Abstract P202: Early To Midlife Smoking Trajectories And Cognitive Function In Middle Aged Us Adults: The Coronary Artery Risk Development In Young Adults Study

Abstract

Introduction: Smoking starts in early adulthood and persists throughout the lifecourse, but the association between these trajectories and midlife cognition remains unclear. We assessed the hypothesis that individuals with a heavy smoking trajectory from early adulthood to midlife would be more likely to demonstrate poor cognition at midlife. Methods: We studied 3364 participants (mean age: 50.1±3.6, 56% female, 46% black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking trajectories were derived in latent class analysis among 1638 ever smokers based on smoking measures every 2-5 years from baseline (age 18-30, 1985-86) through Year 25 (2010-11). We estimated poor cognition using cognitive domain scores ≥1SD below the mean from tests of processing speed (Digit Symbol Substitution Test), executive function (Stroop) and memory (Rey Auditory Verbal Learning Test) at Year 25. Using adjusted logistic regression models, we examined the odds associated with poor midlife cognition and smoking trajectories (reference never smokers, n=1726) from early adulthood to midlife. Results: Five smoking trajectories emerged over 25-years: quitters (20%, 20/100), and minimal stable (40%, 40/100), moderate stable (20%, 20/100), heavy stable (15%, 15/100) and heavy declining smokers (5%, 5/100). As shown in the Figure, heavy stable smokers demonstrated poor cognition on all 3 domains compared to never smokers. Compared to never smokers, both heavy declining and moderate stable smokers exhibited slower processing speed, and heavy declining smokers additionally demonstrated poor executive function. For minimal stable smokers and quitters, no association was observed. Conclusions: In conclusion, we observed a dose-dependent association between early to midlife smoking and cognitive health risk at midlife. Our results underscore the cognitive health risk of moderate and heavy smoking trajectories in early and midlife periods and highlight the potential benefits of quitting, even in midlife.