Cardiovascular risk factors and accelerated cognitive decline in midlife

ObjectiveIncreasing evidence supports an association between midlife
cardiovascular risk factors (CVRFs) and risk of dementia, but less is
known about whether CVRFs influence cognition in midlife. We examined the
relationship between CVRFs and midlife cognitive decline.MethodsIn 2,675
black and white middle-aged adults (mean age 50.2 ± 3.6 years, 57% female,
45% black), we measured CVRFs at baseline: hypertension (31%), diabetes
mellitus (11%), obesity (43%), high cholesterol (9%), and current
cigarette smoking (15%). We administered cognitive tests of memory,
executive function, and processing speed at baseline and 5 years later.
Using logistic regression, we estimated the association of CVRFs with
accelerated cognitive decline (race-specific decline ≥1.5 SD from the mean
change) on a composite cognitive score.ResultsFive percent (n = 143) of
participants had accelerated cognitive decline over 5 years. Smoking,
hypertension, and diabetes mellitus were associated with an increased
likelihood of accelerated decline after multivariable adjustment (adjusted
odds ratio [AOR] 1.65, 95% confidence interval [CI] 1.00–2.71; AOR 1.87,
95% CI 1.26–2.75; AOR 2.45, 95% CI 1.54–3.88, respectively), while obesity
and high cholesterol were not associated with risk of decline. These
results were similar when stratified by race. The likelihood of
accelerated decline also increased with greater number of CVRFs (1–2
CVRFs: AOR 1.77, 95% CI 1.02–3.05; ≥3 CVRFs: AOR 2.94, 95% CI 1.64–5.28)
and with Framingham Coronary Heart Disease Risk Score ≥10 (AOR 2.29, 95%
CI 1.21–4.34).ConclusionsMidlife CVRFs, especially hypertension, diabetes
mellitus, and smoking, are common and associated with accelerated
cognitive decline at midlife. These results identify potential modifiable
targets to prevent midlife cognitive decline and highlight the need for a
life course approach to cognitive function and aging.