Adherence to AHA ideal CVHealth advice protects against vascular brain injury

Pase MP, Beiser A, Enserro D, et al.
Stroke 2016;47:1201-1206

Background

The prevalence of dementia is anticipated to double every 20 years, thus reaching globally 115 million by 2050, and producing yearly healthcare costs of over 1 trillion just in the US [1,2]. There is strong evidence supporting that vascular risk factors, such as physical inactivity, smoking, hypertension, and obesity, are predictors of stroke and cerebrovascular disease, and are associated with the risk to develop cognitive decline and dementia [3]. For example, it is estimated that one third of all Alzheimer disease cases might be due to such modifiable risk factors [4].
AHA recommends the use of a simple ideal cardiovascular health (CVH) metric, which pools together 7 CVH behaviours and factors, with higher scores predictive of less heart disease and stroke [5-7]. The 7 CVH behaviours and factors include nonsmoking status, ideal body mass index, regular physical activity, healthy diet, optimum blood pressure, cholesterol, and fasting blood glucose [8].
However, the ideal CVH score has not been examined with regard to incident dementia and brain atrophy, although preventing dementia is one of the biggest challenges of our aging society.
This study evaluates whether higher adherence to AHA ideal CVH guidelines is associated with a lower risk of incident stroke, incident dementia, cognitive decline, and brain atrophy in 2750 participants of the Framingham Heart Study Offspring cohort [9]. The metric assigns 1 point for each factor at its ideal status, and mean ideal CVH score at baseline ranged from 3.1 to 3.3. 6.9 Years (SD: 0.9) elapsed between quantification of recent and remote ideal CVH scores.

Main results

• The 10-year incidence of events was: stroke: 87 (3%), all-cause dementia: 84 (6%), Alzheimer disease: 64 (5%), vascular dementia: 14 (1%). The mean time from baseline to incident all-cause dementia onset was 5.6 years (SD: 2.7 years).

• Recent ideal CVH was significantly associated with stroke (HR: 0.80; 95% CI: 0.67–0.95),), vascular dementia (HR: 0.49; 95% CI: 0.30–0.81).
  With regard to change in cognition and markers of brain atrophy, recent ideal CVH was significantly associated with frontal brain atrophy (β of frontal brain volume: 0.31±0.10; P=0.003), and with global decline and in tasks measuring visual memory and reasoning (P<0.05).
• Remote ideal CVH was significantly associated with stroke (HR: 0.79; 95% CI: 0.66–0.94), all-cause dementia (HR: 0.80; 95% CI: 0.67–0.97), Alzheimer disease (HR: 0.79; 95% CI: 0.64–0.98) and vascular dementia (HR: 0.49; 95% CI: 0.30–0.81).
  Remote ideal CVH was significantly associated with total brain volume (β of total brain volume: 0.19±0.08; P=0.02), and with global decline and cognitive decline on tasks measuring visual memory and reasoning (P<0.05).
• An additional 14-point ideal CVH score was created that used 3 levels for each variable (poor, intermediate, ideal). The results were similar with the exception that the remote 14-point ideal CVH score was not associated with clinical Alzheimer disease, nor with vascular dementia  

Conclusion

In 2750 community-based participants of the Framingham Heart Study Offspring cohort, adherence to the AHA ideal CVH factors and behaviours, protected against all forms of vascular brain injury, lessening the burden of cognitive decline, stroke, brain atrophy, and dementia, including Alzheimer disease.

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