Childhood Cardiovascular Risk Factors Linked to Midlife Cognitive Performance
These findings highlight the importance of primordial prevention in childhood.
In a recent study published in the Journal of American College of Cardiology, cardiovascular risk factors in childhood and adolescence appeared to be associated with worse cognitive performance in midlife.1
Findings from previous rodent studies and epidemiological research have linked hypertension, hypercholesterolemia, and smoking in midlife to subsequent cognitive decline.2,3 For example, hypertensive rats and rats exposed to nicotine demonstrated later cognitive deficits, and rodents with diet-induced hypercholesterolemia showed memory impairment.4-6
The researchers in the present study noted that while the underlying mechanisms have not been clarified, substantial experimental evidence suggests that, “cardiovascular risk factors may damage both neuronal and vascular tissues of the brain.” They added that it is possible that cognitive performance in midlife could be affected by these cardiovascular risk factors from earlier in life.
To explore this hypothesis, the investigators of the Cardiovascular Risk in Young Finns study examined the relationship between cardiovascular risk factors from childhood to young adulthood and cognitive performance in midlife.
In 1980, 3596 boys and girls (aged 3-18 years) were randomly selected and have been followed up at 6 intervals since that initial selection. At baseline and at each follow-up visit, blood pressure, cholesterol, body mass index, and triglycerides were assessed using standard methods. At the most recent follow-up in 2011, the cognitive performance of 2026 participants (aged 34-49 years) was evaluated with a computerized testing battery that assessed visual and episodic memory, problem-solving, reaction time, visual processing, and other measures of cognition.
The cardiovascular risk factors of high systolic blood pressure, high serum total cholesterol, and smoking were found to be independently associated with worse cognitive performance in midlife, especially memory and learning as assessed by the paired-associates learning (PAL) test.
In addition, inverse associations were observed between the number of early life risk factors and PAL test performance (–0.140 standard deviations per risk factor, P <.0001), even after adjusting for contemporaneous risk factors. Compared with individuals who exceeded recommended levels for all risk factors at least twice, individuals within the recommended ranges between ages 6 and 24 years performed 0.29 standard deviations better (P =.006) in this cognitive domain.
In a related editorial, the authors noted, “In contrast to primary prevention, which focuses on treating the risk factors of a disease, primordial prevention aims to prevent the development of the risk factors themselves.7"
The results “highlight how crucial it is to focus our efforts on primordial prevention in childhood so we can help current and future generations remain in both ideal cardiovascular and cognitive health,” they concluded.
- Rovio SP, Pahkala K, Nevalainen J, et al. Cardiovascular risk factors from childhood and midlife cognitive performance: the Young Finns Study. J Am Coll Cardiol. 2017;69(18):2279-2289. doi:10.1016/j.jacc.2017.02.060
- Knopman D, Boland LL, Mosley T, et al. Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology. 2001;56(1):42-48.
- Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(9):2672-2713. doi:10.1161/STR.0b013e3182299496
- Grünblatt E, Bartl J, Iuhos D-I, et al. Characterization of cognitive deficits in spontaneously hypertensive rats, accompanied by brain insulin receptor dysfunction. J Mol Psychiatry. 2015;3(1):6. doi:10.1186/s40303-015-0012-6
- Counotte DS, Spijker S, Van de Burgwal LH, et al. Long-lasting cognitive deficits resulting from adolescent nicotine exposure in rats. Neuropsychopharmacology. 2009;34(2):299-306. doi:10.1038/npp.2008.96
- Thirumangalakudi L, Prakasam A, Zhang R, et al. High cholesterol-induced neuroinflammation and amyloid precursor protein processing correlate with loss of working memory in mice. J Neurochem. 2008;106(1):475-485. doi:10.1111/j.1471-4159.2008.05415.x
- Lloyd-Jones DM, Allen NB. Childhood cardiovascular risk factors and midlife cognitive performance. J Am Coll Cardiol. 2017;69(18):2290-2292. doi:10.1016/j.jacc.2017.03.020