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Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study

BMJ 2019; 366 doi: (Published 07 August 2019) Cite this as: BMJ 2019;366:l4414

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The determinants of cognitive decline and dementia

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The implications of cardiovascular health for dementia

  1. Séverine Sabia, research associate1 2,
  2. Aurore Fayosse, stastician1,
  3. Julien Dumurgier, associate professor1 3,
  4. Alexis Schnitzler, physician1,
  5. Jean-Philippe Empana, research professor4,
  6. Klaus P Ebmeier, professor5,
  7. Aline Dugravot, statistician1,
  8. Mika Kivimäki, professor2 6,
  9. Archana Singh-Manoux, research professor1 2
  1. 1Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
  2. 2Department of Epidemiology and Public Health, University College London, London, UK
  3. 3Cognitive Neurology Center, Lariboisière – Fernand Widal Hospital, AP-HP, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
  4. 4Inserm, U970, Integrative Epidemiology of Cardiovascular Disease, Paris Descartes University, Paris, France
  5. 5Department of Psychiatry, University of Oxford, Oxford, UK
  6. 6Helsinki Institute of Life Sciences, University of Helsinki, Helsinki, Finland
  1. Correspondence to: S Sabia severine.sabia{at} (or @epiageing on Twitter)
  • Accepted 12 June 2019


Objectives To examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia.

Design Prospective cohort study.

Setting Civil service departments in London (Whitehall II study; study inception 1985-88).

Participants 7899 participants with data on the cardiovascular health score at age 50.

Exposures The cardiovascular health score included four behavioural (smoking, diet, physical activity, body mass index) and three biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three point scale (0, 1, 2). The cardiovascular health score was the sum of seven metrics (score range 0-14) and was categorised into poor (scores 0-6), intermediate (7-11), and optimal (12-14) cardiovascular health.

Main outcome measure Incident dementia, identified through linkage to hospital, mental health services, and mortality registers until 2017.

Results 347 incident cases of dementia were recorded over a median follow-up of 24.7 years. Compared with an incidence rate of dementia of 3.2 (95% confidence interval 2.5 to 4.0) per 1000 person years among the group with poor cardiovascular health, the absolute rate differences per 1000 person years were −1.5 (95% confidence interval −2.3 to −0.7) for the group with intermediate cardiovascular health and −1.9 (−2.8 to −1.1) for the group with optimal cardiovascular health. Higher cardiovascular health score was associated with a lower risk of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 point increment in the cardiovascular health score).

Conclusion Adherence to the Life Simple 7 ideal cardiovascular health recommendations in midlife was associated with a lower risk of dementia later in life.


  • Contributors: ASM and SS developed the hypothesis and study design. SS, AF, and AD did statistical analysis. SS wrote the first and successive drafts of the manuscript. All authors contributed to study concept and design, analysis and interpretation of data, and drafting or critical revision of the manuscript for important intellectual content or, in addition, data acquisition. ASM, MK, and KPE obtained funding. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. SS is the guarantor.

  • Funding: The Whitehall II study has been supported by grants from the UK Medical Research Council (K013351, R024227, S011676); the British Heart Foundation (PG/11/63/29011 and RG/13/2/30098); the British Health and Safety Executive; the British Department of Health; the National Heart, Lung, and Blood Institute (R01HL036310); the National Institute on Ageing, National Institute of Health (R01AG056477, R01AG034454); and the Economic and Social Research Council (ES/J023299/1). The Whitehall II imaging substudy (KPE) was supported by the Medical Research Council (G1001354), the HDH Wills 1965 Charitable Trust (English Charity No 1117747), and the Gordon Edward Small’s Charitable Trust (Scottish Charity No SC008962). MK is supported by the Medical Research Council (K013351, R024227, S011676), NordForsk, the Nordic Programme on Health and Welfare, the Academy of Finland (311492), and the Helsinki Institute of Life Science. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of this manuscript.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare no support from any organisation for the submitted work other than the grants reported in the funding section above; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Written informed consent from participants and research ethics approvals were renewed at each contact; the most recent approval was from the University College London Hospital Committee on the Ethics of Human Research, reference number 85/0938.

  • Data Sharing: Whitehall II data, protocols, and other metadata are available to the scientific community. Please refer to the Whitehall II data sharing policy at

  • Transparency declaration: The lead author (the manuscript’s guarantor) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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