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Association Between Cardiovascular Health and Stroke and Dementia
Study Questions:
Does adherence to the American Heart Association (AHA) ideal cardiovascular health (CVH) guidelines reduce the risk of stroke and dementia?
Methods:
This study used data from the Framingham Heart Study Offspring cohort. The AHA ideal CVH metric was used to calculate a 7-point score with 1 point for each of the following: nonsmoking status; ideal body mass index; regular physical activity; healthy diet; and good control of blood pressure, cholesterol, and blood glucose. The authors aimed to determine if incident stroke and dementia (Alzheimer disease and vascular dementia) were associated with both recent and remote ideal CVH scores. Stroke diagnoses were ascertained by medical record review. Dementia was defined by Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. The authors also looked at the association between ideal CVH score and markers of cognitive decline, assessed by neuropsychological testing, and brain atrophy on magnetic resonance imaging (MRI) over the course of 7 years. Adjusted Cox proportional hazard regression models were used to examine the association between ideal CVH scores and stroke and dementia, while adjusted linear regression was used to evaluate the association between ideal CVH scores and cognitive decline and brain atrophy.
Results:
There were 2,631 subjects in the stroke cohort, 1,364 in the dementia cohort, and 1,597 in the cognitive decline/MRI cohort. The mean ideal CHV score ranged from 3.1-3.3 across the cohorts. There was an average of 6.9 years between calculation of the recent and remote ideal CVH scores. The 10-year incidence of stroke was 87 (3%) and dementia 84 (6%). Higher recent and remote ideal CVH scores were associated with a lower risk of stroke. Higher remote, but not recent ideal CVH score was associated with a lower risk of all-cause dementia and Alzheimer disease. Both recent and remote higher ideal CVH scores were associated with a reduced risk of vascular dementia. When cognitive decline and brain atrophy were examined, higher remote, but not recent, ideal CVH scores were associated with less cognitive decline and brain atrophy.
Conclusions:
Adherence to the AHA ideal CVH score decreased the risk of vascular brain injury.
Perspective:
Stroke and vascular dementia are the most obvious manifestations of vascular brain injury; however, research has shown that vascular risk factors are also implicated in the development of Alzheimer disease. Better control of vascular risk factors can decrease the risk of vascular injury and dementia. The lack of association between recent ideal CVH score and dementia, cognitive decline, and brain atrophy is not unexpected as these are not acute conditions, like stroke, but instead develop over time. Since the components of the ideal CVH score are modifiable, this study suggests that optimization of these vascular risk factors may not only reduce the risk of stroke, but also dementia.
Keywords: Alzheimer Disease, Atrophy, Blood Glucose, Blood Pressure, Body Mass Index, Cerebrovascular Trauma, Cholesterol, Cognition, Dementia, Dementia, Vascular, Diet, Exercise, Magnetic Resonance Imaging, Primary Prevention, Risk Factors, Stroke, Vascular System Injuries
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