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Subclinical carotid atherosclerosis and neurocognitive function in an urban population.

ABSTRACT: BACKGROUND AND AIMS:Examine age, sex, race, and socioeconomic status as modifiers of the association between carotid intimal medial thickness (IMT) and neurocognitive performance in a socioeconomically diverse, biracial, urban, adult population. METHODS:Participants were 1712 community-dwelling adults (45% men, 56% African-American, 38% below poverty threshold, aged 30-64 years) enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Participants underwent initial carotid ultrasonography followed by cognitive testing on up to two occasions over 4 years. Mixed-effects regression analyses were adjusted for demographic, behavioral, and biomedical covariates. RESULTS:Significant cross-sectional IMT × race × poverty interactions were identified for measures of delayed recall memory, auditory-verbal attention, and working memory. An IMT × race interaction also appeared for auditory-verbal learning. Higher IMT was generally associated with worse cognitive performance, but the disadvantage was most pronounced among those with higher socioeconomic status and white participants. No longitudinal associations were identified. CONCLUSIONS:Carotid IMT-cognition associations differed as a function of race and socioeconomic status and were most compelling for measures of attention, executive function, and memory. These findings highlight the possibility that subclinical atherosclerosis may be differentially informative as a predictor of cognitive performance among varied demographic subgroups.

SUBMITTER: Wendell CR

PROVIDER: S-EPMC4879049 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Subclinical carotid atherosclerosis and neurocognitive function in an urban population.

Wendell Carrington R CR Waldstein Shari R SR Evans Michele K MK Zonderman Alan B AB

Atherosclerosis 20160408

<h4>Background and aims</h4>Examine age, sex, race, and socioeconomic status as modifiers of the association between carotid intimal medial thickness (IMT) and neurocognitive performance in a socioeconomically diverse, biracial, urban, adult population.<h4>Methods</h4>Participants were 1712 community-dwelling adults (45% men, 56% African-American, 38% below poverty threshold, aged 30-64 years) enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Partic ...[more]

PMID: 27092741

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Project description:AimsTo define endotypes of carotid subclinical atherosclerosis.Methods and resultsWe integrated demographic, clinical, and molecular data (n = 124) with ultrasonographic carotid measurements from study participants in the IMPROVE cohort (n = 3340). We applied a neural network algorithm and hierarchical clustering to identify carotid atherosclerosis endotypes. A measure of carotid subclinical atherosclerosis, the c-IMTmean-max, was used to extract atherosclerosis-related features and SHapley Additive exPlanations (SHAP) to reveal endotypes. The association of endotypes with carotid ultrasonographic measurements at baseline, after 30 months, and with the 3-year atherosclerotic cardiovascular disease (ASCVD) risk was estimated by linear (β, SE) and Cox [hazard ratio (HR), 95% confidence interval (CI)] regression models. Crude estimates were adjusted by common cardiovascular risk factors, and baseline ultrasonographic measures. Improvement in ASCVD risk prediction was evaluated by C-statistic and by net reclassification improvement with reference to SCORE2, c-IMTmean-max, and presence of carotid plaques. An ensemble stacking model was used to predict endotypes in an independent validation cohort, the PIVUS (n = 1061). We identified four endotypes able to differentiate carotid atherosclerosis risk profiles from mild (endotype 1) to severe (endotype 4). SHAP identified endotype-shared variables (age, biological sex, and systolic blood pressure) and endotype-specific biomarkers. In the IMPROVE, as compared to endotype 1, endotype 4 associated with the thickest c-IMT at baseline (β, SE) 0.36 (0.014), the highest number of plaques 1.65 (0.075), the fastest c-IMT progression 0.06 (0.013), and the highest ASCVD risk (HR, 95% CI) (1.95, 1.18-3.23). Baseline and progression measures of carotid subclinical atherosclerosis and ASCVD risk were associated with the predicted endotypes in the PIVUS. Endotypes consistently improved measures of ASCVD risk discrimination and reclassification in both study populations.ConclusionsWe report four replicable subclinical carotid atherosclerosis-endotypes associated with progression of atherosclerosis and ASCVD risk in two independent populations. Our approach based on endotypes can be applied for precision medicine in ASCVD prevention.

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Subclinical carotid atherosclerosis and neurocognitive function in an urban population.

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Subclinical carotid atherosclerosis and neurocognitive function in an urban population.

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