Cardiovascular health metrics from mid- to late-life and risk of dementia: A population-based cohort study in Finland

Abstract

Background Very few studies have explored the patterns of cardiovascular health (CVH) metrics in midlife and late life in relation to risk of dementia. We examined the associations of composite CVH metrics from midlife to late life with risk of incident dementia. Methods and findings This cohort study included 1,449 participants from the Finnish Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study, who were followed from midlife (baseline from1972 to 1987; mean age 50.4 years; 62.1% female) to late life (1998), and then 744 dementia-free survivors were followed further into late life (2005 to 2008). We defined and scored global CVH metrics based on 6 of the 7 components (i.e., smoking, physical activity, and body mass index [BMI] as behavioral CVH metrics; fasting plasma glucose, total cholesterol, and blood pressure as biological CVH metrics) following the modified American Heart Association (AHA)’s recommendations. Then, the composite global, behavioral, and biological CVH metrics were categorized into poor, intermediate, and ideal levels. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Data were analyzed with Cox proportional hazards and the Fine and Gray competing risk regression models. During the follow-up examinations, dementia was diagnosed in 61 persons in 1998 and additional 47 persons in 2005 to 2008. The fully adjusted hazard ratio (HR) of dementia was 0.71 (95% confidence interval [CI]: 0.43, 1.16; p = 0.174) and 0.52 (0.29, 0.93; p = 0.027) for midlife intermediate and ideal levels (versus poor level) of global CVH metrics, respectively; the corresponding figures for late-life global CVH metrics were 0.60 (0.22, 1.69; p = 0.338) and 0.91 (0.34, 2.41; p = 0.850). Compared with poor global CVH metrics in both midlife and late life, the fully adjusted HR of dementia was 0.25 (95% CI: 0.08, 0.86; p = 0.028) for people with intermediate global CVH metrics in both midlife and late life and 0.14 (0.02, 0.76; p = 0.024) for those with midlife ideal and late-life intermediate global CVH metrics. Having an intermediate or ideal level of behavioral CVH in both midlife and late life (versus poor level in both midlife and late life) was significantly associated with a lower dementia risk (HR range: 0.03 to 0.26; p < 0.05), whereas people with midlife intermediate and late-life ideal biological CVH metrics had a significantly increased risk of dementia (p = 0.031). Major limitations of this study include the lack of data on diet and midlife plasma glucose, high rate of attrition, as well as the limited power for certain subgroup analyses. Conclusions In this study, we observed that having the ideal CVH metrics, and ideal behavioral CVH metrics in particular, from midlife onwards is associated with a reduced risk of dementia as compared with people having poor CVH metrics. Maintaining life-long health behaviors may be crucial to reduce late-life risk of dementia.

The Relationship Between Cardiovascular Health and Rate of Cognitive Decline in Young-Old and Old-Old Adults: A Population-Based Study

“…Better levels of smoking, BMI, glucose, and cholesterol were associated with worse cognitive function. Relatedly, a recent study found that the association of ideal LS7 with a reduced dementia risk was mainly present at mid-life, which was explained by age-varying association between biological health factors and risk of dementia [37]. Similar age-differential patterns have also been observed for other vascular risk scores, such as the Framingham general cardiovascular risk score [44].…”

“…An additional aim of our study was to examine potentially different patterns for younger and older age groups. LS7 has so far mostly been applied to midlife populations, either exploring the link with dementia [16,32,37] or cognition [15,19,38]. However, Samieri et al [39] examined the associations of LS7 with cognitive decline and incident dementia in an older sample (mean age = 73.7 years).…”

General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence

“…This is unfortunate as dementia risk reduction may offer greatest public health benefit in LMICs [98], which will bear greater future dementia burden [99] and likely have less access to advances in disease modifying treatments [100,101]. Similarly, beliefs in younger years can strongly influence behaviour patterns in the critical middle-age period [3,4,102]. Further primary research addressing these gaps will support stronger future reviews and model development.…”

Health status and risk profiles for brain aging of rural‐dwelling older adults: Data from the interdisciplinary baseline assessments in MIND‐China

“…It has been suggested that cardiometabolic risk factors (eg, high blood pressure and high cholesterol), especially when occurring in midlife (eg, 40s–50s years of age), but not necessary in late‐life, could contribute to an increased risk of late‐life cognitive decline and dementia. 10 , 11 , 43 In this context, MIND‐China, as an intervention study in older adults (≥60 years of age), is not able to test the potential effect of control of midlife vascular risk factors on late‐life cognitive outcomes. In addition, we do not have AD biomarkers from CNS (eg, CSF and brain positron emission tomography‐computed tomography [PET/CT] scans) to validate plasma AD biomarkers in our study, although current evidence from literature shows clear correlations of SIMOA‐based plasma AD biomarkers with CNS AD biomarkers and we do have the plan to test additional blood biomarkers that are more sensitive for AD (eg, phosphorated‐tau 181, 217, and 231) in the future by using frozen baseline blood samples.…”