CV risks in midlife linked to accelerated cognitive decline – Healio

Last Updated on July 15, 2020 by


Source/Disclosures


Disclosures:
Yaffe reports serving on data and safety monitoring boards for Eli Lilly and several National Institute on Aging–sponsored studies, being a board member of Alector, and a member of the Beeson Scientific Advisory Board and the Global Council on Brain Health. Please see the study for all other authors’ relevant financial disclosures.

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Certain cardiovascular risk factors in midlife were associated with accelerated cognitive decline, according to a study published in Neurology, the medical journal of the American Academy of Neurology.

Kristine Yaffe

Kristine Yaffe

“What is new here is that almost no one has looked at cardiovascular risk factors or [cardiovascular risk factors] in such a young age (mean 50 years) and cognitive change in middle age,” Kristine Yaffe, MD, professor of psychiatry, neurology and epidemiology at the University of California, San Francisco, and a member of the American Academy of Neurology, told Healio Primary Care.

Risk for accelerated cognitive decline with cardiovascular risk factors
Reference: Yaffe K, et al. Neurology. 2020;doi:10.7272/Q64J0C9D.

Previous studies, she explained, evaluated the presence of these risk factors in midlife or late life and cognition or dementia in late life.

“I think this tells us that the connections between heart health and brain health are happening much earlier than we thought … even when folks are in their 50s,” Yaffe said. “So, all the more reason to recommend that patients pay close attention to these and work with their doctors to lower their blood pressure, stop smoking and reduce diabetes incident or control of diabetes.”

Yaffe and colleagues evaluated participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, an ongoing study which involved young adults who were aged 18 years to 30 years at the time of enrollment in 1985 to 1986.

Previous studies of CARDIA participants showed that cardiovascular health in a person’s 20s may impact brain health later in life.

The baseline of Yaffe and colleagues’ study was year 25 (2010-2011) of the CARDIA study. At baseline, the researchers assessed the presence of cardiovascular risk factors, and found that of the 2,675 participants, 31% had hypertension, 11% had diabetes, 43% had obesity, 9% had high cholesterol and 15% were current cigarette smokers.

Participants underwent cognitive tests at baseline and at 5 years to evaluate their memory, executive function and processing speed.

Among participants, 5% experienced accelerated cognitive decline in 5 years of follow-up.

After a multivariable adjustment, the researchers determined that there was an increased likelihood of accelerated decline among those who smoked (adjusted OR = 1.65; 95% CI, 1.00-2.71), had hypertension (AOR = 1.87; 95% CI, 1.26-2.75) and had diabetes (AOR = 2.45; 95% CI, 1.54-3.88). However, obesity and high cholesterol were not associated with a risk for cognitive decline, according to the researchers. The findings remained similar when stratified by race.

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Yaffe and colleagues also reported that the likelihood of accelerated decline was affected by the number of cardiovascular risk factors that participants had at baseline, increasing between those with one to two risk factors (AOR = 1.77, 95% CI 1.02-3.05) and those with three or more risk factors (AOR = 2.94; 95% CI, 1.64-5.28).

They also determined that those with a Framingham Coronary Heart Disease Risk Score at 10 or more had an increased risk for accelerated decline (AOR = 2.29; 95% CI, 1.21-4.34).

“Patients need to recognize that heart health is key to brain health. In addition, being active, both physically and mentally, seem like important strategies to lower risk,” Yaffe said. “Also, addressing sleep problems and avoiding excessive alcohol and poor diet.”

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