“The study found that midlife heart health factors influenced cognitive aging differently across ethnic groups.”
Janette Vazquez, Rebecca Bernal, Luis A. Aguirre, Jesus D. Melgarejo, Gladys Maestre, Sudha Seshadri, Helen P. Hazuda, Chen-Pin Wang, Claudia L. Satizabal
Introduction and Background
In the United States, approximately 6.7 million people live with Alzheimer’s disease, a number projected to more than double by 2060. Nearly 40% of these cases may be linked to modifiable risk factors, making early intervention critical. The American Heart Association’s Life’s Simple 7 (LS7) framework—which includes lifestyle and health indicators like smoking, diet, physical activity, blood pressure, body mass index (BMI), cholesterol, and blood glucose—is a metric of cardiovascular health.
Previous studies examining the influence of heart health on brain aging have not adequately represented all populations. This is particularly concerning for Hispanic older adults, who face a higher burden of Alzheimer’s and related dementias compared to non-Hispanic Whites. Mexican Americans, for example, experience higher rates of obesity and diabetes, both risk factors for cardiovascular disease and cognitive impairment. This study sought to address this gap by investigating how midlife heart health affects cognitive decline in a cohort of Mexican American and non-Hispanic White adults in South Texas.
Data and Methods
Researchers analyzed data from 402 participants who initially enrolled in the San Antonio Heart Study (1979–1988) and were later followed in the San Antonio Longitudinal Study of Aging (1992–2004). The group was 52% Mexican American and 58.5% women, with a mean age of 58 years at the start of the study.
Midlife cardiovascular health was measured using the LS7 recommendations, categorized as poor versus intermediate or ideal adherence. Cognitive function was evaluated up to four times over an average nine-year period using the Mini-Mental State Examination (MMSE), a 30-point screening tool for cognitive impairment. Generalized estimating equation (GEE) models were used to estimate associations between midlife cardiovascular health and cognitive function change, while accounting for the age, sex, income, and education of the participants. Sensitivity analyses were performed to ensure that the results were not biased by participants who dropped out before the end of the study period.
Results
The study found that midlife heart health factors influenced cognitive aging differently across ethnic groups.
- Physical Activity: Engaging in any level of exercise during midlife was the most consistent protective factor of cognitive function. This was especially true for Mexican Americans, for whom any physical activity was associated with a 0.13-point slower annual decline in cognitive function compared to those who were inactive.
- Blood Glucose: For non-Hispanic White participants, maintaining optimal fasting blood glucose levels (less than 126 mg/dL) was linked to a 0.19-point slower annual cognitive decline in models that accounted for study dropouts.
- Body Mass Index: While initial results suggested that a normal BMI might be linked to faster cognitive decline in Mexican Americans, further analysis revealed this finding was likely due to attrition bias—meaning people with higher health risks may have dropped out of the study earlier. This finding is also consistent with the “obesity paradox”, a phenomenon in which higher BMI at older ages appears to be protective for health outcomes, whereas a lower BMI may signal elevated risk. This is because people who develop cognitive decline and dementia tend to lose weight years before they develop the disease.
Public Health Implications and Future Directions
These findings suggest that public health programs should prioritize midlife physical activity and blood glucose management as primary strategies to protect brain health in later life. Physical activity does not need to be moderate or intense to be beneficial. Light activities such as gardening, dancing, or walking are excellent ways to stay active. Glucose can be monitored with laboratory blood tests and managed with lifestyle changes and medications.
Because the impact of these factors varies by ethnicity, interventions may need to be culturally tailored to be most effective. Encouraging modifiable lifestyle changes during midlife can help reduce the long-term public health burden of Alzheimer’s and other dementias, particularly in high-risk and understudied populations.
Read the Original Paper
Janette Vazquez, Rebecca Bernal, Luis A. Aguirre, Jesus D. Melgarejo, Gladys Maestre, Sudha Seshadri, Helen P. Hazuda, Chen-Pin Wang, Claudia L. Satizabal. Longitudinal association between midlife cardiovascular health and cognitive change in a bi-ethnic cohort. Alzheimer’s Dement. 2026;e70096. https://doi.org/10.1002/bsa3.70096
Acknowledgements
This research was supported by several grants and organizations, including a T32 training grant in Pathobiology of Occlusive Vascular Disease (T32 HL007446), the San Antonio Heart and Mind Study (R01 AG082360), and the San Antonio Longitudinal Study of Aging (R01 AG010444, R01 AG016518). Additional funding was provided by the Burroughs Wellcome Fund Postdoctoral Diversity Enrichment Program, the National Institute of Neurological Disorders and Stroke (UH1NS125513), the National Institute on Aging (P30 AG066546), and the National Heart, Lung, and Blood Institute. The researchers also received support through various endowments, including the Zachry Foundation, the Bill and Rebecca Reed Endowment, and the Barker Foundation.
San Antonio CAPAS acknowledges the use of AI to support the elaboration of the initial draft of this research synopsis. See the process by which our team created the synopsis: Research Synopsis Elaboration.