Impact of diversity on cardiovascular health Insights from the HELIUS study

This thesis explores cardiovascular ageing and its determinants, focusing on differences by sex and ethnicity. We used data from the HELIUS cohort study, a large, multi-ethnic, population-based study in Amsterdam. Part I introduces a conceptual framework for cardiovascular ageing, defined as the progressive deterioration of the cardiac and vascular systems. Key biomarkers, such as pulse wave velocity (PWV), carotid intima-media thickness (IMT), and NT-proBNP, were identified, with an emphasis on the need for ethnic-specific cut-off values. We also examined ethnic differences in carotid plaque presence and IMT, revealing significant disparities. Additionally, longitudinal data showed increasing ethnic differences BMI levels over time, particularly among younger individuals. Part II focuses on hypertension as a key determinant of cardiovascular ageing. Longitudinal analyses revealed widening disparities in systolic blood pressure levels among Ghanaian, Moroccan, and Turkish groups compared to the Dutch. We also explored sex differences in hypertension phenotypes. Compared to men, women had a higher risk of developing sustained hypertension, particularly those with isolated diastolic hypertension, highlighting the need for closer blood pressure monitoring in young women. Part III examines the impact of cardiovascular risk factors on cerebrovascular health. MRI data showed that higher BMI and diabetes were associated with lower brain volumes, while hypertension and a history of cardiovascular disease correlated with white matter hyperintensities. Associations between cardiovascular risk factors and cerebral blood flow were weaker. Finally, carotid plaque components, such as lipid cores, calcifications, and intraplaque hemorrhage, were associated with distinct cardiovascular risk factors.