Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia
Authors: Cécilia Samieri, Marie-Cécile Perier, Bamba Gaye, Cécile Proust-Lima, Catherine Helmer, Jean-François Dartigues, Claudine Berr, Christophe Tzourio, Jean-Philippe Empana
Journal: JAMA (2018)

<h3>Importance</h3> Evidence is limited regarding the relation between cardiovascular health level and dementia risk. <h3>Objective</h3> 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. <h3>Design, Setting, and Participants</h3> 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). <h3>Exposures</h3> 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). <h3>Main Outcomes and Measures</h3> 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). <h3>Results</h3> 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. <h3>Conclusions and Relevance</h3> 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.