Healthy vascular fat during menopause can prevent dementia later in life

The research, published in the journal Alzheimer’s & Dementiais further evidence that the menopausal transition is a particularly important time for women and their doctors to pay attention to heart health, which in turn protects their brain health.

“It’s surprising to learn that two-thirds of Americans with Alzheimer’s disease are women,” said Meiyuzhen (Chimey) Qi, first author and Ph.D. candidate in epidemiology at Pitt Public Health. “The most common modifiable risk factor for dementia is cardiovascular disease, and, interestingly, the risk of cardiovascular disease in women increases after menopause. So the logical next step was to see if there was a link between the cardiovascular risk factors associated with the menopausal transition — such as the type of cardiovascular fat a woman has — and her cognitive function later in life.”

To explore the hunch, the team turned to the long-running Study of Women’s Health Across the Nation (SWAN) and its subsidiary study, SWAN Cardiovascular Fat. SWAN follows a diverse group of middle-aged women through the menopausal transition. At an average age of 51, 531 participants underwent scans to study the fat around their heart and blood vessels. They were then followed for 16 years, receiving several cognitive tests along the way.

Cardiovascular fat is of three main types: epicardial adipose tissue (EAT) which lies within the sac surrounding the heart, paracardial adipose tissue (PAT) which lies outside the sac and thoracic perivascular adipose tissue (PVAT), which surrounds the longest part of the body. biggest. arteries away from the heart. EAT and PAT are typically lower quality “white” fats that the body stores, while thoracic PVAT may be higher quality “brown” fats that the body easily converts into energy. The team used the fat density in the scans as an indicator of fat quality.

In this study, researchers assessed how the quantity and quality of cardiovascular fat during midlife relate to cognitive function as women age. Quantity is measured based on the volume of fat, while quality is determined based on the specific gravity of the fat. Greater thoracic PVAT volume during midlife is associated with stronger long-term memory later in life, while higher thoracic PVAT density – likely reflecting lower-quality white fat – is associated with worse working memory.

“This is an association. We can’t say for sure that high- or low-quality cardiovascular fat causes Alzheimer’s disease – but it is a plausible clue,” said senior author Dr. Samar El Khoudary, professor of epidemiology at Pitt Public Health. “Of the different types of heart fat, PVAT is located closest to the cerebral circulation and brown fat is associated with better whole-body metabolism and lower markers of inflammation.”

During the menopausal transition, women typically experience inflammation of blood vessels or fatty tissue, which can manifest as a higher density, meaning lower quality, thoracic PVAT. Previous studies have found that blood vessel inflammation promotes plaque formation, and inflamed fatty tissue has abnormal secretion of cell signaling molecules, predisposing people to cognitive decline.

The additional study of SWAN Cardiovascular Fat was limited to white and black women, so the researchers emphasized that further studies will be needed to see if the findings extend to women of other races and ethnicities or to men. And more research is needed to determine whether this type of cardiovascular fat actually causes cognitive decline or if efforts to modify the quality of cardiovascular fat – such as taking anti-inflammatory drugs – can prevent dementia.

“Because of that, I believe our study is more evidence that taking care of your heart helps take care of your brain and that menopause is a very sensitive time for heart as well as brain health,” said El Khoudary. “So staying active and regularly doing cardiovascular exercise that gets your heart pumping, as well as eating a healthy diet and keeping up with doctor’s appointments are all very important in middle age. Protecting your heart during the menopausal transition might protect your brain in the future.”