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Eur Heart J. 2019 Mar 11. doi: 10.1093/eurheartj/ehz100. [Epub ahead of print]

Associations between vascular risk factors and brain MRI indices in UK Biobank.

Author information

Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.
Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.
Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.
Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK.
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, UK.
Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK.
Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK.
Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, VU University Amsterdam, Amsterdam UMC, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, UK.
Department of Psychology, University of Texas, 108 E Dean Keeton St, Austin, Texas, USA.
UK Dementia Research Institute at the University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK.
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK.



Several factors are known to increase risk for cerebrovascular disease and dementia, but there is limited evidence on associations between multiple vascular risk factors (VRFs) and detailed aspects of brain macrostructure and microstructure in large community-dwelling populations across middle and older age.


Associations between VRFs (smoking, hypertension, pulse pressure, diabetes, hypercholesterolaemia, body mass index, and waist-hip ratio) and brain structural and diffusion MRI markers were examined in UK Biobank (N = 9722, age range 44-79 years). A larger number of VRFs was associated with greater brain atrophy, lower grey matter volume, and poorer white matter health. Effect sizes were small (brain structural R2 ≤1.8%). Higher aggregate vascular risk was related to multiple regional MRI hallmarks associated with dementia risk: lower frontal and temporal cortical volumes, lower subcortical volumes, higher white matter hyperintensity volumes, and poorer white matter microstructure in association and thalamic pathways. Smoking pack years, hypertension and diabetes showed the most consistent associations across all brain measures. Hypercholesterolaemia was not uniquely associated with any MRI marker.


Higher levels of VRFs were associated with poorer brain health across grey and white matter macrostructure and microstructure. Effects are mainly additive, converging upon frontal and temporal cortex, subcortical structures, and specific classes of white matter fibres. Though effect sizes were small, these results emphasize the vulnerability of brain health to vascular factors even in relatively healthy middle and older age, and the potential to partly ameliorate cognitive decline by addressing these malleable risk factors.


Brain; Cortex; Diffusion; MRI; Vascular risk; White matter


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