Can we save the brain from the ravages of midlife cardiovascular risk factors?

In this issue of Neurology , Carmelli et al. document the important relationship of midlife cardiovascular risk factors to brain morphology in 74 monozygotic male–male twin pairs who participated in the National Heart, Lung, and Blood Institute Twin Study.1 Three risk factors were predictors of greater changes in white matter hyperintensities (WMH) in old age independent of shared genetic and familial influences: higher 1-hour postload glucose level, lower high-density lipoprotein cholesterol, and higher systolic blood pressure at baseline (25 years earlier). Furthermore, a history of coronary heart disease, a lower forced expiratory volume in 1 second/forced vital capacity in midlife, and higher systolic blood pressure and alcohol consumption at follow-up predicted a greater reduction in brain parenchyma. After adjustment for education and clinical stroke, twins with more WMH had …