COMMENTARY

To Prevent Dementia, Focus on the Heart

JoAnn E. Manson, MD, DrPH

Disclosures

September 26, 2019

This transcript has been edited for clarity.

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital in Boston, Massachusetts. I'd like to talk with you about a recent report in the BMJ that provides the strongest evidence to date of the heart-brain connection. What's good for the heart is good for the brain.

The study was done in the United Kingdom, a Whitehall II prospective cohort study. It included nearly 8000 men and women who were followed for about 25 years for the incidence of dementia. Their cardiovascular health was assessed at midlife (age 50) using the American Heart Association's Life's Simple 7 score, which includes four lifestyle behavioral factors (not smoking, physical activity of at least 30 minutes of moderate exercise daily, a healthy weight, and a heart-healthy diet), as well as three biological factors (control of blood pressure, cholesterol, and glucose).

The participants were divided into three groups: poor, intermediate, or good (optimal) cardiovascular health. Compared with those classified as having poor cardiovascular health, those with intermediate Life's Simple 7 scores had about one half the risk of developing dementia. Those who had good cardiovascular health had nearly a two-thirds reduction in the risk of developing dementia. Every 1-point increase in the cardiovascular health score was associated with an 11% lower risk for dementia.

The results were similar for men and women, and for lifestyle and biological factors. Even among those who did not experience a cardiovascular event such as a heart attack or stroke during follow-up, an association was found between their score and risk for dementia, suggesting that it wasn't simply a matter of not having had a clinical cardiovascular event. The investigators also did brain MRIs and related the Life's Simple 7 score to MRI brain volume and gray matter mass.

This study strongly suggests that we should be targeting vascular health and cardiovascular risk factor status in trying to reduce risk for dementia, and that we should be starting earlier, at least by midlife. Some of the earlier studies that had inconsistent results were generally assessing cardiovascular health and lifestyle factors much later in life and had shorter follow-up. Some of the lifestyle factors may have been influenced by some degree of cognitive decline or preclinical dementia.

This study provides strong evidence for the importance of cardiovascular health in preventing cognitive decline, especially in the context of discouraging findings on pharmaceuticals for dementia and the absence of a breakthrough drug on the horizon. It suggests that we should be devoting a great deal of attention to helping patients improve their cardiovascular health, and making these lifestyle changes earlier when they might make a difference to neurologic health as well. This will go a long way in reducing two leading causes of death and disability throughout the world.

Thank you so much for your attention. This is JoAnn Manson.

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