Vascular Risk Factors and Cerebrovascular Pathologic Changes on Autopsy: The 90+ Study

Introduction: Cerebrovascular pathologic changes (CVPC) are prevalent and associated with dementia in those ≥ 90 years. However, CVPC associations to traditional risk factors (hypertension, diabetes, and hyperlipidemia) are variable. We hypothesized that neither traditional risk factors nor related medications would be associated with CVPC presence.

Methods: In autopsy volunteers from The 90+ Study, odds ratios (OR) of CVPC presence to self-reported vascular risk factors and cardiovascular medication classes were calculated using logistic regressions adjusted for age of death, sex, and education.

Results: In 267 participants (mean age at death 98 (±3.5) years; 75% female), CVPC presence was not related to traditional risk factors. Lower odds of atherosclerosis with diuretics [OR 0.55] and lower odds of cerebral amyloid angiopathy (CAA) with B-blocker [OR 0.57] or vasodilator [OR 0.40] use were observed.

Discussion: Our findings suggest that vascular risk factors are not risk factors for CVPC at this age, medications have mitigated risks, or survival bias obscures associations.

Highlights: Cardiovascular risk factors are thought to contribute to cerebrovascular diseases. Risk factors were generally not associated with cerebrovascular changes. Lower odds of certain cerebrovascular changes were associated with antihypertensive use.