Poor Cardiovascular Health in Women Linked to Cognitive Decline in Midlife

Women with poor cardiovascular health (CVH) face an increased risk of early signs of cognitive decline in midlife, with Black women experiencing poorer health outcomes, according to the results of a study published in the Journal of the American Heart Association. The results show significant disparities in cognitive health outcomes between Black and White women, suggesting that enhancing CVH could be a key strategy in preventing the early onset of cognitive decline in Black patients.

These findings provide valuable insights into improving women's access to cardiovascular care, which could potentially prevent the early onset of cognitive decline. Image Credits: © T Mdlungu/peopleimages.com - stock.adobe.com

The study included 363 Black and 402 White women between the ages of 42 to 57 years enrolled in the Study of Women’s Health Across the Nation (SWAN) site in Chicago, a 7-site multiracial, multiethnic study of women experiencing menopause. The Chicago site has 857 enrolled participants who were recruited using a complete community census from 3 contiguous neighborhoods, permitting study authors to compare approximate socioeconomic status between Black and White women. Cognitive testing of the participants was conducted from January 1997 to January 2017 and included annual or biannual assessments over 20 years, with an average follow-up of 9.8 years.¹

The study authors aimed to identify the connection between CVH and cognitive decline in different racial subgroups and whether better CVH leads to less cognitive decline by measuring processing speed and working memory. To best calculate CVH in enrolled participants, they used Life’s Essential 8, a set of health metrics designed by the American heart Association (AHA) that measures diet, physical activity, blood pressure, body mass index, glucose, cholesterol, and sleep.

To measure cognitive decline, study authors assessed processing speed, a lead indicator of early cognitive decline, and working memory, using the Symbol Digit Modalities Test, which prompts participants to identify as many of the 110 symbol-digit matches as possible in 90 seconds.¹ Scores for processing speed ranged from 0 to 110, with higher scores demonstrating better cognition. To measure working memory, study authors used the Digit Span Backwards test, which involves repeating progressively longer strings of digits (ranging from 3 to 8 digits) without making an error.¹

The study authors’ findings showed the mean±SD cognitive scores were 58.2±11.1 for processing speed and 6.7±2.1 for working memory. White women had better scores compared to Black women, with a mean score differential of 4.4 (95% CI, 2.8-6.0) for processing speed and 0.8 (95% CI, .5-1.1) for working memory (P< .001 for both). Overall, the study results show that White women had better overall scores compared with Black women, who had a faster decline in processing speed over time. Based on the study findings, processing speed, especially among Black women with poor CVH, seemed to initiate early in the fourth decade of life.¹

Due to the assessment’s reliance on several self-reported data points (smoking, diet, physical activity, etc), the study results have limitations that require further investigation. Additionally, the study authors noted the study lacked consideration of structural racism, which is linked to poorer health care quality for Black women and may serve as a more fundamental factor influencing decline in processing speed compared with CVH in future studies.¹

These findings provide valuable insights into improving women's access to cardiovascular care, which could potentially prevent the early onset of cognitive decline and contribute to maintaining independence as individuals age.

“The results suggest that promotion of cardiovascular health, particularly management of blood pressure and smoking cessation, in midlife Black women may be important for the early prevention of cognitive decline and maintenance of independence through aging,” corresponding author Imke Janssen, PhD, of Rush University Medical Center, said in a press release. “A clinical trial should determine whether optimizing heart health in midlife slows cognitive decline.”²

REFERENCES

1. Janssen I, Powell L, 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. Does a woman’s heart health affect cognition in midlife? Press Release. Wiley Research Headlines. April 24, 2024. Accessed June 4, 2024. https://johnwiley2020news.q4web.com/press-releases/press-release-details/2024/Does-a-womans-heart-health-affect-cognition-in-midlife/default.aspx