Marta Cortes-Canteli, PhD, and Valentin Fuster, MD, PhD, MACC, et al., studied the association of cerebral metabolism (FDG uptake) with cardiovascular risk factors and atherosclerotic plaque burden in a subcohort of 547 asymptomatic middle-aged participants from the PESA study who had evidence of subclinical atherosclerosis. Participants underwent 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET). Global brain FDG uptake and voxel-wise analyses were used to evaluate the associations of cerebral metabolism with cardiovascular risk factors. Atherosclerotic plaque burden in carotids and femorals were assessed using 3D-vascular ultrasound.

According to the results, the mean age at the time of FDG-PET study was 50.3 years and 451 (82.5%) of participants were men. The most prevalent cardiovascular risk factors were dyslipidemia (60%), followed by smoking (27.1%), hypertension (19.7%) and diabetes (4.6%). Global FDG uptake was inversely associated with the 30-year Framingham Risk Score (β=-0.15, p<0.001). This association was mainly driven by the presence of hypertension (d=0.36, p<0.001). In addition, carotid plaque burden was inversely associated with global brain FDG uptake (β=-0.16, p<0.001), even after adjusting for the 30-year Framingham Risk Score. Brain areas most strongly affected by hypometabolism in association with the 30-year Framingham Risk Score, hypertension and carotid plaque burden were parietotemporal regions (angular, supramarginal and inferior/middle temporal gyri) and the cingulate gyrus.

The findings suggest that the "interplay" between cardiovascular risk factors, atherosclerosis and altered brain metabolism "starts early in life," the researchers note. The potential for cardiovascular disease to drive development of dementia "further supports the critical value of implementing primary [cardiovascular disease] prevention strategies early in midlife as a valuable therapeutic approach to delay or even stop downstream brain alterations, eventually leading to cognitive decline," they conclude.

In an accompanying editorial comment, Neal S. Parikh, MD, MS, and Rebecca F. Gottesman, MD, PhD, write that the findings "provide valuable insights into the impact of midlife cardiovascular risk factors and carotid atherosclerosis on cognitive brain health." Although additional research is need to "comprehensively grasp the role and mechanisms of cardiovascular risk factors in dementia," the data are "abundantly sufficient to concur with the proclamation that dementia may be prevented by preventing stroke, and cardiovascular disease more broadly," they write.