ArticleAnnals of neurology2025
Sex-Specific Vulnerabilities to Subclinical Vascular Brain Injury in Early Late-Life: The Framingham Heart Study.
Article in Annals of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Sex Differences in the Association of Simultaneous Decline in Blood Pressure and Decline in Cognition during Aging.Annals of neurology · 2026Article
- Racial and ethnic differences in cardiometabolic predictors of white matter hyperintensities burden among males: The HABS-HD study.Journal of Alzheimer's disease : JAD · 2025Article
- Cardiovascular contributions to dementia: Examining sex differences and female-specific factors.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Review
- Racial ethnic variations in the cardiometabolic determinants and blood pressure of white matter hyperintensities among females-The HABS-HD Study.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Barriers and solutions in women's health research and clinical care: a call to action.Lancet regional health. Americas · 2025Review
- Sex differences in the association of cardiometabolic risk scores and blood pressure measurements with white matter hyperintensities in diverse older adults-HABS-HD.Frontiers in aging neuroscience · 2025Article
- Sex differences in blood pressure hemodynamics and white matter hyperintensity volume across racial ethnic groups-HABS-HD.Alzheimer's & dementia (New York, N. Y.)Article
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Authors and funding
13 authors.
Funding
Abstract
objectiveSubclinical vascular brain injury is an increasingly recognized risk factor for stroke and dementia. Despite well-established sex differences in vascular risk and disease prevalence, the impact of sex on drivers of subclinical vascular brain injury remains unclear, presenting a barrier to developing sex-specific prevention guidelines. We aimed to establish the extent to which sex moderates associations between vascular risk factors and magnetic resonance imaging (MRI) measures of subclinical brain injury in stroke-free older adults.
methodsWe leveraged cross-sectional data from 1,579 stroke- and dementia-free Framingham Heart Study Offspring participants at exam 8 (age 65.7 ± 8.8 years, 53% women). Vascular risks were assessed using components of the Framingham Stroke Risk Profile (FSRP) and diastolic blood pressure (DBP). White matter hyperintensity volume (WMH), total cerebral brain volume (TBV), and covert brain infarcts were quantified using MRI. We examined whether vascular risk factors were associated with MRI measures across the combined cohort, and then determined whether sex modified these associations.
resultsHigher FSRP and specifically systolic blood pressure (SBP) were associated with greater WMH. These associations were stronger in women and remained after adjusting for menopause age and hormone therapy use. By contrast, diabetes and lower DBP were associated with smaller TBV primarily in men. The DBP-atrophy relationship was only observed in men with declining DBP or prior hypertension.
interpretationOur findings highlight differential vulnerability to the impact of vascular risk factors on white matter health in women and global atrophy in men, supporting the development of sex-specific guidelines to better preserve vascular brain health in aging. ANN NEUROL 2025;97:460-469.
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