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. 2009 Nov;80(11):1194-201.
doi: 10.1136/jnnp.2009.176818. Epub 2009 Aug 19.

Risk of dementia hospitalisation associated with cardiovascular risk factors in midlife and older age: the Atherosclerosis Risk in Communities (ARIC) study

A Alonso  1 , T H Mosley Jr, R F Gottesman, D Catellier, A R Sharrett, J Coresh
Affiliations

Risk of dementia hospitalisation associated with cardiovascular risk factors in midlife and older age: the Atherosclerosis Risk in Communities (ARIC) study

A Alonso et al. J Neurol Neurosurg Psychiatry. 2009 Nov.

Abstract

Background: Cardiovascular risk factors are associated with a higher risk of developing dementia. Studies in older populations, however, have often failed to show this relationship. We assessed the association between cardiovascular risk factors measured in midlife and risk of being hospitalised with dementia and determined whether this association was modified by age and ethnicity.

Methods: We studied 11 151 participants in the population-based Atherosclerosis Risk in Communities cohort, aged 46-70 (23% African-Americans) in 1990-2, when participants underwent a physical exam and cognitive testing. Hospitalisations with dementia were ascertained through December 2004.

Results: During follow-up, 203 cases of hospitalisation with dementia were identified. Smoking (hazard ratio (HR), 95% CI 1.7, 1.2 to 2.5), hypertension (HR, 95% CI 1.6, 1.2 to 2.2) and diabetes (HR, 95% CI 2.2, 1.6 to 3.0) were strongly associated with dementia, in Caucasians and African-Americans. These associations were stronger when risk factors were measured at a younger age than at an older age. In analyses including updated information on risk factors during follow-up, the HR of dementia in hypertensive versus non-hypertensive participants was 1.8 at age <55 years compared with 1.0 at age 70+ years. Parallel results were observed for diabetes (HR 3.4 in <55, 2.0 in >or=70), smoking (4.8 in <55, 0.5 in >or=70) and hypercholesterolaemia (HR 1.7 in <55, 0.9 in >or=70)

Conclusion: In this prospective study, smoking, hypertension and diabetes were strongly associated with subsequent risk of hospitalisation with dementia, particularly in middle-aged individuals. Our results emphasise the importance of early lifestyle modification and risk factor treatment to prevent dementia.

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Conflict of interest statement

None of the authors have any potential conflict of interest. Alvaro Alonso had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Figure 1
Figure 1
Study participants flow diagram. ARIC: Atherosclerosis Risk in Communities study. CVD: cardiovascular disease * Study participants could meet more than one exclusion criteria
Figure 2
Figure 2
Incidence of hospitalization with dementia by age, sex and race. ARIC study, 1990-2004. Age-adjusted hazard ratio (HR) (95% confidence interval) is 2.5 (1.9, 3.3) for African-Americans vs. whites and 1.0 (0.7, 1.3) for men vs. women.
Figure 3
Figure 3
Hazard ratios of dementia hospitalization by quartiles of cognitive score at exam 2 for the entire sample, and for race and age groups separately. Analyses adjusted for age, sex, race and study center. DWR: Delayed Word Recall Test; DSS: Digit Symbol Substitution Test; WF: Word Fluency Test. P-value for trend estimated for cognitive score as a continuous variable.
Figure 4
Figure 4
Hazard ratios and 95% confidence intervals (CI) of dementia associated with the presence of each cardiovascular risk factor, by age at study exam. Cox proportional hazards model adjusted for age, gender, race, study center, educational level, occupation, cognitive test scores at exam 2 and cardiovascular risk factors. P for trend corresponds to an interaction term between age as a continuous variable and the corresponding risk factor. Smoking: current vs. never smokers. Obesity: >=30 kg/m2 vs. 20-25 kg/m2
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Comment in

  • Vascular risk factors and dementia revisited.
    Debette S, Seshadri S. Debette S, et al. J Neurol Neurosurg Psychiatry. 2009 Nov;80(11):1183-4. doi: 10.1136/jnnp.2009.181289. J Neurol Neurosurg Psychiatry. 2009. PMID: 19864653 Free PMC article. No abstract available.

References

    1. Plassman BL, Langa KM, Fisher GG, et al. Prevalence of dementia in the United States: the Aging, Demographics, and Memory Study. Neuroepidemiology. 2007;29:125–32. - PMC - PubMed
    1. Fitzpatrick AL, Kuller LH, Ives DG, et al. Incidence and prevalence of dementia in the Cardiovascular Health Study. J Am Geriatr Soc. 2004;52:195–204. - PubMed
    1. Hebert LE, Scherr PA, Bienias JL, et al. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60:1119–22. - PubMed
    1. Borenstein Graves A. Alzheimer's disease and vascular dementia. In: Nelson LM, Tanner CM, Van Den Eeden SK, McGuire V, editors. Neuroepidemiology: from principles to practice. New York: Oxford University Press; 2004. pp. 102–30.
    1. Neuropathology Group of the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Lancet. 2001;357:169–75. - PubMed

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