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Elevated cardiovascular risk factors in young adulthood linked to poor cognitive function in mid-life

Recent data show that young and middle-aged adults with blood pressure, blood sugar and cholesterol levels higher than those recommended in the American Heart Association’s guidelines scored lower on cognitive function tests.

Kristine Yaffe, MD, of the University of California, San Francisco, and colleagues used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to assess the relationship between cardiovascular (CV) risk factors in early- to mid-adult life and cognitive function at midlife. Researchers in the CARDIA study measured he blood pressure, fasting blood glucose and cholesterol levels of 3,381 participants every 2 to 5 years over a 25-year period. Participants completed memory, thinking speed and mental flexibility tests during year 25. Participants were aged 18 to 30 years at baseline, with a mean age of 50.2 years at follow up.

The AHA defines ideal CV health as systolic blood pressure <120 mm Hg, diastolic blood pressure <80 mm Hg, blood sugar levels <100 mg/dL and cholesterol <200 mg/dL.

Cognitive function tests included the Digit Symbol Substitution Test (DSST) to assess attention, working memory, psychomotor speed and executive function; the Rey Auditory Verbal Learning Test (RAVLT) to indicate verbal memory; and the Stroop Test to establish executive function. DSST scores range from 0 to 133, and RAVLT scores from 0 to 15; for both tests, higher scores indicate better performance. However, higher Stroop Test scores indicate worse performance.

At year 25, participants’ mean systolic blood pressure was 119.7 mm Hg; mean diastolic blood pressure was 74.8 mm Hg; mean fasting blood glucose was 99.5 mg/dL; and mean total cholesterol was 192.1 mg/dL.

Mean scores for cognitive tests were 8.3 on the RAVLT, 69.9 on the DSST and 22.7 on the Stroop Test.

During the follow-up period, 92 participants had a CV event including myocardial infarction (n=32), coronary revascularization (n=32), stroke (n=31), peripheral artery disease (n=4) and congestive heart failure (n=18).

Researchers associated adverse CV events in early to middle adulthood with poorer cognitive performance in midlife. Exposure to blood pressure, blood sugar and cholesterol levels above the recommended guidelines was consistently associated with worse cognitive performance on executive function, processing speed and verbal memory tests.

“Much of the public health debate on cognitive health has focused on early-life development or late-life dementia prevention. Our results not only support a role for early adult [cardiovascular risk factors] but also suggest that duration of exposure could be an important factor in determining the risk of cognitive impairment,” the researchers concluded.

Disclosure: Yaffe reports serving on data safety monitoring boards for Takeda and a study sponsored by the National Institutes of Health; she also reports consulting for Novartis.