Association Between Cardiovascular Health and Cognitive Performance: A Twins Study

Article type: Research Article

Authors: Kulshreshtha, Ambar^a | Goetz, Margarethe^b | Alonso, Alvaro^c | Shah, Amit J.^{c; d} | Bremner, J. Douglas^e | Goldberg, Jack^{f; g} | Vaccarino, Viola^{c; d; *}

Affiliations: [a] Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA | [b] Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA | [c] Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA | [d] Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA | [e] Department of Psychiatry and Behavioral Sciences and the Department of Radiology, Emory University School of Medicine, and the Atlanta VA Medical Center, Decatur, GA, USA | [f] Vietnam Era Twin Registry, Seattle, WA, USA | [g] University of Washington School of Public Health, Seattle, WA, USA

Correspondence: [*] Correspondence to: Viola Vaccarino, MD, PhD, Professor, Department of Epidemiology; Department of Medicine, School of Medicine, 1518 Clifton Rd NE, Room 3011, RSPH, Emory University, Atlanta, GA 30322, USA. Tel.: +1 404 727 8710; Fax: +1 404 727 8737; E-mail: [email protected].

Abstract: Background/Objective:The 2020 Strategic Impact Goal introduced by the American Heart Association (AHA) aims at improving cardiovascular health (CVH) of all Americans by 20%. AHA defined ideal CVH across seven established modifiable risk factors for cardiovascular diseases. Prior studies have indicated that ideal CVH also benefits brain health and cognitive aging, but it is possible that this association is explained by familial factors. Methods:We examined 272 male monozygotic and dizygotic twin pairs (total 544 subjects) free of overt cardiovascular disease and dementia from the Vietnam Era Twin Registry. Memory and learning were measured by Trail Making tests and Wechsler Memory Scale (Immediate and Delayed Memory tests and Visual Reproductive Test). Each of the seven CVH components (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and blood glucose) was scored per established criterion. Results:The mean age of the twins was 55 years, 96% were whites, and 61% monozygotic. When considering twins as individuals, for every unit increase in CVH score (indicating better cardiovascular health), twins demonstrated faster cognitive processing speed (Trail B: – 5.6 s, 95% CI – 10.3, – 0.9; p = 0.03) and better story recall, both immediate (0.35, 95% CI 0.06, 0.62; p = 0.02) and delayed (0.39, 95% CI 0.08, 0.70; p = 0.01). Conclusions:Better CVH is associated with better cognitive health in several domains. As suggested by within-pair analysis, this association is largely explained by familial factors, implying that early life exposures are shared determinants of both brain health and cardiovascular health.

Keywords: Epidemiology, prevention, risk factors

DOI: 10.3233/JAD-190217

Journal: Journal of Alzheimer's Disease, vol. 71, no. 3, pp. 957-968, 2019