Cardiovascular Risk and Dementia #

Men at risk for heart disease may develop dementia up to a decade earlier than similarly at-risk women. Cardiovascular diseases rank as the leading cause of death worldwide, with heart disease being the top killer in the United States for over a century. Risk factors such as obesity, diabetes, high blood pressure, and cholesterol—along with smoking, excessive alcohol consumption, lack of exercise, and inadequate sleep—can contribute to small vessel disease affecting oxygen delivery to the brain.

The damaging impact of cardiovascular risks is evident in people regardless of carrying the APOE ε4 gene, known as a strong risk factor for Alzheimer’s disease in individuals over 65. Modifying cardiovascular risks may prevent Alzheimer’s disease. Research suggests this intervention should occur a decade earlier in males compared to females, irrespective of their genetic predisposition to Alzheimer’s.

Higher levels of cardiovascular risk may be associated with negative neurocognitive outcomes. Men and women over 60 living with heart risk for a decade showed poor performance on cognitive tests measuring executive function, processing speed, and memory. Poor cardiovascular health is linked to both cognitive decline and brain pathology, predictive of dementia.

The study analyzed 34,000 individuals aged 45 to 82, revealing that cardio risk factors and higher abdominal and visceral fat levels correlate with reduced brain gray matter volume. The affected brain regions are responsible for hearing, vision, emotional processing, and memory. Timing is crucial in preventing cognitive decline, with midlife being a key period for addressing vascular risk factors, potentially reducing dementia risk.

Men are most susceptible to cardiovascular risk factors between 55 and 74 years, while women experience this susceptibility between 65 and 74 years. Several reasons, including poor cardiovascular risk profiles and differences in sex hormones, may account for this gender gap. Testosterone in men can increase LDL and decrease HDL levels, affecting heart disease risk. In contrast, estrogen in women provides protective effects pre-menopause.

Men often consume more saturated fats, salt, and red meat, while also using tobacco and alcohol more frequently. Additionally, the type of body fat differs, with men having more visceral fat linked to heart attacks. Given these factors, men may need to address cardio risk factors and body weight earlier than women.

“The influence of heart problems and being obese on brain cell degeneration is sustained and more apparent over twenty years in men than women,” is one perspective. Modifying diet and lifestyle to reduce heart problem risks and obesity can subsequently lower the likelihood of developing dementia.