DOI: 10.1002/alz.072376 ISSN: 1552-5260

Association between cardiovascular health and brain age: a large population‐based study in the UK Biobank

Huijie Huang, Jiao Wang, Jun Ma, Weili Xu
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



Cardiovascular health (CVH) has been associated with cognitive decline and dementia, but the extent to which CVH impact brain age remains unclear. We aimed to investigate the association of CVH assessed by Life’s Essential 8 (LE8) score with neuroimaging‐based brain age and brain predicted age difference (PAD).


The study included a total of 34098 participants (mean age 54.82±7.50 years; 53.21% female) from the UK Biobank, who underwent brain magnetic resonance imaging (MRI) scans 9 years after baseline. A brain age prediction model with the best prediction performance was trained from 9 candidate models (Lasso, support vector regression, and XGBoost, with or without the addition of 2 variable selection methods, respectively) based on T1‐weighted MRI, T2‐FLAIR, T2∗, diffusion‐MRI, task fMRI, and resting‐state fMRI in 4355 healthy participants. Using the model, we calculated brain age and brain PAD (predicted age‐chronological age). Baseline LE8 score was calculated by the mean score of 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure) and tertiled as low, moderate, and high CVH. Data were analyzed using linear regression models.


At baseline, LE8 score was ranged from 15.00 to 100.00. In linear regression adjusted for age, sex and education, better CVH was associated with younger brain age (β [95% CI]: ‐0.029 [‐0.032, ‐0.026]) and smaller brain PAD (β [95% CI]: ‐0.033 [‐0.035, ‐0.030]). Compared to moderate CVH, low CVH was associated with older brain age (β [95% CI]: 0.444 [0.345, 0.543]) and bigger brain PAD (β [95% CI]: 0.513 [0.422, 0.604]), whereas high CVH was associated with younger brain age (β [95% CI]: ‐0.360 [‐0.459, ‐0.261]) and smaller brain PAD (β [95% CI]: ‐0.398 [‐0.489, ‐0.307]). The additional adjustment did not alter the relationships observed. After stratification by age, cardiovascular disease (CVD), or APOE ε4, the association remained significant among adults aged 40‐60 years and 60+ years, among CVD and non‐CVD, as well as among APOE ε4 carriers and non‐ carriers.


Better cardiovascular health is associated with younger brain age and reduced brain PAD. This association is significant even in middle‐aged, non‐CVD and non‐carriers adults.

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