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Total cerebral blood flow and mortality in old age: a 12-year follow-up study
Behnam Sabayan1, Jeroen van der Grond, Rudi G Westendorp
1From the Departments of Radiology (B.S., J.v.d.G., M.J.P.v.O., M.A.v.B.), Gerontology and Geriatrics (B.S., R.G.W., A.J.M.d.C.), and Cardiology (J.W.J.), Leiden University Medical Center; Netherlands Consortium for Healthy Ageing (R.G.W., A.J.M.d.C.), Leiden, the Netherlands; Robertson Center for Biostatistics (I.F.), and Glasgow Cardiovascular Research Centre (N.S.), University of Glasgow, UK; and Department of Pharmacology and Therapeutics (B.M.B.), University College Cork, Ireland.
Insights
Low total cerebral blood flow (CBF) significantly increases mortality risk in older adults. Reduced CBF is associated with higher rates of all-cause, noncardiovascular, and cardiovascular death, regardless of existing conditions.
Area of Science:
- Neurology
- Gerontology
- Cardiovascular Medicine
Background:
- Cardiovascular disease risk increases with age.
- Cerebral blood flow (CBF) is a critical indicator of brain health.
- Understanding CBF's role in mortality is vital for geriatric care.
Purpose of the Study:
- To investigate the association between total cerebral blood flow (CBF) and mortality in elderly individuals at cardiovascular risk.
- To differentiate the impact of CBF on all-cause, noncardiovascular, and cardiovascular mortality.
Main Methods:
- 411 elderly participants (mean age 74.5 years) from a cardiovascular risk study.
- Baseline total CBF measured and standardized for brain parenchymal volume.
- Mortality recorded over an 11.8-year follow-up using Cox regression models.
Main Results:
- Lower total CBF correlated with higher mortality rates.
- Participants in the lowest CBF third had 1.88x higher all-cause mortality risk compared to the highest third.
- Reduced CBF independently predicted increased risks for all-cause, noncardiovascular, and cardiovascular mortality.
Conclusions:
- Low total cerebral blood flow is a significant predictor of mortality in older adults.
- This association persists independently of clinical cardiovascular status and risk factors.
- Findings highlight CBF as a potential biomarker for mortality risk in the elderly.
Objective:
To examine the association of total cerebral blood flow (CBF) with all-cause, noncardiovascular, and cardiovascular mortality in older subjects at risk of cardiovascular disease.
Methods:
We included 411 subjects with a mean age of 74.5 years from the MRI substudy of the Prospective Study of Pravastatin in the Elderly at Risk. Total CBF was measured at baseline, and occurrence of death was recorded in an average follow-up period of 11.8 years. For each participant, total CBF was standardized for brain parenchymal volume. Cox regression models were used to estimate risk of all-cause, noncardiovascular, and cardiovascular mortality in relation to CBF.
Results:
Mortality rates among participants in low, middle, and high thirds of total CBF were 52.1, 41.5, and 28.7 per 1,000 person-years, respectively. Compared with participants in the high third of CBF, participants in the low third had 1.88-fold (95% confidence interval [CI]: 1.30-2.72) higher risk of all-cause mortality, 1.66-fold (95% CI: 1.06-2.59) higher risk of noncardiovascular mortality, and 2.50-fold (95% CI: 1.28-4.91) higher risk of cardiovascular mortality. Likewise, compared with participants in the high third of CBF, participants in the middle third had 1.44-fold (95% CI: 0.98-2.11) higher risk of all-cause mortality, 1.29-fold (95% CI: 0.82-2.04) higher risk of noncardiovascular mortality, and 1.86-fold (95% CI: 0.93-3.74) higher risk of cardiovascular mortality. These associations were independent of prevalent vascular status and risk factors.
Conclusions:
Low total CBF is linked with higher risk of all-cause, noncardiovascular, and cardiovascular mortality in older people independent of clinical cardiovascular status.
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