Cardiovascular risk factors in adolescence and adulthood and late‐life cognition: Study of Healthy Aging in African Americans (STAR)

Abstract

AbstractBackgroundMid‐life cardiovascular disease (CVD) risk factors are associated with late‐life cognition, but it is unknown whether CVD risk factors before mid‐life affect cognition. African Americans develop CVD risk factors at younger ages compared to other racial/ethnic groups. We examined the relationship between CVD during adolescence and adulthood (early through mid‐life) with late‐life cognition in the Study of Healthy Aging in African Americans (STAR).MethodSTAR evaluated cognitive aging in African Americans (N=676) and enrolled approximately equal proportions of participants ages 50‐64 and 65+. Participants were long‐term Kaiser Permanente Northern California members and completed Multiphasic Health Check‐ups (MHC) from 1964‐1985 at which body mass index (BMI), blood pressure, blood glucose, and serum total cholesterol were measured. At STAR baseline (2019), education, income, and cognition were assessed. Cognitive domains of verbal episodic memory, semantic memory, and executive function were measured using the Spanish and English Neuropsychological Assessment Scales (SENAS). Domain scores were z‐standardized and averaged to create a global z‐score. We used linear regression to analyze the association between adolescent and adulthood CVD risk factors with cognition, adjusted for age, gender, and education.ResultAt MHC, participants were adolescents (N=333; ages 14‐25) and adults (N=343; ages 26‐56). Mean age at cognitive assessments was 68 (SD=9) years. Being overweight/obese did not predict late‐life cognition regardless of age at MHC. Hypertension [pooled β=‐0.18 (‐0.33, ‐0.03)] and diabetes [pooled β=‐0.69 (‐1.15, ‐0.24)] were associated with worse cognition among both MHC age groups. Hypercholesteremia was associated with worse cognition in adults at MHC, but not adolescents [Adults β=‐0.22 (‐0.40, ‐0.05) vs. Adolescents β=0.02 (‐0.16, 0.21); interaction p=0.03]. Having 2+ cardiovascular risk factors predicted worse cognition for both MHC age groups [pooled β=‐0.24 (‐0.40, ‐0.08)]. Looking at cognitive domains separately, associations were consistent for executive function and verbal memory, but non‐significant for semantic memory.ConclusionHypertension, diabetes, or a combination of multiple cardiovascular risk factors at adolescence and adulthood were common and associated with worse late‐life cognition. Hypercholesteremia in adulthood, but not adolescence, was associated with worse cognition. Results suggest that cardiovascular risk as early as adolescence may influence late‐life brain health in African Americans.