Cardiovascular Risk and Ethnic Disparities in Cognition among Mexican Americans and Non‐Hispanic Whites: The Health and Aging Brain Study

Abstract

AbstractBackgroundMexican Americans (MAs) may have increased risk for cognitive impairment and greater cardiovascular risk (CVR) compared to non‐Hispanic whites (NHWs). This disproportionate burden of CVR in MAs may be an important driver for ethnic differences in cognitive aging, although population‐based evidence is lacking. As part of the Health and Aging Brain Study, we investigated the contribution of CVR burden to ethnic differences in cognition.MethodsWe studied 1,320 MA and NHW participants without dementia (63% women, 57% MAs) aged 50‐74 years (2017‐2021, mean age 63.7±6.7 years) who underwent a cognitive battery of five tests: Trail Making Test Part A (attention) and B (executive function), Digit Symbol Substitution (processing speed), FAS and Animal Naming (verbal fluency), and Spanish English Verbal Learning Test 30‐minute delay (verbal memory). CVR burden was assessed using the Framingham Risk Score (FRS, range ‐2 to 25 in woman, ‐2 to 19 in men). We used linear regression to assess the association of CVR (intermediate/high: FRS ≥10 vs. low: FRS <10) with cognitive function (z‐standardized) and its contribution to ethnic differences in cognition.ResultsMAs were on average four years younger but have higher FRS (1.8 points; 95% CI 1.5 to 2.2) compared to NHWs. In unadjusted models, intermediate/high CVR was associated with lower cognition in all domains. After adjusting for ethnicity, age, sex, education, and APOE ε4, intermediate/high CVR remained associated with lower cognition in two domains: processing speed (‐0.13, 95% Cl ‐0.23 to ‐0.03) and verbal memory (‐0.13, 95% Cl ‐0.23 to ‐0.03). The strength of the association in MAs was similar to NHW (p >0.05 for interactions by ethnicity). In unadjusted models, intermediate/high CVR explained 4‐6% of ethnic differences in cognition in all domains. Results in multivariable‐adjusted models were similar, although FRS explained a greater portion of the ethnic differences in some domains: 10% in processing speed and 15% in verbal memory.ConclusionCompared to NHWs, MAs had greater CVR burden, which explained some of the ethnic differences in cognition. Efforts to lessen ethnic disparities in cognitive outcomes may benefit from a better understanding, prevention, and management of CVR in a population with growing number of ethnic minorities.