Cardiovascular risk factors and accelerated cognitive decline in midlife The CARDIA Study
Cardiovascular risk factors and accelerated cognitive decline in midlife The CARDIA Study
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DOI：
10.1212/wnl.0000000000010078
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发表时间：
2020-08-18
期刊：
影响因子：
9.9
通讯作者：
Reis, Jared P.
中科院分区：
文献类型：
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作者：
Yaffe, Kristine;Bahorik, Amber L.;Reis, Jared P.
目的越来越多的证据支持中年心血管危险因素（cvrf）与痴呆风险之间的关联，但对于cvrf是否影响中年认知的了解较少。我们研究了cvrf与中年认知能力下降之间的关系。方法在2675名黑人和白人中年人（平均年龄50.2±3.6岁，女性57%，黑人45%）中，我们测量了基线时的cvrf：高血压（31%）、糖尿病（11%）、肥胖（43%）、高胆固醇（9%）和当前吸烟（15%）。我们在基线和5年后进行记忆、执行功能和处理速度的认知测试。使用逻辑回归，我们估计了cvrf与复合认知评分上认知能力加速下降（种族特异性下降=平均变化1.5 SD）的关联。结果5% （n = 143）的参与者在5年内认知能力加速下降。多变量校正后，吸烟、高血压和糖尿病与加速衰退的可能性增加相关（调整比值比[AOR] 1.65, 95%可信区间[CI] 1.00-2.71；调整比值比[AOR] 1.87, 95% CI 1.26-2.75；调整比值比[AOR] 2.45, 95% CI 1.54-3.88），而肥胖和高胆固醇与衰退风险无关。这些结果在按种族分层时是相似的。随着cvrf数量的增加（1-2个cvrf: AOR 1.77, 95% CI 1.02-3.05; >= 3个cvrf: AOR 2.94, 95% CI 1.64-5.28）和Framingham冠心病风险评分>= 10 (AOR 2.29, 95% CI 1.21-4.34)，加速下降的可能性也增加。结论中年cvrf，尤其是高血压、糖尿病和吸烟，与中年认知能力下降加速有关。这些结果确定了防止中年认知能力下降的潜在可修改目标，并强调了对认知功能和衰老的生命历程方法的必要性。
ObjectiveIncreasing evidence supports an association between midlife cardiovascular risk factors (CVRFs) and risk of dementia, but less is known about whether CVRFs influence cognition in midlife. We examined the relationship between CVRFs and midlife cognitive decline.MethodsIn 2,675 black and white middle-aged adults (mean age 50.2 +/- 3.6 years, 57% female, 45% black), we measured CVRFs at baseline: hypertension (31%), diabetes mellitus (11%), obesity (43%), high cholesterol (9%), and current cigarette smoking (15%). We administered cognitive tests of memory, executive function, and processing speed at baseline and 5 years later. Using logistic regression, we estimated the association of CVRFs with accelerated cognitive decline (race-specific decline =1.5 SD from the mean change) on a composite cognitive score.ResultsFive percent (n = 143) of participants had accelerated cognitive decline over 5 years. Smoking, hypertension, and diabetes mellitus were associated with an increased likelihood of accelerated decline after multivariable adjustment (adjusted odds ratio [AOR] 1.65, 95% confidence interval [CI] 1.00-2.71; AOR 1.87, 95% CI 1.26-2.75; AOR 2.45, 95% CI 1.54-3.88, respectively), while obesity and high cholesterol were not associated with risk of decline. These results were similar when stratified by race. The likelihood of accelerated decline also increased with greater number of CVRFs (1-2 CVRFs: AOR 1.77, 95% CI 1.02-3.05; >= 3 CVRFs: AOR 2.94, 95% CI 1.64-5.28) and with Framingham Coronary Heart Disease Risk Score >= 10 (AOR 2.29, 95% CI 1.21-4.34).ConclusionsMidlife CVRFs, especially hypertension, diabetes mellitus, and smoking, are common and associated with accelerated cognitive decline at midlife. These results identify potential modifiable targets to prevent midlife cognitive decline and highlight the need for a life course approach to cognitive function and aging.