Summary Goals: To understand the role of premature CVD (defined as ≤60 years) on brain health earlier in life, we examined the association of premature CVD with midlife cognition and white matter health. Methods: We studied a prospective cohort in the Coronary Artery Risk Development in Young Adults study, who were aged 18 to 30 years at baseline (1985-86) and followed up to age 30 years when five cognitive tests measuring different domains were administered. A subset (656 participants) had brain MRI measures of white matter hyperintensity (WMH) and white matter integrity. Premature CVD event was adjudicated based on medical records of coronary heart disease, stroke/TIA, congestive heart failure, carotid artery disease, and peripheral arterial disease. We performed linear regression to determine the associations of nonfatal premature CVD with cognitive performance (z-standardized), cognitive decline, and MRI measures. Results: Among 3,146 participants , the mean age (57% women and 48% black) was 55.1 ± 3.6 years, with 5% (n=147) having premature CVD. When adjusting for demographics, education, literacy, income, depressive symptoms, physical activity, diet, and APOE, premature CVD was associated with lower cognition in 4 of 5 domains: global cognition (-0.22, confidence interval [ 95% CI -0.37 to -0.08), verbal memory (-0.28, 95% CI -0.44 to -0.12), processing speed (-0.46, CI -0.62 to -0.31) and executive function (-0.38, 95% CI -0.55 to -0.22). Premature CVD was associated with greater WMH (total, temporal, and parietal lobes) and greater mean white matter diffusivity after adjustment for covariates. These associations remained significant after adjusting for cardiovascular risk factors (CVRF) and excluding those with stroke/TIA. Premature CVD was also associated with accelerated cognitive decline over 5 years (adjusted odds ratio 3.07, 95% CI 1.65 to 5.71). Discussion: Premature CVD is associated with poorer midlife cognition and white matter health, which is not entirely driven by stroke/TIA and is even independent of CVRFs. Preventing cardiovascular disease in early adulthood can delay the onset of cognitive decline and promote brain health throughout life. |
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People with early cardiovascular disease may be more likely to have memory and thinking problems and poorer brain health in midlife, according to new research published in Neurology ® , the medical journal of the American Academy of Neurology. .
"Cardiovascular diseases, such as heart disease and stroke, have been associated with an increased risk of cognitive decline and dementia in older adults, but less is known about how having these diseases before age 60 affects cognition and brain health. throughout life," said study author Xiaqing Jiang, PhD, of the University of California, San Francisco. “Our study found that cardiovascular events earlier in life are associated with worse cognition, accelerated cognitive decline, and poor brain health in midlife.”
The study examined 3,146 people . Participants were between 18 and 30 years old at the start of the study and were followed for up to 30 years. At the end of the study, they had an average age of 55 years.
Of the total participants, 147, or 5%, were diagnosed with early cardiovascular disease, which was defined as coronary heart disease, stroke, congestive heart failure, carotid artery disease, or peripheral artery disease before age 60. The average age of the first cardiovascular event was 48 years.
After being followed for three decades , participants received five cognitive tests. The tests measured thinking and memory skills, including global cognition, processing speed, executive function, delayed verbal memory, and verbal fluency.
The researchers found that people with early cardiovascular disease performed worse than those without it on five out of five tests. In a test of recalling a list of words after 10 minutes where scores ranged from zero to 15, those with early cardiovascular disease compared to those without had a mean score of 6.4 versus a mean score of 8, 5. On a test assessing global cognition in which scores ranged from zero to 30, people with early cardiovascular disease had a mean score of 21.4 compared to people without cardiovascular disease who had a mean score of 23.9. . A score of 26 or higher is considered typical, while people with mild cognitive impairment have a median score of 22.
Of the total participants, 656 people underwent brain scans to look at white matter hyperintensities and white matter integrity. White matter hyperintensities usually indicate a vascular lesion in the white matter of the brain. After adjusting for cardiovascular risk factors such as diabetes and high blood pressure, the researchers found that early cardiovascular disease was associated with more white matter hyperintensities in the brain, as well as greater mean white matter diffusivity, indicating a decrease in brain tissue integrity.
For participants who underwent two sets of cognitive tests at ages 25 and 30 in the study, researchers found that early cardiovascular disease was associated with a three-fold increased likelihood of accelerated cognitive decline over five years, with a 13% increase in people with early cardiovascular disease experiencing accelerated cognitive decline compared to 5% of people who did not have the disease.
“Our research suggests that a person’s 20s and 30s are a crucial time to begin protecting brain health through cardiovascular disease prevention and intervention,” Jiang said. “Preventing these diseases can delay the onset of cognitive decline and promote a healthier brain throughout life.”
A limitation of the study is that no cognitive tests were administered at the beginning of the study.
The study was supported by the National Institutes of Health, the National Institute on Aging, the National Heart, Lung, and Blood Institute, the University of Alabama at Birmingham, Northwestern University, the University of Minnesota, and the Research Institute from the Kaiser Foundation.
