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Less than optimal cardiovascular health (CVH) at midlife was associated with a decline in the mental processing speed—a leading indicator of age-related cognitive decline—of Black women, but not White women, according to research published today in the Journal of the American Heart Association.¹

“Take care of your heart, and it will benefit your brain,” lead author Imke Janssen, PhD, professor of family and preventive medicine, Rush University Medical Center, Chicago, Illinois, said in an American Heart Association (AHA) press release. “Better cardiovascular health in women in their 40s is important to prevent later-life Alzheimer’s disease, dementia and to maintain independent living.”²

Previous studies have shown that better CVH is related to less cognitive decline, however, “it is unclear whether this begins early, for all racial subgroups, and all domains of cognitive function,” Janssen and colleagues wrote. They conducted the current study to determine the impact of CVH in middle-aged Black and White women on decline in 2 domains of cognition known to be among the first to decline with aging: processing speed and working memory.¹

Investigators evaluated data from 402 White and 363 Black women from the Chicago site of the Study of Women’s Health Across the Nation, who started cognitive testing in 1997 when they were aged between 42 and 52 years. The cohort was similar in baseline age (mean age, 46 years) and education (mean, 15.7 years).¹

Processing speed and working memory were assessed annually or biennially over a maximum of 20 years (mean, 9.8 years). CVH Z score was calculated using the AHA’s Life’s Essential 8 scoring algorithm, taking into account blood pressure (BP), body mass index (BMI), glucose, non-high-density lipoprotein cholesterol, smoking, physical activity, diet, and sleep.¹

FINDINGS

At baseline, mean processing speed score (55.9 vs 60.3; P < .001), working memory score (6.3 vs 7.1; P < .001), and CVH score (58.2 vs 67.8; P < .001) were all lower among middle-aged Black women compared with White women. Researchers noted that the lower average CVH score among Black women was primarily driven by lower scoring for physical activity, sleep, BMI, glucose, and BP.¹

In a fully adjusted hierarchical model that included the 3-way interaction of race, CVH Z score, and time, results showed a significant difference by race in the association between CVH and decline in processing speed (–0.005, 95% CI, 0.019 to 0.010; P < .05). Researchers reported that lower CVH was associated with an approximately 10% decline in processing speed over time in Black women, but with no change in White women.¹

Moreover, there was no significant change in working memory in the cohort, regardless of race or CVH score.¹

“We were surprised that we did not find results like those of past studies, which showed cognitive decline in Black and white men and women, and found cardiovascular health to be more important for white adults rather than people in Black subgroups,” Janssen said in the release.²

Janssen continued: “We think these differences are due to the younger age of our participants, who began cognitive testing in their mid-40s, whereas previous studies started with adults about 10 to 20 years older. The next step is a clinical trial to confirm whether optimizing heart health in Black women at midlife may slow cognitive aging, maximize independence and reduce racial inequities in dementia risk.”²

References:

1. Janssen I, Powell LH, Dugan SA, Derby CA, Kravitz HM. Cardiovascular health, race, and decline in cognitive function in midlife women: The Study of Women's Health Across the Nation. J Am Heart Assoc. Published online April 24, 2024. doi:10.1161/JAHA.123.031619
2. Good heart health in middle age may preserve brain function among Black women as they age. News release. American Heart Association. April 24, 2024. Accessed April 24, 2024. https://newsroom.heart.org/news/good-heart-health-in-middle-age-may-preserve-brain-function-among-black-women-as-they-age