Sex-specific relationship of cardiometabolic syndrome with lower cortical thickness

Abstract

Objective: To investigate whether cardiometabolic factors were associated with age-related differences in cortical thickness in relation to sex.

Methods: In this cross-sectional study, we enrolled 1,322 cognitively normal elderly (≥65 years old) individuals (774 [58.5%] men, 548 [41.5%] women). We measured cortical thickness using a surface-based analysis. We analyzed the associations of cardiometabolic risk factors with cortical thickness using multivariate linear regression models after adjusting for possible confounders and interactions with age.

Result: Among women, hypertension (β = -1.119 to -0.024, p < 0.05) and diabetes mellitus (β = -0.920, p = 0.03) were independently associated with lower mean cortical thickness. In addition, there was an interaction effect between obesity (body mass index [BMI] ≥27.5 kg/m²) and age on cortical thickness in women (β = -0.324 to -0.010, p < 0.05), suggesting that age-related differences in cortical thickness were more prominent in obese women compared to women with normal weight. Moreover, low education level (<6 years) was correlated with lower mean cortical thickness (β = -0.053 to -0.046, p < 0.05). Conversely, among men, only being underweight (BMI ≤18.5 kg/m², β = -2.656 to -0.073, p < 0.05) was associated with lower cortical thickness.

Conclusions: Our findings suggest that cortical thickness is more vulnerable to cardiometabolic risk factors in women than in men. Therefore, sex-specific prevention strategies may be needed to protect against accelerated brain aging.

Figure. Estimated global cortical thickness models

Estimated global cortical thickness models according to associated cardiometabolic factors in cognitively normal (A) women and (B) men. (C and D) Cortical thickness in women according to years of education. DM = diabetes mellitus; HTN = hypertension.