Association of cardiovascular health with the risk of dementia in older adults

Abstract

It has been becoming important to identify modifiable risk factors to prevent dementia. We investigated the association of individual and combined cardiovascular health (CVH) on dementia risk in older adults. From the National Health Insurance Service of Korea-Senior database, 191,013 participants aged ≥ 65 years without prior dementia or cerebrovascular diseases who had check-ups between 2004 and 2012 were assessed. Participants were stratified into three groups according to the number of optimal levels of CVH (low, 0–2; moderate, 3–4; and high CVH status, 5–6) and grouped by levels of individual CVH metrics, the number of optimal CVH metrics, and the CVH score. Over a median follow-up of 6.2 years, 34,872 participants were diagnosed with dementia. Compared with low CVH status, moderate and high CVH status were associated with a decreased risk of dementia (hazard ratio [95% confidence interval], 0.91 [0.89–0.92] for moderate; 0.78 [0.75–0.80] for high CVH status) including Alzheimer’s and vascular dementia. The risk of dementia decreased with an increase in the number of optimal CVH metrics (0.94 [0.93–0.94] per additional optimal metric) and with an increase in the CVH score (0.93 [0.93–0.94] per 1-point increase). After censoring for stroke, the association of CVH metrics with dementia risk was consistently observed. Among individual metrics, physical activity had the strongest association with the risk of dementia. In an older Asian population without prior dementia or cerebrovascular disease, a consistent relationship was observed between the improvement of a composite metric of CVH and the reduced risk of dementia.

Sex matters in the association between cardiovascular health and incident dementia: evidence from real world data

“…Regarding dementia subtypes, we observed that cardiovascular risk was associated with vascular dementia and Alzheimer’s disease, in line with previous studies [ 4 , 43 – 45 ]. The associations were stronger with vascular dementia; these are expected results because the main risk factors for vascular dementia are included in the REGICOR-Framingham score.…”

“…The main strength of this study was the high external validity grounded on a large sample size and 15 years of follow-up, which is longer than that in previous studies [ 10 , 43 , 45 ]. Moreover, the analysis of electronic health records allows the study of real-life clinical conditions and precludes a selection bias due to low response rates or losses during follow-up, which could be common among people with dementia.…”

“…We also acknowledge several limitations. First, there could be some residual confounding due to unobserved variables that were not available in SIDIAP, such as educational level [ 47 ] or physical activity [ 43 ]. Second, under-registration of certain health records might promote selection bias, but we mitigated this limitation by imputing the missing data.…”

Estimation using 3 scales of cardiometabolic risk in patients with cognitive impairment according to the Hashinsky score.

“…It is plausible that the projected cardiovascular risk for this particular patient population is underestimated. Across all three stratification techniques utilized, patients with VD exhibited a high cardiovascular risk, aligning with heightened mortality rates, including cardiovascular mortality (18)(19)(20). This study underscores the significance of validating the numerous risk equations employed for assessing cardiovascular risk in VD patients and modifying them to incorporate adjustments based on the Hachinski criteria or other pertinent instruments in comprehensive assessments within such patient cohorts.…”

Association between cardiovascular diseases and dementia among various age groups: a population-based cohort study in older adults

“…Accordingly, the observed decreasing risk of CV risk factors or diseases for incident dementia with increasing age might be due to the fact that our studied outcome was all-cause dementia and that the presence of multiple pathologies, rather than vascular dementia on its own, seems to be involved in the development as age increase. Fifth, we should have been taking in account the CV risk level in the risk prediction of dementia with longitudinal data since, the improvement of CV modifiable risk was associated with a reduction of dementia risk 51 – 53 . Finally, we did not take in account the impact of level adherence of CV medication.…”