2 recently published scientific publications for EpiAgeing
- Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies. van der Heide FCT, Valeri L, Dugravot A, Danilevicz I, Landre B, Kivimaki M, Sabia S, Singh-Manoux A. EClinicalMedicine. 2024 Mar 14;70:102539. doi: 10.1016/j.eclinm.2024.102539. eCollection 2024 Apr. PMID: 38516105 Free PMC article.
The contribution of modifiable risk factors to social inequalities in dementia remains unclear. We aimed to quantify the role of cardiovascular health factors, assessed using Life’s Essential 8 (LE8) score (smoking, physical activity, diet, body mass index, blood pressure, fasting blood glucose, lipid levels, sleep duration), in mediating social inequalities in incidence of dementia and, for comparison, in incidence of stroke, coronary heart disease, and mortality.
Counterfactual mediation analysis was used on data from two longitudinal studies, Whitehall II and UK Biobank with a median follow-up of 31.7 and 13.5 years respectively. We show that a third of the excess risk of dementia in socially disadvantaged groups can be explained by Life’s Essential 8 score. The present study is the largest to date and covers the longest follow-up period. Novel is the quantitative insight into the contributions of a comprehensive cluster of cardiovascular health factors in midlife, prior even to the preclinical phase of dementia. As expected, the contribution of Life’s Essential 8 to social inequalities in cardiovascular diseases and total mortality was larger than that for dementia, and similar to that in the literature, providing confidence in the findings on dementia.
Promotion of cardiovascular health in midlife may contribute to reducing social inequalities in risk of dementia, in addition to cardiovascular diseases and all-cause mortality. These findings are particularly relevant for countries that are developing nationwide action plans for the prevention of dementia.
- Age at cardiovascular disease onset, dementia risk, and the role of lifestyle factors. van Gennip ACE, van Sloten TT, Fayosse A, Sabia S, Singh-Manoux A. Alzheimers Dement. 2024 Mar;20(3):1693-1702. doi: 10.1002/alz.13562. Epub 2023 Dec 12. PMID: 38085549
Although there is evidence for an association between cardiovascular disease (CVD) and dementia, the importance of age at CVD onset for dementia and the extent to which CVD-associated dementia risk may be mitigated by multifactorial lifestyle modification after CVD diagnosis remains largely unknown.
The main finding of this study on 10,216 participants of the Whitehall II study using a follow-up of 32 years is that onset of CVD in midlife (before 60 years) but not in late life is associated with a higher risk of dementia. There was no evidence of a dose–response relationship between age at CVD onset and the risk of dementia; the association between CVD and incident dementia appears to be driven by individuals with CVD before age 60. We also found that in individuals with CVD the risk of dementia is lower if a greater number of lifestyle factors, measured after the CVD event, are at recommended levels.
To address the burden of old-age dementia due to increases in life expectancy, our findings highlight the importance of prevention of early-onset CVD, and lifestyle modification as a secondary prevention mechanism in those with CVD. Further research is needed to develop policies for primary CVD prevention in midlife or earlier to mitigate dementia risk at older ages. In addition, trials are needed to determine whether lifestyle interventions in people with CVD reduces their dementia risk at older ages.
