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March 24, 2021
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Cardiovascular risk factors correlate with risk for late cognitive decline

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Certain cardiovascular risk factors, including BMI, fasting glucose and systolic blood pressure, correlated with cognitive decline later in life, according to a pooled analysis of four prospective cohort studies.

The correlation between these cardiovascular risk factors and late-life cognitive decline was greatest in early adulthood, study results demonstrated.

Kristine Yaffe
Kristine Yaffe

“Cardiovascular risk factors (CVRFs) are associated with increased risk [for] cognitive decline, but little is known about how early adult CVRFs and those across the life course might influence late-life cognition,” Kristine Yaffe, MD, professor of psychiatry, neurology and epidemiology, Roy and Marie Scola Endowed Chair and vice chair of research in psychiatry at the University of California, San Francisco, and colleagues wrote in Neurology.

Yaffe and colleagues pooled prospective data of 15,001 participants aged 18 to 95 years from the Coronary Artery Risk Development in Young Adults (mean age at enrollment, 24.9 years; Black, 50.3%) study, which followed adults aged 18 to 30 years for 30 years; the Multi Ethnic Study of Atherosclerosis (mean age at enrollment, 62.2 years; Black, 41%), which followed adults aged 45 to 84 years for 10 years; Cardiovascular Health Study (mean age at enrollment, 72.2 years; Black, 4.4%), which followed adults aged 65 and older for 10 years; and Health Aging and Body Composition studies (mean age at enrollment, 73.4 years), which followed adults aged 70 to 79 years for 11 years.

Variables included BMI, fasting glucose, systolic blood pressure and total cholesterol. According to the researchers, “as expected,” these levels were higher in the cohorts of older adults, while smoking was more common in the youngest cohort at baseline. They assessed the association between these variables in early adulthood, midlife and late life with late-life decline on global cognition and processing speed. They used the Modified Mini-Mental State Exam to assess cognition and the Digit Symbol Substitution Test to assess processing speed, with adjustments for demographics, education and cohort.

Yaffe and colleagues found that elevated BMI, fasting glucose and systolic blood pressure at each time period studied correlated with increased decline in late life, but that there was no significant association for total cholesterol. CVRFs in early life correlated with “an approximate doubling of mean 10-year decline,” indicated by an additional 3-4 points on the Modified Mini-Mental State Exam or Digit Symbol Substitution Test, while those in later life “were associated with declines in early late-life (<80 years) but with gains in very late-life (80 years).” The relationship between early adult and late-life CVRFs and cognitive decline persisted after adjusting for these risk factors at all time periods, according to the study results.

“We found that imputed CVRFs across the life course, especially in early adulthood, were associated with greater late-life cognitive decline," researchers wrote. "Our results suggest that CVRF treatment in early adulthood could benefit late-life cognition, but that treatment in very late-life may not be as helpful for these outcomes."