Race, sex, and mid‐life changes in brain health: Cardia MRI substudy

OBJECTIVE: To examine longitudinal race and sex differences in mid‐life brain health and to evaluate whether cardiovascular health (CVH) or apolipoprotein E (APOE) ε4 explain differences. METHODS: The study included 478 Black and White participants (mean age: 50 years). Total (TBV), gray (GMV), white (WMV), and white matter hyperintensity (WMH) volumes and GM–cerebral blood flow (CBF) were acquired with 3T‐magnetic resonance imaging at baseline and 5‐year follow‐up. Analyses were based on general linear models. RESULTS: There were race x sex interactions for GMV (P‐interaction = .004) and CBF (P‐interaction = .01) such that men showed more decline than women, and this was most evident in Blacks. Blacks compared to Whites had a significantly greater increase in WMH (P = .002). All sex–race differences in change were marginally attenuated by CVH and APOE ε4. CONCLUSION: Race–sex differences in brain health emerge by mid‐life. Identifying new environmental factors beyond CVH is needed to develop early interventions to maintain brain health.