Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study

Abstract

ObjectivesTo examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia.DesignProspective cohort study.SettingCivil service departments in London (Whitehall II study; study inception 1985-88).Participants7899 participants with data on the cardiovascular health score at age 50.ExposuresThe cardiovascular health score included four behavioural (smoking, diet, physical activity, body mass index) and three biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three point scale (0, 1, 2). The cardiovascular health score was the sum of seven metrics (score range 0-14) and was categorised into poor (scores 0-6), intermediate (7-11), and optimal (12-14) cardiovascular health.Main outcome measureIncident dementia, identified through linkage to hospital, mental health services, and mortality registers until 2017.Results347 incident cases of dementia were recorded over a median follow-up of 24.7 years. Compared with an incidence rate of dementia of 3.2 (95% confidence interval 2.5 to 4.0) per 1000 person years among the group with poor cardiovascular health, the absolute rate differences per 1000 person years were −1.5 (95% confidence interval −2.3 to −0.7) for the group with intermediate cardiovascular health and −1.9 (−2.8 to −1.1) for the group with optimal cardiovascular health. Higher cardiovascular health score was associated with a lower risk of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 point increment in the cardiovascular health score).ConclusionAdherence to the Life Simple 7 ideal cardiovascular health recommendations in midlife was associated with a lower risk of dementia later in life.

Effect of Inflammatory Status on the Association Between Cardiovascular Health and Cognitive Function: A Cross-Sectional Study

“…In addition, application of different criteria for measuring cognitive decline in the studies could lead to differences in results. In our study, the criteria for cognitive decline included mild cognitive impairment (MCI), whereas the criterion in previous studies was dementia [5,6]. Since MCI is a pre-dementia stage and its severity is less than that of dementia [21,22], the correlation between CVH and MCI and that between CVH and dementia could be different.…”

“…A previous research study conducted in France included 745 dementia patients in a total study population of 6,626 [6]. Another study conducted in the UK included 347 dementia patients in a total population of 7,899 [5]. Consequently, the smaller sizes of the low cognitive function group and total population in our study could have lowered the accuracy of the analysis.…”

“…Differences in the methods for measuring cognitive dysfunction could be another reason for inconsistent study outcomes. In our study, the Korean version of the MMSE-DS was used, whereas previous studies used a combination of cognitive tests [5].…”

“…The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) study was conducted between 2013-2018 to investigate risk factors for cardiovascular and metabolic disease. The CMERC study enrolled participants meeting the following criteria: (1) aged 30 to 64 years, (2) having an urban residence in Seoul or nearby, (3) able to articulate their own opinions, (4) no history of overt cardiovascular diseases (lifetime), or malignant cancer (within the previous 2 years), (5) no concurrent enrollment in other clinical trials, and (6) not pregnant at baseline. Details of the study are described elsewhere [13].…”

Gender Disparities in Cardiovascular Health Metrics among Rural-Dwelling Older Adults in China: a population-based study

“…We de ned CVH metrics following the AHA's recommendations, [5] with some modi cations (Supplemental Table 1): (1) we did not include diet due to a lack of dietary data; (2) we de ned ideal BMI as <24 kg/m 2 , as recommended for Chinese adults; [23] and (3) we de ned ideal smoking level as never or quitting smoking >5 years. [24] Thus, we included six factors in the CVH metrics: smoking, BMI, physical activity, blood pressure, total cholesterol, and FBG. We considered smoking, BMI, and physical activity as behavioral CVH metrics, and blood pressure, total cholesterol, and FBG as biological CVH metrics.…”