The American Heart Association Life's Simple 7 and Incident Cognitive Impairment: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Thacker, Evan L.; Gillett, Sarah; Wadley, Virginia G.; Unverzagt, Frederick W.; Judd, Suzanne E.; McClure, Leslie A.; Howard, Virginia J.; Cushman, Mary

doi:10.1161/jaha.113.000635

Cited by 146 publications

(150 citation statements)

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“…Numerous studies have established that higher numbers of ideal LS7 metrics or higher LS7 scores are strongly associated with favorable outcomes 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. Our results are comparable to the findings of prior studies that have shown an inverse relationship between higher LS7 scores and the incidence of non‐CVD 15, 16, 17, 18, 19. In the ARIC study, Rasmussen‐Torvik et al demonstrated that participants with 6 or 7 ideal metrics had a 51% lower risk of cancer compared with those with 0 to 2 ideal metrics 15…”

Section: Discussionsupporting

confidence: 86%

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Association Between Life's Simple 7 and Noncardiovascular Disease: The Multi‐Ethnic Study of Atherosclerosis

Ogunmoroti

Allen

Cushman

et al. 2016

JAHA

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107

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BackgroundThe American Heart Association introduced the Life's Simple 7 (LS7) metrics to assess and promote cardiovascular health. We examined the association between the LS7 metrics and noncardiovascular disease.Methods and ResultsWe studied 6506 men and women aged between 45 and 84 years, enrolled in the Multi‐Ethnic Study of Atherosclerosis. Median follow‐up time was 10.2 years. Each component of the LS7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and blood glucose) was assigned points, 0 indicates “poor” category; 1, “intermediate,” and 2, “ideal.” The LS7 score, ranged from 0 to 14, was created from the points and categorized as optimal (11–14), average (9–10), and inadequate (0–8). Hazard ratios and event rates per 1000 person‐years were calculated for outcomes based on self‐reported hospitalizations with the International Classification of Diseases, 9th Revision, diagnoses of cancer, chronic kidney disease, pneumonia, deep venous thromboembolism/pulmonary embolism, chronic obstructive pulmonary disease, dementia, and hip fracture. Analyses were adjusted for age, sex, race/ethnicity, income, and education. Overall, noncardiovascular disease event rates were lower with increasing LS7 scores. With the inadequate LS7 score as reference, an optimal score was associated with a decreased risk for noncardiovascular disease events. The hazard ratio for cancer was, 0.80 (0.64–0.98); chronic kidney disease, 0.38 (0.27–0.54); pneumonia, 0.57 (0.40–0.80); deep venous thromboembolism/pulmonary embolism, 0.52 (0.33–0.82), and chronic obstructive pulmonary disease, 0.51 (0.31–0.83).ConclusionsThe American Heart Association's LS7 score identified individuals who were vulnerable to multiple chronic nonvascular conditions. These results suggest that improving cardiovascular health will also reduce the burden of cancer and other chronic diseases.

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Section: Discussionsupporting

confidence: 86%

“…The inverse relationship between ideal CVH and CVD incidence is well documented 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. However, research exploring the association between ideal CVH and non‐CVDs has just begun 15, 16, 17, 18, 19…”

Section: Introductionmentioning

confidence: 99%

Association Between Life's Simple 7 and Noncardiovascular Disease: The Multi‐Ethnic Study of Atherosclerosis

Ogunmoroti

Allen

Cushman

et al. 2016

JAHA

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107

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“…The prospective study design minimized the likelihood of reverse causality as an Our rich data set allowed for adjustment for many important measured confounders. Our definition of cognitive impairment captured a clinically relevant level of impairment and had face validity given the previously reported associations of risk factors with impairment [18,33], however we did not have evaluation for dementia or brain imaging, which are limitations of the study. Follow-up time was relatively short, which could be considered a weakness, but our large sample allowed accumulation of a large number of cases quickly with minimal attrition of participants.…”

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confidence: 99%

N-Terminal Pro-B-Type Natriuretic Peptide and Risk of Future Cognitive Impairment in the REGARDS Cohort

