American Heart Association Ideal Cardiovascular Health Factors Associated With Cognitive Function

Ideal BMI, lack of smoking, and ideal fasting glucose were the 3 cardiovascular health factors most strongly associated with greater processing speed performance.

In a subanalysis of the Northern Manhattan Study, researchers found that a greater number of American Heart Association (AHA) ideal cardiovascular health (CVH) factors were associated with less decline in cognitive function.

Findings were published in the Journal of the American Heart Association.

Researchers examined the relationship between the ideal CVH factors at enrollment and later cognitive function and decline using linear regression models and adjusting for sociodemographics and MRI brain markers.

The 7 CVH factors determined by the AHA are categorized by ideal vs not ideal. The ideal factors include: smoking status: never or quit >1 year; body mass index (BMI): <25 kg/m2 ; physical activity: ≥150 min/week at moderate intensity, ≥75 min/week at vigorous intensity or equivalent combination; diet: 4 to 5 healthy components based on 5 health dietary metrics (fruits and vegetables, fish, whole grains, low sodium, and low sugar intake); total cholesterol: untreated and <200 mg/dL; blood pressure: untreated and <120/<80 mm Hg; and fasting plasma glucose: untreated and <100 mg/dL.

A total of 1033 participants from the original study underwent repeated neuropsychological (NP) testing (mean interval: 6 ± 2 years), and domain-specific Z-scores were obtained using factor analysis for episodic memory, semantic memory, executive function, and processing speed, based on initial performance and decline over time.

The participants were 39% male, 19% black, 16% white, 65% Hispanic, and were a mean age of 72 ± 8 years. Three percent had 0 ideal CVH factors, 15% had 1 factor, 33% had 2 factors, 30% had 3 factors, 14% had 4 factors, 14% had 5 factors, 1% had 6 factors, and none had all 7 factors.

Ideal BMI, lack of smoking, and ideal fasting glucose were the 3 CVH factors most strongly associated with greater processing speed performance, compared with those with less than ideal health for the same factors after mutual adjustment. Episodic memory performance over time was associated with ideal CVH. Participants with 2 to 7 ideal CVH factors had less decline compared with those with only 0 to 1 factors.

Only a small proportion of participants met ideal blood pressure criteria, so researchers ran sensitivity analyses to evaluate both systolic and diastolic blood pressure “as continuous measurements from baseline enrollment to the cognitive domains, adjusting for the demographic variables in model 1 [time from baseline CVD risk factor assessment to initial NP assessment, age, sex, race/ethnicity, education, insurance].” They found that systolic blood pressure was “inversely associated with z scores for processing speed (beta: –0.003; P=.03) and executive function (beta: –0.003; P=.04).”

Systolic blood pressure was also inversely associated with processing speed only, in relation to z scores for change in cognitive performance (full study population: beta: –0.005; P=.03; among those without cognitive impairment at baseline: beta: –0.005; P=.05).

“We have previously shown a strong graded relationship between the number of ideal CVH metrics and cardiovascular risk overall and for stroke and MI separately in the NOMAS [Northern Manhattan Study] cohort, and this association was similar for whites, blacks, and Hispanics,” the authors wrote. “Our study extends their [previous studies’] findings with prospective data and by showing that ideal CVH metrics relate to change in cognitive performance on specific domains over about half a decade, in large race/ethnically diverse sample with a large proportion of minorities, particularly Caribbean Hispanics.”

Researchers cautioned that as both the US population and number of people at risk for cognitive impairment grows, the public health implications of targeting these modifiable risk factors will be significant.


Gardener H, Wright CB, Dong C, et al. Ideal cardiovascular health and cognitive aging in the Northern Manhattan study. J Am Heart Assoc. 2016. doi:10.1161/JAHA.115.002731.