Midlife Cardiovascular Risk Tied to Early Memory Problems

Kate Johnson

March 09, 2011

March 9, 2011 — Increased cardiovascular risk in midlife is linked to accelerated cognitive decline as early as 10 years later, according to a new analysis from a longitudinal British cohort study.

The findings suggest an adverse cardiovascular profile, determined in midlife using the Framingham General Cardiovascular Risk Profile, predicted later cognitive decline.

"Most cardiovascular disease risk factors result in progressive changes in blood vessels, including those of the brain," explained lead investigator Sara Kaffashian, MSc, from INSERM, the French National Institute of Health and Medical Research, in Paris. "A reduction of blood flow to the brain can cause cerebral damage and lead to cognitive deficits."

The findings were released February 21 and will be presented in April at the American Academy of Neurology 63rd Annual Meeting in Honolulu, Hawaii.

Whitehall II Study

The study included a sample of 3486 men and 1314 women who were enrolled in the Whitehall II study. At baseline, subjects were a mean age of 55 years and were free of cardiovascular disease (CVD).

The Framingham General Cardiovascular Risk Profile is a recently developed tool meant to assess the collective impact of cardiovascular risk factors on the risk of developing not just 1 type of cardiovascular event but any of heart disease, stroke, peripheral artery disease, or heart failure events.

In this report, the investigators used the tool between 1997 and 1999 to predict subjects' risk of having a CVD event, including age, sex, high-density lipoprotein cholesterol, total cholesterol, systolic blood pressure, smoking status, and diabetes status.

Cognitive function was also assessed at baseline and then again at 5 years and 10 years after study entry using tests of reasoning, memory, phonemic fluency, semantic fluency, and vocabulary.

In sex-specific, cross-sectional, age-adjusted models, they found that each 10% increment in cardiovascular risk was associated with measurable declines in cognitive performance in all cognitive domains from baseline to 10 years in both men and women. For example, each 10% increment in CVD risk was associated with statistically significant decreases of 2.8% in memory score for men and a 7.1% decrease for women.

In models further adjusted for age, ethnicity, marital status, and education, the 10% increase in cardiovascular risk was associated with poorer cognitive performance in all domains except for reasoning in men and fluency in women. In multiple-adjusted models, higher cardiovascular risk was associated with overall 10-year cognitive decline in both men and women.

Not a Subtle Effect

"This is not a subtle cardiovascular effect," commented Richard Lipton, MD, director of the Aging and Dementia Division at New York’s Albert Einstein Medical College in New York City, when asked to put the findings in context.

"Of the common risk factors for CVD, such as hypertension, diabetes, hyperlipidemia, positive family history of early MI, or stroke, it takes several to elevate risk to that degree."

The good news is their data suggest treating hypertension and high cholesterol levels when patients are in their mid-50s may slow cognitive decline, said Ms. Kaffashian.

"When we adjusted the analyses for 'use of antihypertensive medications' during the 10-year follow-up, the association between CVD risk at baseline and 10-year cognitive decline weakened," she told Medscape Medical News.

"Strictly speaking we cannot talk about improvement of cognitive function. Rather that the decline was slower."

Dr. Lipton agreed that it's not clear yet if vascular damage in the brain can ever be "undone."

"Controlling high blood pressure, diabetes, and high cholesterol can reverse atherosclerosis. We can hope for reversal of atherosclerosis or stabilization of cognitive decline, but it is not clear if we can hope for reversal of cognitive decline."

Ms. Kaffashian has disclosed no relevant financial relationships. Dr. Lipton acknowledged that he consults for a number of pharmaceutical companies in the aging and dementia field, including Merck and Novartis.

American Academy of Neurology (AAN) 63rd Annual Meeting: Abstract 3393. Released February 21, 2011, ahead of presentation.

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