Abnormalities in the structure and function of the brain can appear in people who are overweight, smoke, have diabetes, hypertension, elevated lipids, or metabolic syndrome before the other consequences of vascular risk factors—such as a heart attack or stroke—appear, according to a team of researchers at Icahn School of Medicine at Mount Sinai.

The researchers, from Mount Sinai Heart and the departments of Radiology, Psychiatry, and Neuroscience, drew their conclusions following a comprehensive review of several hundred brain imaging studies. Seventy-seven of those studies used multiple neuroimaging modalities in patients who harbored the vascular risk factors but showed no signs of vascular disease of the heart, brain, or periphery.

Their findings, which appeared in the October 2014 issue of JACC Cardiovascular Imaging, point to early and subtle changes in the brain, and could help inform the development of future prevention and treatment strategies for vascular disease.

“This is the first time we have been able to disentangle the brain effects of vascular disease risk factors from the brain effects of cardiovascular and cerebrovascular disease after they develop,” says the article’s lead author, Joseph I. Friedman, MD, Associate Professor in the departments of Psychiatry and Neuroscience at Icahn School of Medicine at Mount Sinai. “Given that a greater number of persons in our aging population are projected to develop mild forms of vascular cognitive impairment and cardiovascular disease, this trend necessitates a better understanding of the mechanisms and potential connections between their development, in order to begin to reverse or halt their progression.”

Mount Sinai’s investigators will now look to replicate and extend these findings using a full range of sophisticated imaging technologies. Valentin Fuster, MD, PhD, Director of Mount Sinai Heart, and Physician-in-Chief of The Mount Sinai Hospital, will serve in the primary leadership role, and will bridge the myriad lines of investigation being undertaken collaboratively by the various departments.

“Patients need to start controlling their risk factors today, otherwise their brains may forever harbor physical changes leading to devastating heart and vascular risk conditions impacting their future overall health and cognitive decline,” says Dr. Fuster, who is also the Richard Gorlin, MD, Heart Research Foundation Professor.

The article’s senior author, Jagat Narula, MD, PhD, Director of Cardiovascular Imaging, Professor of Medicine, and the Philip J. and Harriet L. Goodhart Chair in Cardiology at Icahn School of Medicine at Mount Sinai, says, “We hope our publication serves as a primer for cardiologists and other doctors who interpret the early neuroimaging data of their patients who may be at high risk for vascular disease. These subtle brain changes are clues that patients need to start to lower their vascular risk factors way before a cardiac or brain event happens.”

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