth S. Martin,Kunihiro Matsushita,Andrew E. Moran,Michael E. Mussolino,Amanda M. Perak,Wayne D. Rosamond,Gregory A. Roth,Uchechukwu K.A. Sampson,Gary Satou,Emily B. Schroeder,Svati H. Shah,Christina M. Shay,Nicole L. Spartano,Andrew Stokes,David L. Tirschwell,Lisa B. VanWagner,Connie W. Tsao +40 more
TL;DR: This year's edition of the Statistical Update includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association’s 2020 Impact Goals.
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Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association.
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2018 ESC/ESH Guidelines for the management of arterial hypertension : The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension
Bryan Williams,Giuseppe Mancia,Wilko Spiering,Enrico Agabiti Rosei,Michel Azizi,Michel Burnier,Denis Clement,Antonio Coca,Giovanni de Simone,Anna F. Dominiczak,Thomas Kahan,Felix Mahfoud,Josep Redon,Luis M. Ruilope,Alberto Zanchetti,Mary Kerins,Sverre E. Kjeldsen,Reinhold Kreutz,Stéphane Laurent,Gregory Y.H. Lip,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,Roland E. Schmieder,Evgeny Shlyakhto,Costas Tsioufis,Victor Aboyans,Ileana Desormais +27 more
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Journal ArticleDOI
[2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)].
Bryan Williams,Giuseppe Mancia,Wilko Spiering,Enrico Agabiti Rosei,Michel Azizi,Michel Burnier,Denis Clement,Antonio Coca,Giovanni de Simone,Anna F. Dominiczak,Thomas Kahan,Felix Mahfoud,Josep Redon,Luis M. Ruilope,Alberto Zanchetti,Mary Kerins,Sverre E. Kjeldsen,Reinhold Kreutz,Stéphane Laurent,Gregory Y.H. Lip,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,Roland E. Schmieder,Evgeny Shlyakhto,Costas Tsioufis,Victor Aboyans,Ileana Desormais +27 more
TL;DR: Authors/Task Force Members: Bryan Williams* (ESC Chairperson), Giuseppe Mancia* (ESH Chairperson) (Italy), Wilko Spiering (The Netherlands), Enrico Agabiti Rosei ( Italy), Michel Azizi (France), Michel Burnier (Switzerland), Denis L. Kjeldsen (Norway), Reinhold Kreutz (Germany), Stephane Laurent (France)
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