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Better CV health associated with lower risk for dementia, cognitive decline

Patients with more cardiovascular health metrics at optimal levels and higher cardiovascular health scores had lower rates of incident dementia and cognitive decline, according to findings published in JAMA.

“High blood pressure, dyslipidemia, obesity and diabetes in midlife have been associated with cardiovascular disease as well as increased risk of dementia and cognitive decline, whereas healthy behaviors, including nonsmoking, engaging in moderate-intensity exercise and adopting diets rich in fruit, vegetables and fish have been related to lower risk of dementia outcomes,” Cécilia Samieri, PhD, from Université de Bordeaux, France, and colleagues wrote.

“However, few studies have investigated the combined effect of these risk factors on the risk of dementia and on cognitive aging and have mostly focused on lifestyle risk factors,” they added.

Samieri and colleagues conducted a population-based cohort study to determine the association between cardiovascular health level and risk for dementia and cognitive decline among adults aged 65 years and older without history of CVD or dementia at baseline (n = 6,626; mean age, 73.7 years; 63.4% women).

The researchers evaluated cardiovascular health level using the American Heart Association’s (AHA) Life’s Simple 7 metrics score (range, 0-7) and global health score (range, 0-14).

The AHA tool measured the number of optimal cardiovascular health metrics including nonsmoking, BMI less than 25 kg/m², regular physical activity, consuming fish twice a week or more and fruits and vegetables at least three times a day, cholesterol less than 200 mg/dL (untreated), fasting glucose less than 100 mg/dL (untreated) and BP less than 120/80 mm Hg (untreated). The global health score was calculated by assigning zero points for poor levels of each metric, one point for intermediate levels and two points for optimal levels.

Incident dementia was defined as change in composite score of global cognition and was validated by an expert committee.

Data showed that incident adjudicated dementia occurred in 745 participants over a mean follow-up of 8.5 years.

Participants with zero or one health metric at an optimal level had an incidence rate of dementia of 1.76 (95% CI, 1.38-2.15) per 100 person-years. The absolute differences in incident dementia rates were –0.26 (95% CI, –0.48 to –0.04) per 100 person-years for two metrics, –0.59 (95% CI, –0.8 to –0.38) per 100 person-years for three metrics, –0.43 (95% CI, –0.65 to –0.21) per 100 person-years for four metrics, –0.93 (95% CI, –1.18 to –0.68) per 100 person-years for five metrics and –0.96 (95% CI, –1.37 to –0.56) per 100 person-years for six to seven metrics.

A higher number of optimal health metrics was significantly associated with reduced risk for dementia (HR = 0.9 for each additional optimal metric; 95% CI, 0.84-0.97) and cognitive decline (HR = 0.92 for each additional optimal metric; 95% CI, 0.89-0.96). Moreover, each additional optimal metric at baseline, year 6 and year 12 was associated with increases in global cognition.

“These findings may support the promotion of cardiovascular health to prevent risk factors associated with cognitive decline and dementia,” Samieri and colleagues concluded.

In an accompanying editorial, Jeffrey L. Saver, MD, from University of California, Los Angeles, and Mary Cushman, MD, MSc, from the University of Vermont, wrote that larger, longer trials are needed to confirm the findings of Samieri and colleagues and to offer an immediate message to clinicians, policy makers and patients for a course of action.

“Available evidence indicates that to achieve a lifetime of robust brain health free of dementia, it is never too early or too late to strive for attainment of ideal cardiovascular health,” they wrote. “Avoid smoking, eat a healthy diet, be physically active, maintain normal weight, and keep blood pressure, cholesterol levels, and glucose-insulin levels low. Given the aging population, this positive health message is important to communicate to all members of society.” – by Alaina Tedesco

Disclosures: Cushman reports being the board director for the American Heart Association National Center from 2014 to 2018. Samieri and Saver report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.