Racial/ethnic disparities in young adulthood and midlife cardiovascular risk factors and late-life cognitive domains the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study

Background: Midlife cardiovascular risk factors (CVRF) increase dementia risk. Less is known about whether CVRF identified before midlife impact late-life cognition in diverse populations. Methods: Linear regression models examined hypertension, hyperlipidemia, and overweight/obesity at ages 30 to 59 with late-life executive function, semantic memory, verbal episodic memory, and global cognition in a cohort of Asians, blacks, Latinos, and whites (n = 1127; mean age = 75.8, range = 65 to 98). Models adjusted for age at CVRF, age at cognitive assessment, sex, race/ethnicity, participant education, and parental education. Results: Overall, 34% had 1 CVRF at ages 30 to 59; 19% had 2+. Blacks (26%) and Latinos (23%) were more likely to have 2+ CVRF than Asians (14%) or whites (13%). Having 2+ CVRF was associated with lower global cognition [β = −0.33; 95% confidence interval (CI) = −0.45, −0.21], executive function (β = −0.26; 95% CI = −0.39, −0.13), verbal episodic memory (β = −0.34; 95% CI = −0.48, −0.20), and semantic memory (β = −0.20; 95% CI = −0.33, −0.07). Interaction by age (P = 0.06) indicated overweight/obesity was negatively associated with executive function at ages 30 to 39 but not at ages 40 to 59. Race/ethnic-specific effects showed disparities in CVRF prevalence impact population disparities in late-life cognition. Conclusion: Being overweight/obese in early adulthood and having 2+ CVRF in early adulthood/midlife are modifiable targets to redress racial/ethnic disparities in cognitive impairment and dementia.