Introduction: The American Heart Association (AHA) has proposed a 7-point Cardiovascular Health (CVH) score as a way of quantifying and promoting ideal CVH. Despite awareness that vascular risk is associated with cognitive decline, this index is yet to be examined with respect to vascular cognitive impairment (VCI) or subclinical brain injury.
Hypothesis: We hypothesize that ideal CVH is associated with a lower risk of VCI, stroke and vascular brain injury on MRI.
Methods: We studied 2,750 stroke- and dementia-free Framingham Offspring Cohort participants (mean age 61±9y; 55%F). Ideal CVH was calculated for participants who attended the 7th exam (1998-2001) by combining 4 ideal health behaviors (nonsmoking, optimal body mass index plus both physical activity and dietary habits at current recommendations) and 3 ideal health factors (total cholesterol, blood pressure and fasting blood glucose all untreated and at optimal levels). We related CVH scores to change in neuropsychological and MRI data over approximately 7 years, and to the incidence of stroke over a median follow-up of 11 years.
Results: In adjusted models, higher ideal CVH predicted a lower risk of incident stroke (HR = 0.83, 95% CI 0.71-0.97), less cognitive decline on tasks measuring visual memory (visual reproductions delayed; β±SE =0.02±0.01, p=0.012) and reasoning (Similarities; β±SE =0.02±0.01, p=0.044) and less decline in frontal brain volume (β±SE = 0.32±0.10, p=0.002). A 1-point higher CVH score reduced the rate of decline in frontal brain volume to that of someone 3.4 years younger. Ideal CVH was not associated with silent brain infarcts or verbal memory.
Conclusion: Ideal CVH predicted stroke and a vascular pattern of cognitive decline. Adherence to the AHA’s ideal health factors and behaviors may protect against vascular cognitive impairment.