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Adverse effects of childhood CVD risk on midlife cognition

By Nicole MacKee
Cardiovascular risk factors from childhood and adolescence can adversely affect midlife cognitive performance, regardless of adulthood exposure, say Finnish researchers, prompting calls for a greater focus on primordial prevention.

An analysis of the Cardiovascular Risk in Young Finns Study – an ongoing population-based study that has followed children to adulthood over more than 30 years – evaluated the cumulative burden of blood pressure, serum lipids, smoking and body mass index during three life stages: childhood (6 to 12 years), adolescence (12 to 18 years) and early adulthood (18 to 24 hours).

After cognitive testing of 2026 participants, when aged 34 to 49 years, the researchers found that the cumulative burden of high systolic blood pressure, elevated total cholesterol and smoking was associated with poorer cognitive function, particularly memory and learning. The associations remained significant after adjustment for adulthood exposure to risk factors, according to the study, which was published in the Journal of the American College of Cardiology. 

The researchers also examined whether the effect of early life risk exposure was attributable to levels of risk factors that repeatedly exceeded the recommended guidelines for atherosclerosis prevention. They found that study participants who exceeded the guidelines at least twice on all risk factors had a cognitive age 6 years older than those whose risk factors remained within recommended levels from childhood to early adulthood. 

The authors of an accompanying editorial said the findings highlighted the need to focus on primordial prevention in childhood to promote ideal cardiovascular and cognitive health in adulthood. 

Professor Garry Jennings, Chief Medical Adviser at the Heart Foundation, said the standard approach to cardiovascular risk was to target absolute risk – with Australian guidelines advising absolute risk assessment from age 45 years and from age 35 years in Aboriginal and Torres Strait Islander Australians – but there was increasing evidence to suggest that efforts to address risk should occur much earlier in life.

‘An absolute risk approach – where people are only considered at high risk when they are adults – is probably missing the boat to some extent,’ Professor Jennings told Cardiology Today.

‘It might be the lifetime burden of the damage that these risk factors do to the arteries that’s most important, rather than [a person’s risk] on any particular day. Some of the new biology suggests that early life – as early as during pregnancy and infancy – is a time when a number of things are set up for later life.’

Professor Jennings described primordial prevention as the ‘holy grail’. Although, in a practical sense, he said this meant reinforcing the standard advice of engaging in physical activity, healthy nutrition and avoiding toxins such as tobacco, because medicating children to address elevated blood pressure or cholesterol was not an ‘attractive proposition’.

Professor Jennings said that although the current study didn’t look at dementia, future analyses should be able to cast more light on the longer-term trends in cognitive function.
J Am Coll Cardiol 2017; 69: 2279-2289.
J Am Coll Cardiol 2017; 69: 2290-2292. 

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