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J Gerontol A Biol Sci Med Sci. 2019 Feb 23. pii: glz039. doi: 10.1093/gerona/glz039. [Epub ahead of print]

Carotid intima-media thickness and markers of brain health in a bi-racial middle-aged cohort: CARDIA Brain MRI Sub-study.

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National Institute of Mental Health, Klecany, Czech Republic.
Third Faculty of Medicine, Charles University Prague, Czech Republic.
Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, United States of America.
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, United States of America.
Karolinska University Hospital, Geriatric Clinic, Stockholm, Sweden.
Division of Epidemiology and Community Health, University of Minnesota, United States of America.
Department of Radiology, University of Pennsylvania, Philadelphia, United States of America.



We investigated whether carotid intima-media thickness (cIMT) is associated with measures of cerebral blood flow (CBF), white matter hyperintensities and brain volume in a bi-racial cohort of middle-aged individuals.


We performed a cross-sectional cohort study based on data from a multicenter, population-based study Coronary Artery Risk Development in Young Adults (CARDIA). Using linear and logistic regression, we estimated the association of the composite cIMT measured in 3 segments of carotid arteries (common carotid artery, carotid artery bulb and internal carotid artery) with volume (cm3) and CBF (ml/100 g/min) in the total brain and gray matter as well as volume of white matter hyperintensities (cm3).


461 participants (54% women, 34% African Americans) were included in the analysis. Greater cIMT was associated with lower CBF in gray matter (ß=-1.36; p=0.04) and total brain (ß=-1.26; p=0.04), adjusting for age, sex, race, education and total brain volume. The associations became statistically non-significant after further controlling for cardiovascular risk factors. CIMT was not associated with volumes of total brain, gray matter and white matter hyperintensities.


This study suggests that lower CBF in middle-age is associated with markers of atherosclerosis in the carotid arteries. This association may reflect early long-term exposure to traditional cardiovascular risk factors. Early intervention on atherosclerotic risk factors may modulate the trajectory of CBF as people age and develop brain pathology.


brain perfusion; carotid intima-media thickness; epidemiology


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