Samieri C, et al. - Researchers explored the link 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. They observed that increased numbers of optimal cardiovascular health metrics and a higher cardiovascular health score were related to a lower risk of dementia and lower rates of cognitive decline. Promoting cardiovascular health as a means to prevent risk factors correlated with cognitive decline and dementia was supported in this analysis.

Methods

• Study participants in this population-based cohort study were persons aged 65 years or older from Bordeaux, Dijon, and Montpellier, France, without history of cardiovascular diseases or dementia at baseline who had repeated in-person neuropsychological testing (January 1999–July 2016) and systematic detection of incident dementia (date of final follow-up, July 26, 2016).
• Main exposures were the number of the AHA’s Life’s Simple 7 metrics at recommended optimal level (nonsmoking, body mass index < 25, regular physical activity, eating fish twice a week or more and fruits and vegetables at least 3 times a day, cholesterol < 200 mg/dL [untreated], fasting glucose < 100 mg/dL [untreated], and blood pressure < 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).
• Main outcomes and measures were 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).

Results

• At baseline, among 6,626 study participants (mean age, 73.7 years; 4,200 women [63.4%]), 2,412 (36.5%), 3,781 (57.1%), and 433 (6.5%) had 0 to 2, 3 to 4, and 5 to 7 health metrics at optimal levels, respectively.
• Seven hundred forty-five study participants had incident adjudicated dementia over a mean follow-up duration of 8.5 (range, 0.6-16.6) years.
• 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 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 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 in multivariable models.
• The study results showed that the gain in global cognition related to 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.