Associations of Cardiovascular Risk Factors and Cerebrovascular Pathologies in the Elderly: A Systematic Review

Abstract Background Cerebrovascular pathologies are common in the elderly and are associated with dementia. Cardiovascular risk factors are thought to contribute to their development, but this evidence mainly comes from imaging studies or autopsy studies in younger individuals. We performed a systematic review to investigate associations of cardiovascular risk factors with cerebrovascular pathologies in the oldest‐old (age >80) vs. the younger‐old (ages 65‐80). Methods Figure 1 describes how studies were identified. Cardiovascular risk factors were hypertension (HTN), hyperlipidemia (HLD), and diabetes (DM). Cerebrovascular pathologies were arteriolosclerosis, atherosclerosis, CAA, and MVLs. PubMed, Scopus, and Web of Science databases were searched for articles in English that investigated associations between self‐reported cardiovascular risk factors and presence of cerebrovascular pathologies on autopsy with a mean age >65 years, which reported odds ratios (OR), or information to calculate OR, for the individual associations of cardiovascular risk factors and cerebrovascular pathologies. Initial searching involved all combinations of cardiovascular MeSH terms by cerebrovascular pathology MeSH terms (n = 1038). JW and RR screened titles and abstracts to identify potential studies (n = 45), which reduced to 10 after applying the restrictions above. We used meta‐analytic methods to estimate OR when multiple studies reported on the same associations. Results We reviewed 10 studies (Table 1) from 6 unique cohorts (n = 1,815, ages 65‐80 and n = 7,995, age >80). HTN was positively associated with cerebrovascular pathologies for all the instances except arteriolosclerosis‐oldest‐old OR = 1.20, n = 2,089, (arteriolosclerosis‐younger‐old OR = 1.30 n = 1,599, atherosclerosis‐oldest‐old OR = 1.29, n = 2,620, CAA‐oldest‐old OR = 1.23, n = 2,198, and MVLs‐oldest‐old OR = 1.54, n = 1,710) (Figure 2). HLD was associated with arteriolosclerosis in the younger‐old (OR = 1.27 n = 922), but not the oldest‐old (OR = 0.98, n = 1,255), and not associated with CAA in the oldest‐old (OR = 1.13, n = 3,508). DM was not associated in any situation in which it was investigated (Figure 2). Conclusions Cardiovascular risk factors were more associated with cerebrovascular pathologies in the younger‐old than oldest‐old. HTN was consistently associated with cerebrovascular pathologies in both age groups while DM was consistently not associated. Cardiovascular risk factors were understudied in the younger‐old. These findings highlight the importance of further clinicopathologic studies to clarify age‐dependent associations of cardiovascular risk factors and cerebrovascular pathologies.