Cardiovascular Risk Factors, Cognitive Decline Are Linked

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Risk factors that predict cardiovascular disease can also help predict cognitive decline, according to findings reported in the Journal of the American Heart Association.

Using data from 2,254 adult participants in the National Health and Nutrition Examination Survey from 2011 to 2014, lead author Jingkai Wei, Ph.D., of the Arnold School of Public Health at the University of South Carolina, and colleagues measured risk using both the 10-year Framingham risk score (based on, for example, age, sex, smoking, cholesterol, blood pressure, and diabetes) and cognition tests (Animal Fluency Test, Consortium to Establish a Registry for Alzheimer’s Disease Word List Memory Task [CERAD], Digit Symbol Substitution Test).

Overall, the 10-year risk of cardiovascular disease was more than 18%. (The researchers note that antihypertensive medication use increased between 2011 to 2012 and 2013 to 2014, and the level of total cholesterol decreased.)

Participants with medium and high Framingham scores had lower cognitive scores. Every 5% increment in the cardiovascular disease risk score was related to lower cognitive function, including overall cognition and particular domains of cognition, such as executive function and processing speed, and immediate and delayed memory.

Other research has also found that smoking, hypertension, diabetes, high cholesterol and other pointers to poor cardiac health are associated with poorer cognitive outcomes, through numerous mechanisms. For example, a high level of cholesterol is associated with a high accumulation of beta-amyloid, a marker of Alzheimer’s disease and, according to some experts, a key factor in causing the disease. Smoking may increase the level of inflammation, which may change the structure of the brain. Those findings, however, had not been validated in a representative sample in the United States. This study had a larger sample, and measured differences among racial and ethnic subgroups.

Socioeconomic status, particularly race or ethnicity and monthly income levels, were strong effect measure modifiers of the associations. However, Wei and colleagues point out, “it is noticeable that there were some differences in the associations of 10-year CVD risk and cognitive function.” The associations were weak among non-Hispanic Black participants, participants with low levels of education, and participants with low levels of income. “It is possible,” the researchers say, “that the Framingham may not work very well to predict poor cognition among these groups, and given the disparities contributed by socioeconomic factors, socioeconomic factors may also

be added to the prediction models for cognitive impairment.”

Given the “severe consequences of CVD and cognitive aging,” the researchers conclude, their findings have important public health significance. Research has suggested that better adherence to the American Heart Association’s “Life’s Simple 7” modifiable behaviors is associated with better cognitive outcomes, the researchers note. Four components (smoking, blood pressure, blood sugar, cholesterol) in the Life’s Simple 7 overlap with the Framingham cardiovascular risk score, as do the individual associations of diet, physical activity, and weight loss with cognitive outcomes.

In short, helping patients reduce their cardiovascular risk factors could have synergistic benefits for their cognitive health.