Longitudinal association between midlife cardiovascular health and cognitive change in a bi‐ethnic cohort

INTRODUCTION Midlife cardiovascular burden contributes to cognitive decline and dementia. However, research in diverse populations remains scarce. METHODS We included 402 San Antonio Heart Study participants (1979–1988; midlife mean age 57.9 ± 3.8, 58.5% women, 52% Mexican American) later enrolled in the San Antonio Longitudinal Study of Aging (1992–2004). Midlife cardiovascular health was assessed using Life's Simple 7. Cognition was measured up to four times with the Mini‐Mental State Examination. Generalized estimating equation models adjusted for age, sex, income, and education were used to relate cardiovascular factors to cognitive change. Sensitivity analyses evaluated attrition bias. RESULTS Physical activity was associated with slower cognitive decline, particularly among Mexican Americans. Body mass index < 30 kg/m 2 related to faster cognitive decline among Mexican Americans, but this was attenuated after attrition weighting. Fasting glucose < 126 mg/dL was associated with slower cognitive decline among non‐Hispanic Whites in attrition‐weighted models. DISCUSSION Physical activity and glycemic status were differentially associated with cognitive change across ethnicities.