Vascular cognitive impairment (VCI) may be ideally suited for prevention as it is common and thought to be linked to several major cardiovascular risk factors that are modifiable. The population attributable (PAR) risks of dementia and cognitive impairment after stroke are estimated to be about 18.4% and 8.5%, respectively. Key modifiable atherogenic risk factor candidates for VCI include hypertension, cigarette smoking, diabetes mellitus, hypercholesterolemia, and heavy alcohol consumption. In addition, dietary factors such as vitamin E, monounsaturated fats, and fish consumption may protect against VCI. It is intriguing to note that several traditional cardiovascular risk factors have been linked to Alzheimer’s disease (AD). In AD, indicators of atherosclerosis such as carotid vessel wall thickness and plaques and ankle-to-brachial systolic blood pressure ratio, and other atherogenic factors such as diabetes type II, atrial fibrillation, and hypertension have been shown to be associated with risk for AD. Therefore, it is possible that both VCI and AD are linked by similar pathogenic mechanisms. The vascular endothelium could play a key role in both disorders (see Vagnucci AH, Li WW, Lancet 2003; 361: 605-08, for angiogenesis hypothesis in AD). Damage to the vascular endothelium by traditional and emerging cardiovascular risk factors may lead to inflammation and subsequent stroke (see Gorelick PB, Stroke 2002; 33: 862-875). Furthermore, cerebral ischemia may upregulate the production of amyloid precursor protein and promote its cleavage to the A-beta form of amyloid, which can be cytotoxic to the neuron, promote release of inflammatory mediators that worsen post-ischemic inflammation, and cause vascular dysregulation that renders the brain more vulnerable to injury (see Iadecola C, Gorelick PB, Stroke 2003; 34: 335-337). VCI and AD may be synergistic rather than just additive.
In this discussion we will review the evidence from observational and experimental epidemiologic studies regarding the role of various cardiovascular risk factors that elevate risk for VCI and the outlook for prevention of this disorder. Based on calculation of the PAR and available clinical trial data, it is anticipated that hypertension represents the most important modifiable risk factor target for prevention of VCI.
Back to S022 Vascular Cognitive Impairment
Back to The Eleventh International Congress