Key result
Black race is linked to ~37% higher dementia risk vs Whites, mediated by BMI and glucose.
Why the study?
It was unknown whether cardiovascular risk factors across the life course contribute to racial disparities in dementia and cognition.
Do life course cardiovascular risk factors (BMI, fasting glucose, systolic blood pressure, and LDL cholesterol) mediate the racial disparities in dementia incidence between Black and White older adults?
Cohort (n=5,098)
Yes
Do life course cardiovascular risk factors (BMI, fasting glucose, systolic blood pressure, and LDL cholesterol) mediate the racial disparities in dementia incidence between Black and White older adults?
Odds Ratio: 1.37 (95% CI 1.17–1.6)
Cardiovascular risk factors across the life course, particularly BMI and fasting glucose, partially mediate the increased risk of dementia observed in Black compared to White older adults.
May support targeting life-course BMI and glucose to narrow racial dementia gaps; hypothesis-generating for prospective trials before practice change.
Background: Racial disparities in dementia outcomes persist in the United States. Targeting modifiable risk factors, including cardiovascular risk factors (CVRFs), is a conceivable way to reduce health disparities. Life course CVRFs are often higher in non-White adults and are associated with risk of dementia, but it is unknown whether they contribute to racial disparities in dementia and cognition. Methods: Using a pooled cohort of 4,159 White and 939 Black participants aged 65-95 years, we conducted a mediation analysis to estimate the proportional effect of race on dementia that is explained by four CVRFs imputed over the life course (20-49, 50-69, and 70-89 years of age): body mass index, fasting glucose, systolic blood pressure, and low-density lipoprotein cholesterol. Results: Compared to White participants, Black participants had greater risk of dementia (adjusted OR = 1.37; 95% CI: 1.17-1.60). BMI and fasting glucose over the life course were significant mediators of the effect of race on dementia risk, mediating 39.1% (95% CI: 10.5-67.8%) and 8.2% (95% CI: 0.1-16.2%) of the effect, adjusted for sex and age. All four CVRFs together were also significant mediators of the effect of race on scores on global cognition and processing speed, accounting for approximately 11% of the effect. Conclusions: We found that CVRFs across the life course partially explain disparities in dementia risk and cognition in late-life. Improved prevention and treatment of CVRFs across the life course may be important to reduce health disparities for dementia.
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Ferguson et al. (2023) conducted a cohort in Dementia (n=5,098). Black race vs. White race was evaluated on Incident dementia (OR 1.37, 95% CI 1.17-1.60). Black race was associated with a higher risk of dementia compared to White race (OR 1.37), with life course body mass index and fasting glucose mediating 39.1% and 8.1% of this effect, respectively.
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