Midlife cardiovascular risk factors and risk of dementia in late life.
OBJECTIVE
To evaluate if midlife cardiovascular risk factors are associated with risk of late-life dementia in a large, diverse cohort.


METHODS
The authors conducted a retrospective cohort study of 8,845 participants of a health maintenance organization who underwent health evaluations from 1964 to 1973 when they were between the ages of 40 and 44. Midlife cardiovascular risk factors included total cholesterol, diabetes, hypertension, and smoking. Diagnoses of dementia were ascertained by medical records from January 1994 to April 2003.


RESULTS
The authors identified 721 participants (8.2%) with dementia. Smoking, hypertension, high cholesterol, and diabetes at midlife were each associated with a 20 to 40% increase in risk of dementia (fully adjusted Cox proportional hazards model: HR 1.24, 95% CI 1.04 to 1.48 for hypertension, HR 1.26, 95% CI 1.08 to 1.47 for smoking, HR 1.42, 95% CI 1.22 to 1.66 for high cholesterol, and HR 1.46, 95% CI 1.19 to 1.79 for diabetes). A composite cardiovascular risk score was created using all four risk factors and was associated with dementia in a dose-dependent fashion. Compared with participants having no risk factors, the risk for dementia increased from 1.27 for having one risk factor to 2.37 for having all four risk factors (fully adjusted model: HR 2.37, 95% CI 1.10 to 5.10).


CONCLUSIONS
The presence of multiple cardiovascular risk factors at midlife substantially increases risk of late-life dementia in a dose dependent manner.
Whitmer
R A
RA
Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA. raw@dor.kaiser.org
Sidney
S
S
Selby
J
J
Johnston
S Claiborne
SC
Yaffe
K
K
D000328:Adult; D017668:Age of Onset; D000368:Aged; D002140:California / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*