Ideal Cardiovascular Health and Cognitive Aging

Study Questions:

Is a greater number of American Heart Association ideal cardiovascular health (CVH) metrics associated with less decline in cognitive performance in a multiethnic population?

Methods:

A subsample from the population-based Northern Manhattan Study (all >40 years old) underwent repeated neuropsychological testing (mean interval, 6 ± 2 years). Domain-specific Z scores were derived using factor analysis for episodic memory, semantic memory, executive function, and processing speed, based on initial performance and decline over time. Linear regression models were constructed to examine the relationship between the number of ideal CVH metrics (smoking, body mass index, physical activity, diet, blood pressure, cholesterol, glucose) at enrollment with later cognitive performance and decline, adjusting for sociodemographics and magnetic resonance imaging (MRI) brain markers. Persons with a previous stroke were excluded.

Results:

Among 1,033 participants (mean age at initial cognitive assessment, 72 ± 8 years; 39% male; 19% black, 16% white, 65% Hispanic; n = 722 with repeat testing), 3% had 0 ideal factors, 1 factor = 15%, 2 factors = 33%, 3 factors = 30%, 4 factors = 14%, 5 factors = 14%, 6 factors = 1%, 7 factors = 0%. An increasing number of ideal CVH factors was associated with better processing speed at initial assessment, and less decline. The association was driven by nonsmoking and glucose. Among those with better cognitive performance at initial assessment, positive associations were observed between the number of ideal CVH factors and less decline in executive function and episodic memory. The findings remained consistent in models adjusting for subclinical markers of cerebrovascular damage including white matter volume, brain atrophy, and MRI-defined infarcts.

Conclusions:

The number of ideal CVH metrics was associated with less decline in processing speed, and to a lesser extent, executive function and episodic memory. Ideal CVH promotion benefits brain health and cognitive aging.

Perspective:

The number of ideal CVH factors correlates inversely with incident myocardial infarction, stroke, and CV deaths. The results of the relationship of the sum of factors with cognitive decline are intuitive, but now there is evidence of the benefit for patient education to change at-risk behaviors, particularly in those with the metabolic syndrome and smokers. I would have thought blood pressure would be related to dementia, particularly the ischemic/multi-infarct type. It is important to realize the study did not evaluate risk factors, but the lack of them as defined by ideal values.

Clinical Topics: Diabetes and Cardiometabolic Disease, Clinical Topic Collection: Dyslipidemia, Noninvasive Imaging, Prevention, Lipid Metabolism, Nonstatins, Magnetic Resonance Imaging, Diet, Smoking, Sleep Apnea

Keywords: Blood Pressure, Body Mass Index, Cholesterol, Cognition, Dementia, Diet, Executive Function, Glucose, Magnetic Resonance Imaging, Memory, Episodic, Metabolic Syndrome X, Motor Activity, Primary Prevention, Risk Factors, Smoking


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