Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-Life Cognition: Study of Healthy Aging in African Americans.
Level 3 - non-randomized controlled study
Longitudinal cohort study linking historical health checkup data to late-life cognitive testing
PubMed 34387334 · doi:10.1093/gerona/glab143
What was done
The Study of Healthy Aging in African Americans (STAR) examined the association between early-to-midlife cardiovascular risk factors (CVRFs) and late-life cognitive performance in 764 Black Americans aged ≥50 (mean age = 69, SD = 9, range = 53–95). Measurements of body mass index, blood pressure, glucose, and total cholesterol were obtained from historical Multiphasic Health Checkups (MHC; 1964–1985), when participants were adolescents (age 12–20; 22%), young adults (age 21–34; 62%), or midlife adults (age 35–56; 16%). At STAR baseline (2018–2019), executive function, verbal episodic memory, and semantic memory were evaluated via the Spanish and English Neuropsychological Assessment Scales. Linear regression models adjusted for demographics and years elapsed since MHC.
What was found
At MHC, 36% of participants had 1 CVRF and 26% had ≥2. Overweight/obesity was not associated with late-life cognition. Hypertension was associated with worse executive function (β = -0.14 [95% CI: -0.28, -0.0003]) and verbal episodic memory (β = -0.22 [95% CI: -0.37, -0.07]) compared to normotension. Diabetes was associated with worse executive function (β = -0.43 [95% CI: -0.83, -0.03]). Having ≥2 CVRFs versus 0 was associated with worse executive function (β = -0.19 [95% CI: -0.34, -0.03]) and verbal episodic memory (β = -0.25 [95% CI: -0.41, -0.08]). By life stage: adolescent hypertension was associated with worse late-life executive function (β = -0.39 [95% CI: -0.67, -0.11]); young adult hypertension was associated with lower verbal episodic memory (β = -0.29 [95% CI: -0.49, -0.09]); and midlife hyperlipidemia was associated with lower verbal episodic memory (β = -0.386 [95% CI: -0.70, -0.02]).
Why it matters
This study demonstrates that cardiovascular risk factors emerging as early as adolescence and young adulthood are independently linked to poorer late-life executive function and episodic memory in Black Americans, underscoring the importance of life-course vascular health.
Limits
The study is susceptible to survival bias, as only individuals surviving to age 50 and beyond were assessed. Exposure was measured at discrete historical time points rather than continuously over the life course, and interval treatments, lifestyle changes, or midlife interventions were not detailed in the abstract.
Cited by
- supports Cumulative exposure to elevated blood pressure from a young age significantly increases the risk of dementia later in life by causing damage to the small vessels of the brain.