title: Association of Ideal Cardiovascular Health With Vascular Brain Injury and Incident Dementia.
abstract: The American Heart Association developed the ideal cardiovascular health (CVH) index as a simple tool to promote CVH; yet, its association with brain atrophy and dementia remains unexamined.
  
  
  
  Our aim was to investigate the prospective association of ideal CVH with vascular brain injury, including the 10-year risks of incident stroke and dementia, as well as cognitive decline and brain atrophy on magnetic resonance imaging, measured for ≈7 years. We studied 2750 stroke- and dementia-free Framingham Heart Study Offspring cohort participants (mean age, 62±9 years; 45% men). Ideal CVH was quantified on a 7-point scale with 1 point awarded for each of the following: nonsmoking status, ideal body mass index, regular physical activity, healthy diet, as well as optimum blood pressure, cholesterol, and fasting blood glucose. Both recent (baseline) and remote (6.9 years earlier) ideal CVH scores were examined.
  
  
  
  Recent ideal CVH was associated with stroke (hazard ratio, 0.80; 95% confidence interval, 0.67-0.95), vascular dementia (hazard ratio, 0.49; 95% confidence interval, 0.30-0.81), frontal brain atrophy (P=0.003), and cognitive decline on tasks measuring visual memory and reasoning (P<0.05). In addition to predicting stroke, vascular dementia, whole-brain atrophy, and cognitive decline, remote ideal CVH was associated with the incidence of all-cause dementia (hazard ratio, 0.80; 95% confidence interval, 0.67-0.97) and Alzheimer disease (hazard ratio, 0.79; 95% confidence interval, 0.64-0.98).
  
  
  
  Adherence to the American Heart Association's ideal CVH factors and behaviors, particularly in midlife, may protect against cerebrovascular disease and dementia.
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Pase
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Alexa
authors.initials: A
authors.lastname: Beiser
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Danielle
authors.initials: D
authors.lastname: Enserro
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Vanessa
authors.initials: V
authors.lastname: Xanthakis
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Hugo
authors.initials: H
authors.lastname: Aparicio
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Claudia L
authors.initials: CL
authors.lastname: Satizabal
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Jayandra J
authors.initials: JJ
authors.lastname: Himali
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Carlos S
authors.initials: CS
authors.lastname: Kase
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.).
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.affiliation: From the Department of Neurology (M.P.P., A.B., H.A., C.L.S., J.J.H., S.S.), and Section of Preventive Medicine, Department of Medicine (D.E., V.X., R.S.V.), Boston University School of Medicine and Framingham Heart Study (M.P.P., A.B., D.E., V.X., H.A., C.L.S., J.J.H., R.S.V., S.S.), Boston, MA; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, Boston Medical Centre, MA (H.A., C.S.K.); and Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (C.D.). suseshad@bu.edu.
authors.forename: Sudha
authors.initials: S
authors.lastname: Seshadri
mesh_terms: D000368:Aged; D000572:American Heart Association; D001284:Atrophy / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000517:prevention & control; D020214:Cerebrovascular Trauma / Q000453:epidemiology*; D015331:Cohort Studies; D003704:Dementia / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D019983:Guideline Adherence; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D012306:Risk; D020521:Stroke / Q000517:prevention & control*; D014481:United States
keywords: American Heart Association; brain; cerebrovascular disorders; epidemiology; risk factors