{"title":"痴呆症的心血管致病风险因素--观察和遗传研究的启示。","authors":"Emilie Westerlin Kjeldsen, Ruth Frikke-Schmidt","doi":"10.1093/cvr/cvae235","DOIUrl":null,"url":null,"abstract":"<p><p>The escalating prevalence of dementia worldwide necessitates preventive strategies to mitigate its extensive health, psychological, and social impacts. As the prevalence of dementia continues to rise, gaining insights into its risk factors and causes become paramount, given the absence of a definitive cure. Cardiovascular disease has emerged as a prominent player in the complex landscape of dementia. Preventing, dyslipidaemia, unhealthy Western type diets, hypertension, diabetes, being overweight, physical inactivity, smoking, and high alcohol intake have the potential to diminish not only cardiovascular disease but also dementia. The purpose of this review is to present our current understanding of cardiovascular risk factors for Alzheimer's disease (AD) and vascular dementia (VaD) by using clinical human data from observational, genetic studies and clinical trials, while elaborating on potential mechanisms. Hypertension and type 2 diabetes surface as significant causal risk factors for both AD and VaD, as consistently illustrated in observational and Mendelian randomization studies. Antihypertensive drugs and physical activity have been shown to improve cognitive function in clinical trials. Important to note is, that robust genome wide associations studies are lacking for VaD, and indeed more and prolonged clinical trials are needed to establish these findings and investigate other risk factors. Trials should strategically target individuals at the highest dementia risk, identified using risk charts incorporating genetic markers, biomarkers, and cardiovascular risk factors. Understanding causal risk factors for dementia will optimise preventive measures, and implementation of well-known therapeutics can halt or alleviate dementia symptoms if started early. Needless to mention is that future health policies should prioritise primordial prevention from early childhood to prevent risk factors from even occurring in the first place. Together, understanding the role of cardiovascular risk factors in dementia, improving GWASs for VaD, and advancing clinical trials are crucial steps in addressing this significant public health challenge.</p>","PeriodicalId":9638,"journal":{"name":"Cardiovascular Research","volume":" ","pages":""},"PeriodicalIF":10.2000,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Causal cardiovascular risk factors for dementia - insights from observational and genetic studies.\",\"authors\":\"Emilie Westerlin Kjeldsen, Ruth Frikke-Schmidt\",\"doi\":\"10.1093/cvr/cvae235\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>The escalating prevalence of dementia worldwide necessitates preventive strategies to mitigate its extensive health, psychological, and social impacts. 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Antihypertensive drugs and physical activity have been shown to improve cognitive function in clinical trials. Important to note is, that robust genome wide associations studies are lacking for VaD, and indeed more and prolonged clinical trials are needed to establish these findings and investigate other risk factors. Trials should strategically target individuals at the highest dementia risk, identified using risk charts incorporating genetic markers, biomarkers, and cardiovascular risk factors. Understanding causal risk factors for dementia will optimise preventive measures, and implementation of well-known therapeutics can halt or alleviate dementia symptoms if started early. Needless to mention is that future health policies should prioritise primordial prevention from early childhood to prevent risk factors from even occurring in the first place. 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引用次数: 0
摘要
痴呆症在全球的发病率不断攀升,因此有必要制定预防策略,以减轻其对健康、心理和社会的广泛影响。随着痴呆症发病率的持续上升,在目前尚无根治方法的情况下,深入了解其风险因素和病因变得至关重要。心血管疾病已成为痴呆症复杂病因中的一个重要因素。预防血脂异常、不健康的西式饮食、高血压、糖尿病、超重、缺乏运动、吸烟和高酒精摄入不仅有可能减少心血管疾病,还有可能减少痴呆症。本综述旨在通过观察、基因研究和临床试验中的临床人类数据,介绍我们目前对阿尔茨海默病(AD)和血管性痴呆(VaD)的心血管风险因素的理解,同时阐述潜在的机制。观察性研究和孟德尔随机研究一致表明,高血压和 2 型糖尿病是导致 AD 和 VaD 的重要风险因素。临床试验表明,抗高血压药物和体育锻炼可改善认知功能。值得注意的是,目前还缺乏针对退行性脑损伤的强有力的全基因组关联研究,因此需要更多和更长时间的临床试验来确定这些发现并调查其他风险因素。试验应战略性地针对痴呆风险最高的个体,这些个体应通过包含遗传标记、生物标记和心血管风险因素的风险图表来确定。了解痴呆症的致病风险因素将优化预防措施,如果及早开始实施知名的治疗方法,可以阻止或减轻痴呆症症状。毋庸置疑,未来的卫生政策应优先考虑从儿童早期开始进行原始预防,从根本上防止风险因素的出现。了解心血管风险因素在痴呆症中的作用、改进针对 VaD 的 GWAS 研究以及推进临床试验是应对这一重大公共卫生挑战的关键步骤。
Causal cardiovascular risk factors for dementia - insights from observational and genetic studies.
The escalating prevalence of dementia worldwide necessitates preventive strategies to mitigate its extensive health, psychological, and social impacts. As the prevalence of dementia continues to rise, gaining insights into its risk factors and causes become paramount, given the absence of a definitive cure. Cardiovascular disease has emerged as a prominent player in the complex landscape of dementia. Preventing, dyslipidaemia, unhealthy Western type diets, hypertension, diabetes, being overweight, physical inactivity, smoking, and high alcohol intake have the potential to diminish not only cardiovascular disease but also dementia. The purpose of this review is to present our current understanding of cardiovascular risk factors for Alzheimer's disease (AD) and vascular dementia (VaD) by using clinical human data from observational, genetic studies and clinical trials, while elaborating on potential mechanisms. Hypertension and type 2 diabetes surface as significant causal risk factors for both AD and VaD, as consistently illustrated in observational and Mendelian randomization studies. Antihypertensive drugs and physical activity have been shown to improve cognitive function in clinical trials. Important to note is, that robust genome wide associations studies are lacking for VaD, and indeed more and prolonged clinical trials are needed to establish these findings and investigate other risk factors. Trials should strategically target individuals at the highest dementia risk, identified using risk charts incorporating genetic markers, biomarkers, and cardiovascular risk factors. Understanding causal risk factors for dementia will optimise preventive measures, and implementation of well-known therapeutics can halt or alleviate dementia symptoms if started early. Needless to mention is that future health policies should prioritise primordial prevention from early childhood to prevent risk factors from even occurring in the first place. Together, understanding the role of cardiovascular risk factors in dementia, improving GWASs for VaD, and advancing clinical trials are crucial steps in addressing this significant public health challenge.
期刊介绍:
Cardiovascular Research
Journal Overview:
International journal of the European Society of Cardiology
Focuses on basic and translational research in cardiology and cardiovascular biology
Aims to enhance insight into cardiovascular disease mechanisms and innovation prospects
Submission Criteria:
Welcomes papers covering molecular, sub-cellular, cellular, organ, and organism levels
Accepts clinical proof-of-concept and translational studies
Manuscripts expected to provide significant contribution to cardiovascular biology and diseases