Cardiovascular health may improve long-term brain functioning

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Adults with more ideal cardiovascular health factors had better brain processing speed at initial assessment and less of a decline in processing speed, memory and executive functioning over time, according to a prospective multiethnic population-based study.

Lead researcher Hannah Gardener, ScD, of the University of Miami, and colleagues published their results online in the Journal of the American Heart Association on March 16.

The researchers used the following seven health factors that the American Heart Association (AHA) has identified as being largely responsible for cardiovascular disease morbidity and mortality: smoking, body mass index (BMI), physical activity, diet, blood pressure, total cholesterol and fasting glucose. By reducing those risk factors, the AHA hopes to decrease deaths from cardiovascular disease and stroke by 20 percent by 2020.

For this analysis, the researchers evaluated 1,033 participants from the Northern Manhattan Study, a prospective, population-based cohort trial that determined risk factors for stroke and other outcomes. Participants were eligible if they had never had a stroke, were older than 40 years old and lived in northern Manhattan for at least three months in a household with a telephone.

Northern Manhattan, which is located in New York City, has a diverse population: 63 percent of residents are Hispanic, 20 percent are non-Hispanic black and 15 percent are non-Hispanic white.

The researchers classified the seven risk factors as ideal or not ideal. Participants were classified as ideal if they never smoked or quit for at least a year; had a BMI of less than 25 kg/m2; had at least 150 minutes per week of moderate intensity exercise or at least 75 minutes per week of vigorous intensity exercise; had four to five healthy components based on five health dietary metrics; had untreated total cholesterol of less than 200 mg/dL; had untreated blood pressure of less than 120/80 mm Hg; and untreated fasting plasma glucose of less than 100 mg/dL.

Research assistants conducted the neuropsychological battery of tests in a quiet room.

Of the participants, 65 percent were Hispanic, 19 percent were black and 16 percent were white. The mean age was 72 years old. After approximately six years, 722 of the participants underwent follow-up testing on the ideal cardiovascular health factors and neuropsychological testing.

The researchers said the positive association between ideal cardiovascular health factors and brain processing speed at initial assessment persisted even after controlling for MRI markets of subclinical vascular damage. The association was strongest for ideal BMI, lack of smoking and ideal fasting glucose.

The study had a few limitations, according to the authors, including that it did not include all participants from the Northern Manhattan Study. The participants in this analysis were younger, slightly healthier and more likely to be insured, have hypercholesterolemia and have completed high school compared with the entire study population. They were also less likely to be obese, smoke and have diabetes.

In addition, some participants did not undergo a follow-up cognitive assessment. Further, the researchers noted unmeasured risk factors for cognitive impairment may have been a potential source of bias and that associations observed in the study may be due to chance.

“The results of this study suggest that achievement of the AHA’s ideal [cardiovascular health] metrics may have benefits for brain health in addition to preventing strokes and myocardial infarctions, even among elderly individuals, underscoring the importance of public health initiatives aimed to better control these seven factors,” the researchers wrote. “The current study provides support for future studies assessing the value of routine assessment and treatment of these health factors by clinicians with the goal of reducing vascular cognitive impairment. As the U.S. population ages, and the number of people at risk for cognitive impairment grows, the public health implications of targeting these modifiable risk factors will be substantial.”