Key result
High cardiorespiratory fitness is linked to ~31% lower dementia risk despite elevated coronary calcium.
Why the study?
The independent and joint associations of cardiorespiratory fitness and coronary artery calcium with dementia remain unclear.
Are higher cardiorespiratory fitness and lower coronary artery calcium independently associated with a reduced risk of incident later-life dementia in community-dwelling adults?
Cohort (n=10,933)
No
Are higher cardiorespiratory fitness and lower coronary artery calcium independently associated with a reduced risk of incident later-life dementia in community-dwelling adults?
Hazard Ratio: 0.69 (95% CI 0.53–0.9)
Absolute Event Rate: 10.8% vs 14.8%
Higher midlife cardiorespiratory fitness and lower coronary artery calcium are independently associated with a reduced risk of later-life dementia, highlighting the importance of lifelong cardiovascular health for brain aging.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The findings underscore the potential role of both physical fitness and long-term cardiovascular health in dementia risk reduction.”
High CRF and CAC ≥100 may aid midlife dementia risk stratification; extends prior markers to brain aging but leaves causality open.
BACKGROUND: Cardiorespiratory fitness (CRF) and coronary artery calcium (CAC) are established cardiovascular risk markers reflecting physiological reserve and subclinical atherosclerosis, respectively. Their independent and joint associations with dementia remain unclear. OBJECTIVES: We examined mid-to-late midlife CRF and CAC in relation to later-life dementia within a large U.S. METHODS: Participants in the Cooper Center Longitudinal Study (1998-2018) were linked to Medicare claims (1999-2019). CRF was estimated via maximal treadmill testing (categorized as age- and sex-specific low, moderate, or high); CAC was categorized as <100 vs ≥100 Agatston units. Incident all-cause dementia was identified via Medicare surveillance. Parametric illness-death models estimated HRs for dementia, accounting for competing mortality and adjusting for demographic, behavioral, and cardiometabolic risk factors, with mutual adjustment for CRF and CAC. RESULTS: Among 10,933 participants free of cardiovascular disease and dementia at baseline (mean age 57.2 years; 30.2% women), 868 dementia cases occurred over a median follow-up of 5.8 years. After multivariable adjustment, high CRF (vs low) was associated with a lower dementia risk (HR: 0.69; 95% CI: 0.53-0.90), whereas CAC ≥100 (vs <100) was associated with a higher risk (HR: 1.24; 95% CI: 1.07-1.44). Continuous analyses demonstrated a linear inverse association for CRF and a graded positive association for CAC. No interaction between CRF and CAC was observed. CONCLUSIONS: Lower CRF and higher CAC are independently associated with incident dementia. These findings support complementary, nonoverlapping roles of functional fitness and cumulative vascular injury in dementia pathogenesis, highlighting the importance of lifelong cardiovascular health.
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Gerber et al. (2026) conducted a cohort in Dementia (n=10,933). High cardiorespiratory fitness (CRF) vs. Low cardiorespiratory fitness (CRF) was evaluated on Incident all-cause dementia (HR 0.69, 95% CI 0.53-0.90). High cardiorespiratory fitness (vs low) was associated with a lower dementia risk (HR 0.69), whereas coronary artery calcium ≥100 (vs <100) was associated with a higher risk (HR 1.24).