Novel Dementia Risk Charts Underline the Role of Lifestyle

Ten-year dementia risk charts that combine cardiovascular and genetic risk factors have been developed by Danish researchers and graphically underline the impact of modifiable lifestyle factors, even in the face of increased genetic risk.

The research was presented at the European Atherosclerosis Society (EAS) 2020 Virtual Congress, held online this year due to the COVID-19 pandemic, and simultaneously published October 7 in the European Heart Journal.

Ida Juul Rasmussen, MD, PhD, Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, combined data from more than 60,000 patients — more than 2000 with dementia — with a median follow-up of 10 years.

By combining genetic risk factors with gender and age, as well as lifestyle factors — such as diabetes, smoking, and educational level — they were able to develop a series of risk charts similar to those for cardiovascular risk from the Framingham study.

This showed that a women at least 80 years of age with the highest genetic risk factors who had diabetes, smoked, and had a low educational level would have a 66% risk for dementia over 10 years; this would drop to 45% if she did not smoke or have diabetes and had a higher educational level.

With this pattern repeated across age groups and in both men and women, Rasmussen said that “the overall message from this study is that a healthy cardiovascular risk lifestyle attenuates genetic susceptibility for dementia.”

She added that “by combining genetic risk factors and modifiable risk factors, we are indeed able to identify the individuals at the highest risk of a future dementia disease that would benefit the most” from an intensive lifestyle intervention.

Ralph L. Sacco, MD, professor and chair of neurology and executive director at the Evelyn F. McKnight Brain Institute, Leonard Miller School of Medicine, University of Miami, told theheart.org | Medscape Cardiology that an “important message” of the study is that lifestyle factors still have an appreciable impact on the risk for dementia, even in those at high genetic risk.

“I think the novelty here is the combination of cardiovascular lifestyle factors and the genetics,” Sacco said.

“In the past, there are numerous scores that have been developed on the lifestyle side, some developed on the genetic side, but this group combined both, and I think that makes it an important and well-done comprehensive risk model.”

However, Sacco noted that there were some limitations to the study, saying that the way in which some of the risk factors were defined “is pretty, I would say, crude,” citing, for example, the threshold for hypertension of 140/90 mm Hg blood pressure or medications, or 4 hours a week for high physical activity.

He also believes that the concept of the tables may not fit with the way in which, “nowadays, everybody works with an app and a portable device,” allowing them to enter continuous measures rather than rely on “categorical definitions.”

Sacco added that the very idea of using risk stratification to assign individuals to lifestyle interventions to lower

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