Feature Article

Improved cardiovascular health associated with lower incidence of dementia in older adults

1. In this prospective cohort study, older patients with more optimal cardiovascular (CV) health metrics had a lower rate of developing dementia in a dose-dependent manner.

2. Similarly, the rate of cognitive decline was slower in those with more optimal CV health metrics.

Evidence Rating Level: 2 (Good)

Study Rundown: The AHA has set forth 7 cardiovascular (CV) health risk factors that when optimized have been shown to be associated with reduced risk of death, coronary heart disease, and stroke. However, it is unknown if optimization of these CV metrics is associated with lower risk of dementia and slower cognitive decline in older adults. In this multisite prospective cohort study, older adults with more optimal CV metrics had a lower rate of developing dementia in a linear and dose-dependent manner. Similarly, the rate of cognitive decline was found to be slower in patients who had more optimal CV metrics.

As poor cardiovascular health is likely to impact cerebrovascular health, which influences pathological brain aging, the results of this study fit well with current literature. As such, only a few limitations are noted. First, the scores for global cognition were not externally validated and so it is unclear if the effect size associated with each increase in modifiable risk factor is clinically relevant. Also, this study was unable to assess if individual risk factors had differing influence on subsequent cognition than others. Finally, this study recruited mostly urban and white participants, reducing generalizability to other populations.

Click here to read the study in JAMA

Relevant Reading: Cardiovascular health through young adulthood and cognitive functioning in midlife

In-Depth [prospective cohort]: In the Three-City (3C) study comprising recruitment of 6626 older patients (median age 73.7; 63.4% women) from three French cities from 1999 to 2016, the AHA Life’s Simple 7 tool comprising 4 modifiable behaviors and 3 biomarkers for CV risk was tracked along with the incidence of dementia and global cognition on 4 different tests over time. The risk of dementia decreased with each optimal CV metric (Hazard Ratio 0.90; CI95 0.84 to 0.97 per metric) in a dose-dependent manner. No significant interaction was detected for sex or APOE𝜀4 status (p = 0.23). Similarly, the estimated change in global cognition z-score increased by 0.031 per metric at study inclusion (CI95 0.009 to 0.053), 0.068 at 6 years (CI95 0.045 to 0.092), and 0.072 at 12 years (CI95 0.042 to 0.102). Controlling for other socioeconomic status indicators, such as income and occupational attainment, as well as excluding stroke events yielded statistically significant results consistent with the main analysis (p < 0.05).

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