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

Educational Objective
To understand the relationship between cardiovascular health and dementia.
1 Credit CME
Key Points

Question  Is there an association between cardiovascular health level in older age and risk of incident dementia?

Findings  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).

Meaning  These findings may support the promotion of cardiovascular health to prevent development of risk factors associated with dementia.

Abstract

Importance  Evidence is limited regarding the relation between cardiovascular health level and dementia risk.

Objective  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.

Design, Setting, and Participants  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).

Exposures  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  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  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.

Conclusions and Relevance  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.

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Article Information

Corresponding Author: Cécilia Samieri, PhD, INSERM, U1219, Université de Bordeaux, ISPED, CS 61292, 146 rue Léo-Saignat, Bordeaux 33076, France (cecilia.samieri@u-bordeaux.fr).

Accepted for Publication: July 22, 2018.

Author Contributions: Dr Samieri had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Samieri, Gaye, Dartigues, Empana.

Acquisition, analysis, or interpretation of data: Samieri, Périer, Proust-Lima, Helmer, Dartigues, Berr, Tzourio, Empana.

Drafting of the manuscript: Samieri, Gaye, Empana.

Critical revision of the manuscript for important intellectual content: Périer, Proust-Lima, Helmer, Dartigues, Berr, Tzourio, Empana.

Statistical analysis: Samieri, Périer, Gaye, Proust-Lima, Empana.

Obtained funding: Helmer, Dartigues, Berr, Tzourio.

Administrative, technical, or material support: Berr, Tzourio.

Supervision: Dartigues, Empana.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Dartigues reports receipt of a grant from Roche. No other disclosures were reported.

Funding/Support: The Three-City Study is conducted under a partnership agreement between INSERM, the ISPED of the University of Bordeaux, and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The Three-City Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, Mutuelle Générale de l’Education Nationale, Institut de la Longévité, Conseils Régionaux of Aquitaine and Bourgogne, Fondation de France, and Ministry of Research-INSERM Programme “Cohortes et collections de données biologiques,”French National Research Agency COGINUT ANR-06-PNRA-005 and COGICARE ANR Longvie (LVIE-003-01), the Fondation Plan Alzheimer (FCS 2009-2012), and the Caisse Nationale pour la Solidarité et l’Autonomie.

Role of the Funder/Sponsor: The sponsors were not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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