Cardiovascular health metrics from mid- to late-life and risk of dementia: A population-based cohort study in Finland

Abstract

Background: Very few studies have explored the patterns of cardiovascular health (CVH) metrics in midlife and late life in relation to risk of dementia. We examined the associations of composite CVH metrics from midlife to late life with risk of incident dementia.

Methods and findings: This cohort study included 1,449 participants from the Finnish Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study, who were followed from midlife (baseline from1972 to 1987; mean age 50.4 years; 62.1% female) to late life (1998), and then 744 dementia-free survivors were followed further into late life (2005 to 2008). We defined and scored global CVH metrics based on 6 of the 7 components (i.e., smoking, physical activity, and body mass index [BMI] as behavioral CVH metrics; fasting plasma glucose, total cholesterol, and blood pressure as biological CVH metrics) following the modified American Heart Association (AHA)'s recommendations. Then, the composite global, behavioral, and biological CVH metrics were categorized into poor, intermediate, and ideal levels. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Data were analyzed with Cox proportional hazards and the Fine and Gray competing risk regression models. During the follow-up examinations, dementia was diagnosed in 61 persons in 1998 and additional 47 persons in 2005 to 2008. The fully adjusted hazard ratio (HR) of dementia was 0.71 (95% confidence interval [CI]: 0.43, 1.16; p = 0.174) and 0.52 (0.29, 0.93; p = 0.027) for midlife intermediate and ideal levels (versus poor level) of global CVH metrics, respectively; the corresponding figures for late-life global CVH metrics were 0.60 (0.22, 1.69; p = 0.338) and 0.91 (0.34, 2.41; p = 0.850). Compared with poor global CVH metrics in both midlife and late life, the fully adjusted HR of dementia was 0.25 (95% CI: 0.08, 0.86; p = 0.028) for people with intermediate global CVH metrics in both midlife and late life and 0.14 (0.02, 0.76; p = 0.024) for those with midlife ideal and late-life intermediate global CVH metrics. Having an intermediate or ideal level of behavioral CVH in both midlife and late life (versus poor level in both midlife and late life) was significantly associated with a lower dementia risk (HR range: 0.03 to 0.26; p < 0.05), whereas people with midlife intermediate and late-life ideal biological CVH metrics had a significantly increased risk of dementia (p = 0.031). Major limitations of this study include the lack of data on diet and midlife plasma glucose, high rate of attrition, as well as the limited power for certain subgroup analyses.

Conclusions: In this study, we observed that having the ideal CVH metrics, and ideal behavioral CVH metrics in particular, from midlife onwards is associated with a reduced risk of dementia as compared with people having poor CVH metrics. Maintaining life-long health behaviors may be crucial to reduce late-life risk of dementia.

Fig 1. Flowchart of the study population.

*The analytical sample 1 was used for analyzing the association between midlife CVH metrics and late-life risk of dementia detected both in the 1998 and 2005 to 2008 examinations. The analytical sample 2 was used for analyzing the association between late-life CVH metrics measured in the 1998 examination as well as the patterns of CVH metrics from midlife to late life (1998) with risk of dementia detected in the 2005 to 2008 examination. CAIDE, Cardiovascular Risk Factors, Aging, and Dementia; CVH, cardiovascular health.

Fig 2. The HR (95% CI) of dementia associated with the joint patterns of midlife and late-life CVH metrics: A, global CVH metrics; B, behavioral CVH metrics; C, biological CVH metrics.

HR (95% CI) was derived from the Cox proportional hazards models controlling for age, sex, education, APOE ε4 allele, and cardiovascular disease in midlife. *p < 0.05. APOE, apolipoprotein E; CVH, cardiovascular health; CI, confidence interval; HR, hazard ratio; IM, intermediate; NA, not available; n/N, the number of dementia cases/number of participants.