Life's Essential 8 and midlife trajectories in cognition and brain health: The CARDIA study

Abstract

Introduction: Poor cardiovascular health (CVH) is linked to Alzheimer's disease and dementia; however, its association with neurocognitive trajectories earlier in life remains underexplored.

Methods: We included 3224 participants with information on CVH at early midlife (mean age 45.0 ± standard deviation 3.4) an cognitive assessments, and neuroimaging 5, 10, and 15 years later including white matter hyperintensities (WMHs), total gray matter (GM), and hippocampal volume. CVH was operationalized according to the American Heart Association's (AHA) "Life's Essential 8" (LE8) guidelines. The association between LE8 and cognitive and neuroimaging measures was examined using mixed linear regression adjusting for age, sex, race, and education.

Results: Worse LE8 score was associated with steeper decline in cognition, higher accumulation of WMHs, and steeper decline in total GM and hippocampal volume.

Discussion: Poor CVH is related to accelerated brain aging across midlife, highlighting the need to screen for and improve CVH earlier to prevent adverse cognitive outcomes.

Highlights: Poor cardiovascular health in early midlife is associated with faster decline in cognition across 10 years overall and in specific domains. Poor and intermediate cardiovascular health was associated with higher accumulation of white matter hyperintensities across midlife. Poor cardiovascular health was associated with faster atrophy in total gray matter volume and hippocampal volume.

Keywords: cardiovascular; cognition; cohort study; longitudinal; magnetic resonance imaging; midlife; neuroimaging.

FIGURE 1

Life's Essential 8 risk factors and level and change in cognitive tests over 10 years (n = 3224^a). Adjusted for age, sex, education, and race. Ideal n = 562, (17.4%); Intermediate n = 2179, (67.6%); n = 483, (15.0%). ^a n = 1322 had all three cognitive assessments, n = 1336 had two, and n = 548 had one assessment.

FIGURE 2

Life's Essential 8 risk factors and change in brain measures over 10 years (n = 1022^a). Adjusted for age, sex, education, race, and intracranial volume. Ideal n = 198, (19.4%); Intermediate n = 693, (67.8); Poor n = 131, (12.8%). ^a n = 334 had all three MRIs, n = 279 had two MRIs, and n = 409 had one MRI exam. MRI, magnetic resonance imaging.

FIGURE 3

The association of individual Life's Essential 8 factor scores and 5‐year change in the composite cognitive score and brain measures. Reference group: ideal score of each individual factor. Model adjusted for age, sex, education, race. Models with MRI outcomes were additionally adjusted for intracranial volume. BMI, body mass index; BP, blood pressure; CI, confidence interval; DSST, Digit Symbol Substitution Test; GMV, gray matter volume; HPV, hippocampal volume; MRI, magnetic resonance imaging; RAVLT, Rey Auditory Verbal Learning Test; WMH, white matter hyperintensities.