A Healthy Heart in Youth Protects the Brain Later On

Megan Brooks

March 04, 2020

A healthier heart in young adulthood could mean fewer cognitive problems later in life, new research suggests.

New findings from the Coronary Artery Risk Development in Young Adults (CARDIA) study show that individuals who had better cardiovascular (CV) health in their 20s scored higher on tests of thinking and memory 30 years later than their peers who had poorer CV health as young adults.

"We have learned that midlife vascular risk factors, rather than risk factors in older age, are particularly associated with cognition in older age," study author Farzaneh Sorond, MD, PhD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, told Medscape Medical News.

"Our findings from the CARDIA study expand this knowledge and show that vascular health during young adulthood, rather than midlife, is also specifically associated with brain vascular health and cognitive function in midlife," Sorond said.

"These results indicate that people need to pay close attention to their health even in their early 20s," she added in a statement.

The findings were released in advance of being presented at the upcoming American Academy of Neurology (AAN) 2020 Annual Meeting.

Early Prevention Key

The analysis examined data from 189 participants (45% women, 45% black) in the CARDIA study who were followed for 30 years. The mean age at baseline was 24 years.

Vascular risk factors were assessed eight times during the 30-year study period. A CV health score (range, 0 – 10) was calculated on the basis of smoking status, body mass index, blood pressure, total cholesterol level, and fasting glucose level.

At the final assessment, which was conducted 30 years after baseline, dynamic cerebral autoregulation was calculated as the transfer function phase of the spontaneous oscillations in blood pressure and flow velocity in the middle cerebral artery using transcranial Doppler ultrasound.

Cognition was assessed using a series of standard neuropsychological tests. Multivariate linear regression models were used to assess the association of heart health at each visit with cerebral autoregulation and cognition.

Results showed that the participants with better CV health at the beginning of the study were more likely to have higher cognitive test scores 30 years later in comparison with those with worse CV health.

For example, on a test of attention skills in which scores ranged from 7 to 103, each point higher on the CV health score was associated with a 2.2-point higher score in attention skills. These results held up after adjustment for other factors that could affect cognitive test scores, such as education level.

Better CV health at baseline and at 7 years was also associated with significantly better dynamic cerebral autoregulation.

"Our findings suggest that the earlier vascular risk factors are modified and addressed, the more likely that they will impact brain health across life span," Sorond said.

"Moreover, these findings underscore the importance of primordial prevention and addressing the significant knowledge gap that currently exist in this domain," she added.

Full data from the study will be presented at the AAN meeting in April.

Good for the Heart, Good for the Brain

Commenting on the findings for Medscape Medical News, Rebecca Edelmayer, PhD, director of scientific engagement for the Alzheimer's Association, said that the longitudinal study adds to the growing body of research showing that "what is good for the heart is also good for the brain."

"This is still a relatively small study, and larger studies have been published that show similar results," said Edelmayer, who was not involved with the research.

She noted that results of the large SPRINT-MIND trial, published last year in JAMA and reported by Medscape Medical News, "provided the strongest evidence to date about reducing risk of mild cognitive impairment through the management of high blood pressure."

The Alzheimer's Association has provided seed funding for SPRINT-MIND 2.0, a 2-year extension of the study to evaluate whether intensive blood pressure management reduces risk for all-cause dementia.

Support for the current study was provided by the National Institutes of Health, the National Heart, Lung, and Blood Institute, the University of Alabama at Birmingham, Northwestern University, the University of Minnesota, and the Kaiser Foundation Research Institute. Sorond and Edelmayer have reported no relevant financial relationships.

American Academy of Neurology (AAN) 2020 Annual Meeting: Abstract 1060. To be presented in April 2020.

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