Early Adult to Mid-Life Cardiovascular Risk Factors and Cognitive Function
Background—Studies have linked mid- and late-life cardiovascular risk factors (CVRFs) to cognitive function, yet little is known about CVRF exposure in early adulthood and subsequent cognitive function. In addition, most studies rely on single assessments of CVRFs which may not accurately reflect long-term exposure. We sought to determine the association between cumulative exposure to CVRFs from early to mid-adulthood and cognitive function at mid-life.
Methods and Results—In a prospective study of 3,381 adults (ages 18 to 30 at baseline) with 25 years of follow-up, we assessed cognitive function at Year 25 (2010-11) with the Digit Symbol Substitution Test (DSST), Stroop Test, and Rey Auditory Verbal Learning Test (RAVLT) analyzed with standardized z-scores. The primary predictor was 25 year cumulative exposure estimated by areas under the curve (AUCs) for resting systolic and diastolic blood pressure (SBP, DBP), fasting blood glucose (FBG), and total cholesterol. Higher cumulative SBP, DBP, and FBG were consistently associated with worse cognition on all three tests. These associations were primarily significant for exposures above recommended guidelines; cognitive test z scores were between 0.06 to 0.30 points less, on average, for each SD increase in risk factor AUC, after adjusting for age, race, gender, and education, p<0.05 for all. Fewer significant associations were observed for cholesterol.
Conclusions—Cumulative exposure to CVRFs from early to mid-adulthood, especially above recommended guidelines, was associated with worse cognition in mid-life. The meaning of this association and whether it warrants more aggressive treatment of CVRFs earlier in life requires further investigation.
- Received July 1, 2013.
- Revision received January 13, 2014.
- Accepted January 17, 2014.