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Can good cardiovascular health protect against cognitive decline?

Can good cardiovascular health protect against cognitive decline?

Strategies aimed at reducing the incidence of cardiovascular disease have traditionally focused on using medications to prevent cardiovascular disease in people already showing high levels of risk factors. In 2010, the American Heart Association introduced the concept of cardiovascular health, and set a goal of improving cardiovascular health by 20% by the year 2020 [1]. This new prevention initiative focuses on lifestyle interventions aimed at improving cardiovascular health across the lifespan, with the goal of reducing risk for all people, including those not yet showing clinical signs of health problems. Recent studies indicate that this lifespan prevention approach toward cardiovascular health may also reduce the risk for dementia.

Cardiovascular health is defined by a set of seven factors [2].  Individuals can be classified as poor, intermediate, or ideal in terms of how well they meet the recommended guidelines for each factor.  Ideal cardiovascular health is characterized by:

1) being a non-smoker
2) not being overweight or obese
3) getting at least 150 minutes of moderate physical activity per week
4) not having high total cholesterol levels (ideally lower than 200 mg/dL)
5) not having high blood pressure (ideally lower than 120/80 mm Hg)
6) not having high fasting glucose levels (ideally lower than 100 mg/dL)
7) eating a healthy diet

The healthy diet score is based on recommendations associated with the DASH diet, which emphasizes diets rich in fruits, vegetables, whole grains and fish, while being low in salt, sugary drinks, trans fat, and saturated fat [1].  However, the authors of the cardiovascular health guidelines acknowledge that since diet represents a mix of multiple factors, and that people have different dietary needs, there is not necessarily a single best diet that will maximize health for all people.

Less than 1% of people in the US meet all seven criteria for ideal cardiovascular health [3], and according to an international study, only about 3% meet at least six criteria, making the US a country with one of the lowest rates of ideal cardiovascular health [4]. While middle and older age adults typically only meet the ideal criteria for 2 or 3 factors, young adults still only manage to meet ideal criteria for 3 to 5 factors, indicating that there is ample room for improvement at all stages across the lifespan [3].

The majority of cardiovascular disease events occur in people in the intermediate category with only moderate levels of risk factors, because the majority of the population falls into this intermediate range [1]. The evidence suggests that even small improvements on individual factors could have a large impact over time. For example, even if someone has difficulty meeting the recommended level, there are still benefits to increasing physical activity at a lower level. Better cardiovascular health is associated with lower risk for dementia, disability, and mortality.

A study in 272 male, middle aged twin pairs found that higher scores of cardiovascular health were associated with better performance on cognitive tasks assessing memory and cognitive flexibility, which is the ability to switch between mental tasks [5]. This relationship may be related to the finding that people with better fitness of the heart and lungs maintain more of their brain volume as they age, particularly in areas associated with memory and cognitive flexibility, such as the hippocampus and frontal cortex [6]. While the twin study failed to find a strong genetic influence between cardiovascular health and cognitive decline, it did find that early life environmental factors, such as nutrition and access to a good education, had a strong influence [5]. This supports the notion that lifestyle-based efforts should be implemented throughout life to offer the strongest protection against both cardiovascular disease and dementia, and reinforces that it is never too early to start protecting your heart or brain.

  1. Lloyd-Jones DM, Hong Y, Labarthe D et al. (2010) Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction. Circulation  121, 586-613.
  2. The American Heart Association. 2020 Impact Goal: Life's Simple 7.
  3. Shay CM, Ning H, Allen NB et al. (2012) Status of cardiovascular health in US adults: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2003-2008. Circulation  125, 45-56.
  4. Younus A, Aneni EC, Spatz ES et al. (2016) A Systematic Review of the Prevalence and Outcomes of Ideal Cardiovascular Health in US and Non-US Populations. Mayo Clinic Proceedings  91, 649-670.
  5. Kulshreshtha A, Goetz M, Alonso A et al. (2019) Association Between Cardiovascular Health and Cognitive Performance: A Twins Study. J Alzheimers Dis  71, 957-968.
  6. Wittfeld K, Jochem C, Dörr M et al. (2020) Cardiorespiratory Fitness and Gray Matter Volume in the Temporal, Frontal, and Cerebellar Regions in the General Population. Mayo Clinic Proceedings  95, 44-56.

Betsy Mills, PhD, is Senior Program Manager of Aging and Alzheimer’s Prevention at the Alzheimer’s Drug Discovery Foundation. She earned her doctorate in neuroscience at Johns Hopkins University School of Medicine, where she studied the role of glial cells in the optic nerve and their contribution to neurodegeneration in glaucoma; and completed a Postdoctoral fellowship at the University of Michigan, where she worked to uncover genes that could promote retina regeneration. Dr. Mills has a strong passion for community outreach, and served as program presenter with the Michigan Great Lakes Chapter of the Alzheimer's Association to promote dementia awareness.

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