Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation: Cardiovascular Imaging https://doi.org/10.1161/CIRCIMAGING.125.019105 Dr. Constantin-Cristian Topriceanu et al.
Points
- Higher life-course blood pressures, steeper increases, and greater cumulative burden significantly associate with lower myocardial perfusion at age 77.
- Each 10 mmHg higher SBP between ages 36 and 69 years correlated with a 3–6% lower sMBFN at 77 years.
- A sustained 10 mmHg higher SBP from age 36 to 77 years was associated with an 11% lower sMBFN.
- Each 1% lower sMBFN was critically associated with a 3% higher odds of major adverse cardiovascular events (MACE).
- sMBFN mediated 20–40% of life-course SBP-late gadolinium enhancement associations, indicating a direct link to higher fibrosis burden.
Summary
This MyoFit46 study (NCT05455125) investigated the profound impact of life-course blood pressure (BP) on myocardial perfusion at age 77, specifically examining normalized stress myocardial blood flow (sMBFN) and myocardial perfusion reserve (MPR) using cardiovascular magnetic resonance (CMR). The study involved 459 participants from the National Survey of Health and Development 1946 birth cohort, with BP meticulously recorded across six distinct ages from 36 to 77 years.
The analysis revealed significant associations between elevated life-course BP, steeper BP increases, and reduced myocardial perfusion. Notably, each 10 mmHg higher systolic BP (SBP) between ages 36 and 69 correlated with a 3–6% lower sMBFN at 77 years. A sustained 10 mmHg higher SBP from age 36 to 77 was associated with an 11% (95% CI: 8–14) lower sMBFN. Furthermore, each 1 mmHg/year steeper SBP rise during various age intervals (36–43, 43–53, 53–63, and 63–69 years) independently associated with a 2–5% lower sMBFN at 77 years, irrespective of baseline or final BPs.
These findings carry substantial clinical relevance: each 1% lower sMBFN was linked to a 3% higher odds of major adverse cardiovascular events (MACE), encompassing myocardial infarction, stroke, and heart failure. Mediation analyses demonstrated that sMBFN mediated 20–40% of the life-course SBP-late gadolinium enhancement associations, indicating a clear pathway to increased fibrosis. These results underscore the critical importance of early-life BP screening and trajectory-guided treatment, moving beyond single BP readings, to effectively mitigate later-life cardiovascular risk and fibrosis burden.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.125.019105
References
Topriceanu, C.-C., Webber, M., Shiwani, H., Chan, F. T., Martin, E., Falconer, D., Stanley, M. A., Bennett, J., Gonzalez-Martin, P., Shah, H., De, S., Wong, A., Pierce, I., Davies, R. H., Lambiase, P. D., Chaturvedi, N., Kellman, P., Hardy, R., Moon, J. C., … Captur, G. (2025). Higher life-course blood pressure associates with reduced myocardial perfusion in older age: Insights from myofit46. Circulation: Cardiovascular Imaging, CIRCIMAGING.125.019105. https://doi.org/10.1161/CIRCIMAGING.125.019105
