ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Alzheimer's Disease and Related Dementias
Volume 17 - 2025 | doi: 10.3389/fnagi.2025.1607646
Sex Differences in the Association of Cardiometabolic Risk Scores and Blood Pressure Measurements with White Matter Hyperintensities in Diverse Older Adults -HABS-HD Running Head: Sex Differences in Blood Pressure and WMH
Provisionally accepted
- 1Stanford University, Stanford, United States
- 2University of North Texas Health Science Center, Fort Worth, Texas, United States
- 3Indiana Alzheimer Disease Center, School of Medicine, Indiana University Bloomington, Indianapolis, Indiana, United States
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We aimed to determine whether cardiometabolic risk factors and blood-pressure (BP) metrics were differentially associated with white matter hyperintensities volume (WMHV) in males versus females in the Health and Aging Brain Study-Health Disparities. We analyzed 3,585 community-dwelling adults (2,207 females) from non-Hispanic White, non-Hispanic Black, and Hispanic groups who underwent BP measurement and WMHV quantification. Linear regression models assessed (i) individual risk factors (diabetes, hypertension, dyslipidemia, obesity, tobacco dependence), (ii) a composite risk score, and (iii) four BP metrics (systolic, diastolic, pulse pressure, mean arterial pressure), each including a sex-interaction term and adjusting for age, education, race/ethnicity, and scanner. A second BP model also controlled for all five risk factors. Diabetes (β = 0.46, 95 % CI 0.28-0.64), hypertension (β = 0.47, 0.30-0.64), and higher composite risk (β = 0.19, 0.12-0.26) were associated with greater WMHV. Diastolic BP (β = 0.18, 0.11-0.26) and mean arterial pressure (β = 0.14, 0.07-0.21) related to larger WMHV, with diastolic BP remaining significant after full adjustment (β = 0.14, 0.07-0.22). No sex interactions survived correction. These findings underscore the importance of aggressive cardiometabolic and BP control, particularly diastolic BP, to mitigate WMHV in both sexes.
Keywords: Aging, Cardiometabolic risk factors, sex differences, Vascular brain injury, white matter hyperintensities
Received: 07 Apr 2025; Accepted: 18 Jul 2025.
Copyright: © 2025 Hayes, Vintimilla, Chaudhuri and Odden. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Cellas Hayes, Stanford University, Stanford, United States
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