Midlife Vascular Risk Factors Linked to 12.6 Fewer Dementia-Free Years
KEY TAKEAWAYS
- Adults with hypertension, diabetes, and current smoking in midlife averaged 17.5 dementia-free years from age 55, compared with 30.1 years among those with none of these risk factors.
- Having all 3 risk factors was associated with a 2.69-fold higher hazard of dementia and a 5.61-fold higher hazard of death without dementia compared with having none.
- The association between greater vascular risk burden and fewer dementia-free years was seen across sex, race, and APOE-ε4 subgroups.
Adults with no hypertension, diabetes, or current smoking in midlife lived an average of 12.6 more years without dementia from age 55 than those with all 3 risk factors, according to findings from the Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study. Greater vascular risk burden was associated with progressively shorter dementia-free survival.
The prospective cohort study included 12,409 adults from 4 US communities who were alive and dementia-free at age 55. Investigators assessed hypertension, diabetes, and current smoking in midlife and grouped participants according to the number of risk factors present, from 0 to 3. Dementia was identified using cognitive assessments, informant interviews, ongoing surveillance, and expert adjudication through 2022. Over a median 26.3 years of follow-up, 3008 participants developed dementia and 5238 died without dementia. Analyses accounted for death as a competing risk.
What the Data Showed
- Dementia-free survival declined stepwise from 30.1 years (95% CI, 29.9-30.4) with no vascular risk factors to 26.3, 21.0, and 17.5 years with 1, 2, and 3 risk factors, respectively.
- Compared with no risk factors, having all 3 was associated with a higher hazard of dementia (HR, 2.69; 95% CI, 1.94-3.73).
- Participants with all 3 risk factors also had a 5.61-fold higher hazard of death without dementia (95% CI, 4.67-6.74).
Although participants with the highest vascular risk burden had a lower cumulative incidence of dementia by age 95, this reflected substantially higher competing mortality—not lower dementia risk. The study was observational and assessed vascular risk factors at a single point in midlife, limiting conclusions about whether preventing or treating these factors would extend dementia-free survival.
Source:
Hu J, Coresh J, Smith JR, et al. Midlife vascular risk burden and dementia-free survival years: the Atherosclerosis Risk in Communities Neurocognitive Study. Neurol Open Access. 2026;2:e000152. doi:10.1212/WN9.0000000000000152