Cushman

Callas

McClure

et al. 2016

JAD

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1 Background: Improved understanding of the etiology of cognitive impairment is needed to develop effective preventive interventions. Higher amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is a biomarker of cardiac dysfunction associated with risk cardiovascular diseases and stroke in apparently healthy people.Objective: To study the association of NT-proBNP with risk of incident cognitive impairment.Methods: The Reasons for Geographic and Racial Differences in Stroke is a national cohort study of 30,239 black and white Americans age 45 and older at baseline, enrolled in 2003-7.Among participants without prebaseline stroke or cognitive impairment, baseline NT-proBNP was measured in 470 cases of incident cognitive impairment and 557 controls. Cases were participants scoring below the 6 th percentile of demographically-adjusted means on at least 2 of 3 serially administered tests (word list learning, word list recall and semantic fluency) over 3.5 years follow-up.Results: Adjusting for age, gender, race, region of residence, education and income there was an increased odds ratio of incident cognitive impairment with increasing NT-proBNP; participants in the 4 th versus 1 st quartile (>127 versus ≤33 pg/ml) had a 1.69-fold increased odds (95% CI 1.11-2.58). Adjustment for cardiovascular risk factors and presence of an apolipoprotein E4 allele had no substantial impact on the odds ratio. Results did not differ by age, race, gender or presence of an apolipoprotein E4 allele.Conclusion: Higher NT-pro-BNP was associated with incident cognitive impairment in this prospective study, independent of atherogenic and Alzheimer's disease risk factors. Future work should clarify pathophysiologic connections of NT-proBNP and cognitive dysfunction.Key Words: Cognition disorders; biomarkers; risk factors; prospective study; Natriuretic peptide, brain 2 IntroductionOver 5 million people in the United States are cognitively impaired, and each year 12% of these will develop dementia [1]. As there are no effective treatments, identification of risk factors for cognitive impairment is crucial to developing prevention strategies [2]. Emerging evidence suggests that cardiovascular risk factors are related to increased risk of dementia [2,3].N-terminal pro-B-type Natriuretic peptide (NT-proBNP) is a marker of cardiac function used in detection and monitoring of congestive heart failure. Higher NT-proBNP is also a risk marker for future stroke, coronary heart disease and atrial fibrillation [4][5][6][7][8][9][10]. Levels are higher with increasing age and in the presence of heart disease, atrial fibrillation and kidney disease [10].Given the similar risk factors for vascular disease and cognitive impairment, and associations of heart failure and Framingham Stroke Risk Scale scores with cognitive impairment [11,12], we hypothesized that higher NT-proBNP would be associated with risk of cognitive impairment.We addressed this hypothesis by studying the association of baseline NT-proBNP with risk of incident cognitive impairment usi...

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“…Participants were considered to have incident cognitive impairment if, over the course of the study, they had no cognitive impairment at the baseline 6-item screener and an impaired score on at least 2 of the other 3 tests during follow-up. 22 Requiring impaired scores in at least 2 of the tests was intended to further select for significant cognitive impairment. The mean follow-up time was 3.4 years.…”

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ABO blood type, factor VIII, and incident cognitive impairment in the REGARDS cohort

et al. 2014

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Objective: To assess the relationships among ABO group, factor VIII (FVIII), and incident cognitive impairment in a large, prospective cohort study of black and white adults in the United States using a nested case-control design.Methods: Incident cognitive impairment was defined using cognitive domain tests over a mean follow-up of 3.4 years. ABO blood group was measured by genotyping in a nested case-control sample of 495 cases with cognitive impairment and 587 controls.Results: Those with blood group AB and those with higher FVIII had an increased risk of cognitive impairment, adjusting for age, race, region, and sex (respective odds ratios 1.82, 95% confidence interval [CI] 1.15-2.90; and 1.24, 95% CI 1.10-1.38 for 40 IU/dL higher FVIII). Mean FVIII was higher in those with blood type AB (142 IU/dL; 95% CI 119-165) compared with O (104 IU/dL; 95% CI 101-107), and FVIII mediated 18% of the association between AB group and incident cognitive impairment (95% CI for mediation 230% to 68%).Conclusions: Blood group AB and higher FVIII were associated with increased incidence of cognitive impairment in this prospective study. The association of blood group AB with incident cognitive impairment was not significantly mediated by FVIII levels. There is a growing understanding that cardiovascular disease (CVD) and cognitive impairment share many common risk factors. Hypertension, 1,2 elevated cholesterol, 3 hyperglycemia, 2,4 and obesity 4,5 are all associated with longitudinal declines in cognitive function and dementia. Higher levels of the hemostatic markers von Willebrand factor (vWF), coagulation factor VIII (FVIII), and D-dimer have also been related to risk of cognitive impairment and dementia. [6][7][8][9] ABO blood group is associated with many forms of CVD, including coronary heart disease (CHD), stroke, and venous thromboembolism. [10][11][12] In general, individuals with blood group O have a reduced risk of CVD.13,14 Non-O blood types are associated with higher levels of vWF and FVIII, procoagulant proteins that circulate as a complex in blood, 11,12 because the ABO antigen affects clearance of vWF.15 Levels of both vWF and FVIII are associated with thrombosis, 16 and were recently linked to dementia risk. 17 A recent report demonstrating an association between blood type AB and stroke risk found that 60% of that association was mediated by differences in FVIII level. 18Although ABO blood group is a CVD risk factor, we are not aware of studies on its relationship with cognitive impairment. In this study, we examined the relationships among ABO group, FVIII, and incident cognitive impairment in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We hypothesized that blood group A, B, or AB would be associated with an increased risk of cognitive impairment relative to group O.

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The American Heart Association Life's Simple 7 and Incident Cognitive Impairment: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Cited by 146 publications

References 24 publications

Association Between Life's Simple 7 and Noncardiovascular Disease: The Multi‐Ethnic Study of Atherosclerosis

Association Between Life's Simple 7 and Noncardiovascular Disease: The Multi‐Ethnic Study of Atherosclerosis

N-Terminal Pro-B-Type Natriuretic Peptide and Risk of Future Cognitive Impairment in the REGARDS Cohort

ABO blood type, factor VIII, and incident cognitive impairment in the REGARDS cohort

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