Midlife heart health potential risk factor for early cognitive decline in Black women

Key takeaways:

• Lower CV health scores at midlife may be tied to early signs of cognitive decline among Black women.
• The same was not observed in white women, whose processing speed did not appear affected by midlife CV health.

Less than optimal heart health at midlife was associated with a decline in the mental processing speed of Black women, but not white women, researchers reported.

Adherence to the American Heart Association’s Life’s Essential 8 may be a method to prevent early cognitive decline among Black women, according to a study published in the Journal of the American Heart Association.

“Take care of your heart, and it will benefit your brain,” Imke Janssen, PhD, professor of family and preventive medicine at Rush University Medical Center, said in a press release. “Better cardiovascular health in women in their 40s is important to prevent later-life Alzheimer’s disease, dementia and to maintain independent living.”

To better understand the impact of CV health score on change in cognition for women at midlife, Janssen and colleagues evaluated data from 402 white and 363 Black women from the Chicago site of the Study of Women’s Health Across the Nation (mean age, 47 years).

CV health z score was calculated using the AHA’s Life’s Essential 8 scoring algorithm, taking into account BP, BMI, glucose, non-HDL, smoking, physical activity, diet and sleep. Cognition was measured as processing speed and working memory assessed annually or biennially during an average of 9.8 years.

At baseline, mean processing speed score (55.9 vs. 60.3; P < .001), working memory score (6.3 vs. 7.1; P < .001) and CV health score (58.2 vs. 67.8; P < .001) were all lower among midlife Black women compared with white women.

The lower average CV health score among Black compared with white women was primarily driven by lower scoring for physical activity, sleep, BMI, glucose and BP.

Black women also reported slightly fewer mean years of education than white women (15.5 vs. 15.9 years; P = .007).

In a fully adjusted hierarchical model that included the three-way interaction of race, CV health z score and time, the researchers observed a significant difference by race in the association between CV health and decline in processing speed (0.005; 95% CI, 0.019 to 0.01; P < .05). Janssen and colleagues reported that lower CV health was associated with an approximately 10% decline in processing speed over time in Black women, but with no change in white women.

Moreover, there was no significant change in working memory in the overall cohort, regardless of race or CV health score.

“We were surprised that we did not find results like those of past studies, which showed cognitive decline in Black and white men and women, and found cardiovascular health to be more important for white adults rather than people in Black subgroups,” Janssen said in the release. “We think these differences are due to the younger age of our participants, who began cognitive testing in their mid-40s, whereas previous studies started with adults about 10 to 20 years older. The next step is a clinical trial to confirm whether optimizing heart health in Black women at midlife may slow cognitive aging, maximize independence and reduce racial inequities in dementia risk.”

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