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Late-Life Vascular Risk Score in Association With Postmortem Cerebrovascular Disease Brain Pathologies
Shahram Oveisgharan1,2, Lei Yu1,2, Ana Capuano1,2
1Rush Alzheimer's Disease Center (S.O., L.Y., A.C., Z.A., L.L.B., J.A.S., D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.
Insights
The general cardiovascular Framingham Risk Score (FRS) is linked to increased odds of some cerebrovascular disease (CVD) pathologies in older adults. However, FRS shows low accuracy in predicting individual CVD pathologies.
Area of Science:
- Neurology
- Cardiology
- Gerontology
Background:
- The Framingham Risk Score (FRS) is a widely used tool for assessing cardiovascular disease risk.
- Cerebrovascular disease (CVD) encompasses a range of conditions affecting the brain's blood vessels.
- Understanding risk factors for CVD pathologies is crucial for preventative strategies.
Purpose of the Study:
- To investigate the association between the baseline Framingham Risk Score (FRS) and the presence of postmortem cerebrovascular disease (CVD) pathologies.
- To determine if FRS can predict specific types of CVD pathologies in older adults.
Main Methods:
- Analysis of postmortem brain tissue from 1672 older decedents with available baseline FRS.
- Quantification of CVD pathologies including macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy.
- Logistic regression models were used to assess the relationship between FRS and each CVD pathology.
Main Results:
- A higher baseline FRS was significantly associated with increased odds of macroinfarcts, microinfarcts, atherosclerosis, and arteriolosclerosis.
- The predictive accuracy (C-statistics) of FRS for these CVD pathologies was low, ranging from 0.537 to 0.595.
- No significant association was found between baseline FRS and the presence of cerebral amyloid angiopathy.
Conclusions:
- Elevated FRS in older adults correlates with a higher likelihood of certain CVD pathologies but not all.
- The current FRS demonstrates limited ability to accurately predict individual CVD pathologies at the postmortem level.
- Development of more precise risk assessment tools is necessary for identifying individuals susceptible to accumulating CVD pathologies.
Background And Purpose:
The general cardiovascular Framingham risk score (FRS) identifies adults at increased risk for stroke. We tested the hypothesis that baseline FRS is associated with the presence of postmortem cerebrovascular disease (CVD) pathologies.
Methods:
We studied the brains of 1672 older decedents with baseline FRS and measured CVD pathologies including macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy. We employed a series of logistic regressions to examine the association of baseline FRS with each of the 5 CVD pathologies.
Results:
Average age at baseline was 80.5±7.0 years and average age at death was 89.2±6.7 years. A higher baseline FRS was associated with higher odds of macroinfarcts (odds ratio, 1.10 [95% CI, 1.07-1.13], P<0.001), microinfarcts (odds ratio, 1.04 [95% CI, 1.01-1.07], P=0.009), atherosclerosis (odds ratio, 1.07 [95% CI, 1.04-1.11], P<0.001), and arteriolosclerosis (odds ratio, 1.04 [95% CI, 1.01-1.07], P=0.005). C statistics for these models ranged from 0.537 to 0.595 indicating low accuracy for predicting CVD pathologies. FRS was not associated with the presence of cerebral amyloid angiopathy.
Conclusions:
A higher FRS score in older adults is associated with higher odds of some, but not all, CVD pathologies, with low discrimination at the individual level. Further work is needed to develop a more robust risk score to identify adults at risk for accumulating CVD pathologies.
