Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia

Abstract

<div class="section"> <a class="named-anchor" id="ab-joi180087-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e366">Question</h5> <p id="d2063344e368">Is there an association between cardiovascular health level in older age and risk of incident dementia? </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180087-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e371">Findings</h5> <p id="d2063344e373">In this French population-based cohort study involving 6626 individuals, an increased number of optimal cardiovascular health metrics (defined using a 7-item tool from the American Heart Association) were significantly associated with lower risk of incident dementia (hazard ratio, 0.90 for each additional metric at recommended optimal level). </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180087-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e376">Meaning</h5> <p id="d2063344e378">These findings may support the promotion of cardiovascular health to prevent development of risk factors associated with dementia. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180087-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e382">Importance</h5> <p id="d2063344e384">Evidence is limited regarding the relation between cardiovascular health level and dementia risk. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180087-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e387">Objective</h5> <p id="d2063344e389">To investigate the association between cardiovascular health level, defined using the 7-item tool from the American Heart Association (AHA), and risk of dementia and cognitive decline in older persons. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180087-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e392">Design, Setting, and Participants</h5> <p id="d2063344e394">Population-based cohort study of persons aged 65 years or older from Bordeaux, Dijon, and Montpellier, France, without history of cardiovascular diseases or dementia at baseline who underwent repeated in-person neuropsychological testing (January 1999–July 2016) and systematic detection of incident dementia (date of final follow-up, July 26, 2016). </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180087-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e397">Exposures</h5> <p id="d2063344e399">The number of the AHA’s Life’s Simple 7 metrics at recommended optimal level (nonsmoking, body mass index &lt;25, regular physical activity, eating fish twice a week or more and fruits and vegetables at least 3 times a day, cholesterol &lt;200 mg/dL [untreated], fasting glucose &lt;100 mg/dL [untreated], and blood pressure &lt;120/80 mm Hg [untreated]; score range, 0-7) and a global cardiovascular health score (range, 0-14; poor, intermediate, and optimal levels of each metric assigned a value of 0, 1, and 2, respectively). </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180087-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e402">Main Outcomes and Measures</h5> <p id="d2063344e404">Incident dementia validated by an expert committee and change in a composite score of global cognition (in standard units, with values indicating distance from population means, 0 equal to the mean, and +1 and −1 equal to 1 SD above and below the mean). </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180087-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e407">Results</h5> <p id="d2063344e409">Among 6626 participants (mean age, 73.7 years; 4200 women [63.4%]), 2412 (36.5%), 3781 (57.1%), and 433 (6.5%) had 0 to 2, 3 to 4, and 5 to 7 health metrics at optimal levels, respectively, at baseline. Over a mean follow-up duration of 8.5 (range, 0.6-16.6) years, 745 participants had incident adjudicated dementia. Compared with the incidence rate of dementia of 1.76 (95% CI, 1.38-2.15) per 100 person-years among those with 0 or 1 health metrics at optimal levels, the absolute differences in incident dementia rates for 2, 3, 4, 5, and 6 to 7 metrics were, respectively, −0.26 (95% CI, −0.48 to −0.04), −0.59 (95% CI, −0.80 to −0.38), −0.43 (95% CI, −0.65 to −0.21), −0.93 (95% CI, −1.18 to −0.68), and −0.96 (95% CI, −1.37 to −0.56) per 100 person-years. In multivariable models, the hazard ratios for dementia were 0.90 (95% CI, 0.84-0.97) per additional optimal metric and 0.92 (95% CI, 0.89-0.96) per additional point on the global score. Furthermore, the gain in global cognition associated with each additional optimal metric at baseline was 0.031 (95% CI, 0.009-0.053) standard units at inclusion, 0.068 (95% CI, 0.045-0.092) units at year 6, and 0.072 (95% CI, 0.042-0.102) units at year 12. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180087-10"> <!-- named anchor --> </a> <h5 class="section-title" id="d2063344e412">Conclusions and Relevance</h5> <p id="d2063344e414">In this cohort of older adults, increased numbers of optimal cardiovascular health metrics and a higher cardiovascular health score were associated with a lower risk of dementia and lower rates of cognitive decline. These findings may support the promotion of cardiovascular health to prevent risk factors associated with cognitive decline and dementia. </p> </div><p class="first" id="d2063344e417">This cohort study assesses the association between cardiovascular (CV) health, defined by measures of healthy lifestyle and controlled CV risk factors, and risk of cognitive decline and dementia in community-dwelling people in France aged 65 years or older. </p>