CARDIOVASCULAR morbidity and mortality rates are lower in inhabitants of the Pacific Rim than in Western countries,^1-3 and some of the reduced risk is likely attributable to differences in diet. One of the more dramatic dietary differences is the high consumption of soybean products in the Pacific Rim compared with Western countries, which has been postulated to decrease risk of coronary heart disease.^4-6 There is good rationale for this: soy is not only an excellent source of protein,⁷ but also contains high concentrations of isoflavones^8,9 (micronutrient substances shown in nonhuman primates to have many of the properties of mammalian estrogen, including the lowering of cholesterol levels¹⁰), reducing the risk of atherosclerosis,¹¹ and improving vascular function.¹²

Coronary artery calcium (CAC) measured by noncontrast cardiac computed tomographic (CT) scan is a noninvasive measure of coronary artery disease that is associated with coronary heart disease (CHD) and cardiovascular disease (CVD) in middle and older age.^1-4 The Coronary Artery Risk Development in Young Adults (CARDIA) Study previously reported that nonoptimal levels of modifiable cardiovascular risk factors at a mean age of 25 years were associated with prevalent CAC measured 15 years later at a mean age of 40 years.⁵ It is unknown if the presence of CAC by midlife increases the risk of CHD clinical events during the next decade in this younger population.

A deep learning calcium scoring method can accurately determine cardiovascular risk from a range of CT scan protocols. Background Although several deep learning (DL) calcium scoring methods have achieved excellent performance for specific CT protocols, their performance in a range of CT examination types is unknown...

Background: Mechanisms underlying the association between age-related arterial stiffening and poor brain health remain elusive. Cerebral blood flow (CBF) homeostasis may be implicated. This study evaluates how aortic stiffening relates to resting CBF and cerebrovascular reactivity (CVR) in older adults. Methods: Vanderbilt Memory & Aging Project participants free of clinical dementia, stroke, and heart failure were studied, including older adults with normal cognition (n=155; age, 72±7 years; 59% male) or mild cognitive impairment (n=115; age, 73±7 years; 57% male). Aortic pulse wave velocity (PWV; meters per second) was quantified from cardiac magnetic resonance. Resting CBF (milliliters per 100 g per minute) and CVR (CBF response to hypercapnic normoxia stimulus) were quantified from pseudocontinuous arterial spin labeling magnetic resonance imaging. Linear regression models related aortic PWV to regional CBF, adjusting for age, race/ethnicity, education, Framingham Stroke Risk Profile (diabetes mellitus, smoking, left ventricular hypertrophy, prevalent cardiovascular disease, atrial fibrillation), hypertension, body mass index, apolipoprotein E4 ( APOE ε4) status, and regional tissue volume. Models were repeated testing PWV× APOE ε4 interactions. Sensitivity analyses excluded participants with prevalent cardiovascular disease and atrial fibrillation. Results: Among participants with normal cognition, higher aortic PWV related to lower frontal lobe CBF (β=−0.43; P =0.04) and higher CVR in the whole brain (β=0.11; P =0.02), frontal lobes (β=0.12; P <0.05), temporal lobes (β=0.11; P =0.02), and occipital lobes (β=0.14; P =0.01). Among APOE ε4 carriers with normal cognition, findings were more pronounced with higher PWV relating to lower whole-brain CBF (β=−1.16; P =0.047), lower temporal lobe CBF (β=−1.81; P =0.004), and higher temporal lobe CVR (β=0.26; P =0.08), although the last result did not meet the a priori significance threshold. Results were similar in sensitivity models. Among participants with mild cognitive impairment, higher aortic PWV related to lower CBF in the occipital lobe (β=−0.70; P =0.02), but this finding was attenuated when participants with prevalent cardiovascular disease and atrial fibrillation were excluded. Among APOE ε4 carriers with mild cognitive impairment, findings were more pronounced with higher PWV relating to lower temporal lobe CBF (β=−1.20; P =0.02). Conclusions: Greater aortic stiffening relates to lower regional CBF and higher CVR in cognitively normal older adults, especially among individuals with increased genetic predisposition for Alzheimer’s disease. Central arterial stiffening may contribute to reductions in regional CBF despite preserved cerebrovascular reserve capacity.

Subclinical atherosclerosis, identified by the presence of coronary artery calcification (CAC),¹ progresses over time,² and predicts the development of coronary heart disease events.³ In general, established risk factors for coronary heart disease are similar to those for CAC, including older age, male sex, elevated blood pressure, diabetes, cigarette smoking, and abnormal levels of low-density lipoprotein and high-density lipoprotein cholesterol.² The degree of overall and abdominal obesity, as reflected by an increased body mass index (BMI) and waist circumference, respectively, are also important risk factors for the presence and progression of CAC.^2,4,5 Less studied, however, is the influence of obesity duration as an independent risk factor for coronary atherosclerosis.