Key result
Hypertension is linked to greater white matter hyperintensity burden in older men.
Why the study?
Cardiometabolic risk factors contribute to cognitive decline and cerebrovascular pathology and are more prevalent among non-Hispanic Black than non-Hispanic White adults, with the greatest burden in males.
Does the hypothetical elimination of cardiometabolic risk factors improve cognitive domain performance and reduce white matter hyperintensity burden in NHW and NHB males?
Cross-Sectional (n=974)
No
Does the hypothetical elimination of cardiometabolic risk factors improve cognitive domain performance and reduce white matter hyperintensity burden in NHW and NHB males?
Effect estimate: β = 0.61 (95% CI 0.09 to 1.12)
p-value: p=0.02
Targeted modification of cardiometabolic risk factors, notably tobacco dependence, diabetes, and hypertension, may yield modest but measurable cognitive and structural brain health benefits, particularly for non-Hispanic Black males.
Should not yet change practice in older males; leaves open whether cardiometabolic risk modification reduces WMH burden or cognitive deficits.
Cardiometabolic risk factors contribute to cognitive decline and cerebrovascular pathology and are more prevalent among non-Hispanic Black (NHB) adults than non-Hispanic White (NHW) adults, with the greatest burden observed in males. We analyzed 974 male participants (581 non-Hispanic White [NHW], 393 NHB) from the Healthy Aging Brain Study – Health Disparities baseline visit. Multivariable linear regression models were used to examine associations between cardiometabolic risk factors, including hypertension, diabetes, dyslipidemia, obesity, and tobacco dependence, and outcomes of cognitive domain performance (memory, executive function, processing speed, and language) and white matter hyperintensity burden, adjusting for age, education, apolipoprotein ε4 status, and race. Population intervention models (PIM), a counterfactual regression-based approach, were applied to estimate projected changes in cognition and WMH burden under hypothetical scenarios in which individual cardiometabolic risk factors were absent, with analyses stratified by racial ethnicity and mutually adjusted for the other cardiometabolic risks. Diabetes was associated with lower memory (β = −0.14, 95% CI: −0.27 to −0.01) and language (β = −0.15, 95% CI: −0.29 to −0.02). Tobacco dependence was linked to poorer performance across all domains (β range = −0.20 to −0.29). Hypertension was associated with greater WMH volume (β = 0.61, 95% CI: 0.09 to 1.12). PIM analyses projected memory gains from eliminating diabetes of 0.027 (95% CI: 0.002–0.052) in NHW and 0.039 (95% CI: 0.004–0.075) in NHB males, and gains from eliminating tobacco dependence of 0.015 (95% CI: 0.004–0.027) and 0.056 (95% CI: 0.017–0.098), respectively. Removing hypertension was projected to reduce WMH by −0.394 (95% CI: −0.769 to −0.014) in NHW and −0.481 (95% CI: −0.940 to −0.018) in NHB participants.
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Hayes et al. (2026) conducted a cross-sectional in Cognitive aging and white matter hyperintensities (n=974). Hypertension vs. Absence of hypertension was evaluated on White matter hyperintensity (WMH) volume (β = 0.61, 95% CI 0.09 to 1.12, p=0.02). Among 974 older males, hypertension was significantly associated with greater white matter hyperintensity volume (β = 0.61), while diabetes and tobacco dependence predicted poorer cognitive performance.
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