CVD Risk Factors, Carotid Plaque Burden, and Brain Hypometabolism

Carotid artery
Carotid artery
The presence of cardiovascular risk factors and subclinical carotid atherosclerosis in midlife may be associated with brain hypometabolism.

The presence of cardiovascular risk factors and subclinical carotid atherosclerosis in midlife may be associated with brain hypometabolism, according to a study published in the Journal of the American College of Cardiology.

This was an analysis of the Progression of Early Subclinical Atherosclerosis study in which 547 asymptomatic middle-aged adults (mean age, 50±4 years; 82% men) with evidence of subclinical atherosclerosis were enrolled. All participants underwent 18F-fluorodeoxyglucose (FDG)-positron emission tomography. Associations between cerebral metabolism and cardiovascular risk factors and atherosclerotic plaque burden in carotid and femoral arteries were evaluated.

Cardiovascular risk factors in this cohort included dyslipidemia (60% of participants), smoking (27.1%), hypertension (19.7%), and diabetes (4.6%). Median 30-year Framingham Risk Score (FRS) was 24.2%, and the total plaque burden (in carotid and femoral arteries) was 79.6 mm3. An inverse correlation between global FDG uptake and the 30-year Framingham Risk Score (FRS) was detected (P <.001), which was predominantly driven by hypertension (P <.001).

In addition, an inverse association between carotid plaque burden and global brain FDG uptake was established after adjusting for the 30-year FRS (P <.001). Brain areas most affected by hypometabolism associated with 30-year FRS, hypertension, and carotid plaque burden were parietotemporal regions and the cingulate gyrus.

Limitations of the study include its cross-sectional design as well as the lack of information on the cognitive status of some participants.

 “The potential ability of a modifiable disorder (CVD) to drive the evolution of a non-treatable condition (dementia) further supports the critical value of implementing primary [cardiovascular] prevention strategies early in midlife as a valuable therapeutic approach to delay or even stop downstream brain alterations, eventually leading to cognitive decline,” concluded the researchers.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Cortes-Canteli M, Gispert JD, Salvadó G, et al. Subclinical atherosclerosis and brain metabolism in middle-aged individuals: The PESA study. J Am Coll Cardiol. 2021;77(7):888-898. doi:10.1016/j.jacc.2020.12.027