The link between cardiovascular health and dementia is well established; research shows that what’s good for your heart generally is also good for your brain. Now, a new study suggests that avoiding a few specific risk factors in adulthood could allow you to live a greater portion of your life without dementia — roughly 13 more years.
The study, published in Neurology Open Access, explored how vascular risk factors at midlife may affect the age at which people develop dementia and when they die of other causes. The finding underscores the importance of good cardiovascular health in middle age: It seems to give you more years free of dementia compared with your peers, said Josef Coresh, the study’s senior investigator and founding director of the Optimal Aging Institute at NYU Langone.
To start, the researchers measured three risk factors in more than 12,400 middle-aged people (on average, 56 years old): whether they had high blood pressure, had diabetes and currently smoked. (None of them had dementia when the study began.) Then, the researchers followed these participants for about 30 years, periodically conducting cognitive tests at in-person visits and via phone, and using medical records to identify who got dementia and who died without developing dementia.
In the end, people with zero of the tracked risk factors skirted dementia for 30.1 years, compared with just 17.5 in those with all three risk factors.
What the study shows about how vascular risk factors affect aging
While prior studies have tied various measures of poor heart health at midlife to greater dementia risk, these results have mostly reflected population-level patterns and relative lifetime risk. What this new study adds is a clearer picture of how vascular risk factors affect a person’s aging trajectory: The more you have at midlife, the fewer years you may live with no cognitive issues.
Each additional risk factor — high blood pressure, diabetes or smoking — was tied to about four fewer years of dementia-free survival, Coresh said, such that those with one risk factor lived 26.3 years without dementia and those with two risk factors lived 21 years without dementia.
Some of that drop is the result of people with any of these heart-related risk factors dying sooner of non-dementia causes, for instance stroke or heart attack; the rest reflects people with such risk factors getting dementia earlier in life. Avoiding both outcomes — which the researchers described as dementia-free survival — is what people truly care about, said Heather Whitson, director of the Duke Center for the Study of Aging and Human Development, who was not involved in the study. “Yes, people want to live longer, but nobody wants to outlive their brain.”
Though the link between vascular risk factors and years without dementia held true across all groups, Black participants consistently lived fewer years without dementia than their White counterparts, and women lived longer without dementia than men — which suggests that the benefits of early intervention might be even more powerful for some than others.
A few limitations of the study include that it was observational and therefore can’t prove that avoiding those risk factors caused a delay in dementia, just that avoiding them is linked to more years without the condition.
The researchers also only checked people’s vascular risk factors at one moment in time. So they weren’t able to capture whether making changes to certain risk factors at a later point in life — for instance, picking up or quitting smoking — would then influence a person’s dementia-free survival.
Why lowering cardiovascular risk factors could stave off dementia
The new study didn’t explore the reasons behind this link, but based on the growing understanding of what drives dementia, health experts have several possible explanations.
For starters, each of the risk factors in the study can damage blood vessels, which threatens the brain in several ways. If the little vessels inside the brain are harmed, “you get fewer nutrients into the brain and poorer clearance of toxins out of the brain,” Coresh said. “And the brain requires a good supply of oxygen and glucose to every part of it to function.” (A stroke caused by a bigger decrease in blood to the brain can also majorly raise dementia risk, he noted.)
There’s also the “inflammatory reaction” to that vessel damage, Whitson said. The body ramps up inflammation to try to repair vessels, but as a by-product, you can wind up with poor healing, plaque buildup and further inflammation, Coresh said, which may also affect brain health.
At the same time, vascular disease may “enhance the accumulation of the Alzheimer’s disease proteins like amyloid in the brain,” Coresh added, which would layer on additional risk.
By avoiding high blood pressure, diabetes and smoking, you can help prevent this negative cascade from starting, which may then safeguard your brain.
How to improve your cardiovascular health and protect your brain along the way
Ideally, the goal is to “prevent the onset” of high blood pressure and Type 2 diabetes (the most common type of diabetes, which can sometimes be delayed or prevented with lifestyle changes), and to not smoke at midlife, Coresh said, which often means thinking about these factors and taking action before then. He pointed to the lifestyle tactics included in the American Heart Association’s “Life’s Essential 8,” such as following a diet rich in whole plant foods and engaging in a total of 2.5 hours of moderate physical activity or 75 minutes of vigorous activity per week.
Last year, a large clinical trial found that lifestyle interventions alone — including diet and exercise modifications — could improve cognitive function in people at risk of dementia, Whitson said, which lends credence to the benefit of embracing these behaviors at any point.
If you already have one or more of the vascular risk factors in the new study, and especially if you’re at or approaching midlife, you should know that there are plenty of solutions and resources to help that didn’t exist even 10 years ago, Whitson said. For instance, in the realm of smoking cessation, there are modern text-to-quit programs and multiple nicotine replacement therapies. GLP-1s, a class of medications used for blood sugar and weight management, have also been game-changing for diabetes, and some research even suggests these same drugs could help people stop smoking too, Whitson pointed out. It’s worth starting (or restarting) the conversation with your doctor about the best risk-mitigating tactics for you.
Ultimately, this study adds to an increasing body of evidence that shifting your risk profile in your 50s or 60s can benefit your brain down the line, Whitson said: “Many of us really feel that our best chance of defeating [dementia], which has been stumping the field for a long time, is to start early.”
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