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Optimal CV health at midlife reduces dementia risk
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Patients aged 50 years who adhered to recommendations from the American Heart Association’s Life’s Simple 7 metric for CV health had a lower risk for dementia later in life, according to a study published in The BMJ.
“Our findings suggest that the Life’s Simple 7, which comprises the cardiovascular health score, at age 50 may shape the risk of dementia in a synergistic manner,” Séverine Sabia, PhD, of the epidemiology department for aging and neurodegenerative diseases at the French National Institute of Health and Medical Research and department of epidemiology and public health at University College London, and colleagues wrote. “Cardiovascular risk factors are modifiable, making them strategically important prevention targets.”
Whitehall II study data
Researchers analyzed data from 7,899 participants from the Whitehall II study who were aged 50 years. Questionnaires and a clinical evaluation were conducted at baseline to assess anthropometric and CV measures, in addition to metabolic risk factors and diseases.
For this study, information on CV health metrics based on the AHA’s Life’s Simple 7 recommendations were assessed: BP, cholesterol, fasting glucose concentration, physical activity, diet, weight and smoking status. This information was used to calculate a CV health score that ranged from 0 to 14, with the highest score indicating better CV health. Poor CV health was defined as a score between 0 and 6, intermediate health was between 7 and 11 and optimal CV health was defined as a score between 12 and 14. Scores were also calculated for behavioral and biological metrics.
During a median follow-up of 24.7 years, 347 patients developed dementia.
The incidence rate of dementia in participants with poor CV health was 3.2 per 1,000 person-years (95% CI, 2.5-4). Compared with the poor CV health group, those with intermediate CV health had an absolute rate difference of –1.5 per 1,000 person-years (95% CI, –2.3 to –0.7). The absolute rate difference for participants with optimal CV health was –1.9 when compared with those with poor CV health (95% CI, –2.8 to –1.1).
Each point increase in the CV health score was associated with a lower risk for dementia (HR = 0.89; 95% CI, 0.85-0.95). This was also seen for each point increase in the behavioral score (HR = 0.87; 95% CI, 0.81-0.93) and biological score (HR = 0.91; 95% CI, 0.83-1).
The link between CV health at age 50 years and dementia was also observed in patients who did not develop CVD during follow-up (HR per 1-point increment in the CV health score = 0.89; 95% CI, 0.84-0.95).
“This study supports public health policies to improve cardiovascular health as early as age 50 to promote cognitive health,” Sabia and colleagues wrote.
Implications for clinical practice
“The implications from this study and many others are that the healthier the vascular system is in midlife, the lower the risk of subsequent dementia,” Carol Brayne, MD, director at the Institute of Public Health at University of Cambridge, and Fiona E. Matthews, PhD, professor of epidemiology at the Institute of Health and Society at University of Newcastle in the United Kingdom, wrote in a related editorial. – by Darlene Dobkowski
Disclosures: The authors of the study and the editorial report no relevant financial disclosures.
Perspective
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Larry B. Goldstein, MD, FAAN, FANA, FAHA
There is considerable evidence showing that many CV and stroke risk factors overlap with those associated with vascular dementia and Alzheimer’s disease. These new findings are consistent with these observations, finding an association between adherence to healthy lifestyles in midlife and a lower risk of dementia in later life — there is a link between CV health and brain health.
These findings further reinforce the need to discuss the importance of following a healthy lifestyle at every patient encounter. Providing a consistent measure from health care providers may increase patients’ motivation to continue a healthy lifestyle or change behaviors.
Cardiologists can play a role in reducing the risk for dementia in patients aged 50 years by continuing to reinforce the importance of following a healthy lifestyle and addressing CV and stroke risk factors. Cardiologists may not only reduce the risk for cardiac and cerebrovascular events, but may also reduce the risk of cognitive impairment.
Further studies showing that changing lifestyle leads to improved brain health would support these observations; however, there is already ample evidence of the importance of following a healthy lifestyle.
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