Early Adult to Midlife Cardiovascular Risk Factors and Cognitive Function
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Background—: Studies have linked midlife 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 middle adulthood and cognitive function at midlife. Methods and Results—: In a prospective study of 3381 adults (age, 18–30 years at baseline) with 25 years of follow-up, we assessed cognitive function at year 25 (2010–2011) with the Digit Symbol Substitution Test, Stroop Test, and Rey Auditory Verbal Learning Test analyzed with standardized z scores. The primary predictor was 25-year cumulative exposure estimated by areas under the curve for resting systolic and diastolic blood pressures, fasting blood glucose, and total cholesterol. Higher cumulative systolic and diastolic blood pressures and fasting blood glucose were consistently associated with worse cognition on all 3 tests. These associations were significant primarily for exposures above recommended guidelines; cognitive test z scores were between 0.06 and 0.30 points less, on average, for each 1-SD increase in risk factor area under the curve after adjustment for age, race, sex, and education ( P <0.05 for all). Fewer significant associations were observed for cholesterol. Conclusions—: Cumulative exposure to CVRFs from early to middle adulthood, especially above recommended guidelines, was associated with worse cognition in midlife. The meaning of this association and whether it warrants more aggressive treatment of CVRFs earlier in life require further investigation.
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The CARDIA study found that cumulative systolic and diastolic blood pressures and fasting glucose were consistently associated with worse cognition.
“The CARDIA study (Coronary Artery Risk Development in Young Adults), for example, showed that cumulative systolic and diastolic BPs and fasting glucose were consistently associated with worse cognition.89”
From Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association (2017) · cites this paper as [89]
Cumulative exposure to cardiovascular risk factors from early to middle adulthood, especially above recommended guideline levels, is associated with worse cognition in midlife.
“Furthermore, in another study, cumulative exposure to cardiovascular risk factors from early to middle adulthood, especially above recommended guideline levels, has been associated with worse cognition in midlife.89”
From Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association (2017) · cites this paper as [89]
Several other study results support the belief that favorable cardiovascular health earlier in life leads to maintenance of cognitive vitality.
“Although cognition was not the primary focus of this publication, several other study results support the belief that favorable cardiovascular health earlier in life leads to maintenance of cognitive vitality.89,174”
From Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association (2017) · cites this paper as [89]
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- Authors
- Yaffe, K., Vittinghoff, E., Pletcher, M. J., Hoang, T. D., Launer, L. J., Whitmer, R. A., Coker, L. H., & Sidney, S.
- Affiliations
- National Institutes of Health (US)
- ORCID
- Venue
- Circulation
- Published
- 2014-04-15
- Volume
- 129
- Issue
- 15
- Pages
- 1560-1567
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC4700881
- OpenAlex
- W2052534047
- Cited by
- 308
- References
- 55
- Citations by year
- 2026: 14 · 2025: 23 · 2024: 23 · 2023: 22 · 2022: 33 · 2021: 32 · 2020: 27 · 2019: 34 · 2018: 16 · 2017: 28 · 2016: 28 · 2015: 18 · 2014: 9 · 2013: 1
- FWCI
- 21.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute on Aging (AG 0005, Z01AG007380)
- National Heart, Lung, and Blood Institute (HHSN268201300028C, HHS-N2-68201300029C, HHSN268201300027C, HHSN268200900041C, HHSN268201300026C, HHS-N2-68201300025C)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- cardiovascular risk factors, cognitive function, cumulative exposure, early adulthood, midlife, blood pressure, fasting blood glucose, total cholesterol, area under the curve, executive function, memory
- MeSH terms
- Adolescent, Adult, Blood Glucose, Blood Pressure, Cardiovascular Diseases, Cholesterol, Cognition, Cognition Disorders, Female, Follow-Up Studies, Heart Failure, Humans, Hypertension, Male, Middle Aged, Myocardial Infarction, Neuropsychological Tests, Predictive Value of Tests, Prospective Studies, Risk Factors, Age Distribution, Stroke, Young Adult, Peripheral Arterial Disease
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