04157nas a2200409 4500008004100000022001400041245009900055210006900154260001600223520291000239100002303149700002003172700002303192700002103215700002403236700002703260700002303287700002303310700002303333700002003356700002603376700002303402700002103425700002003446700002603466700002203492700001903514700002303533700002003556700002003576700002003596700002303616700002403639700002403663700002403687856003603711 2020 eng d a2168-615700aAssociation Between Blood Pressure and Later-Life Cognition Among Black and White Individuals.0 aAssociation Between Blood Pressure and LaterLife Cognition Among c2020 Apr 133 a

Importance: Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain.

Objective: To determine whether cumulative BP levels explain racial differences in cognitive decline.

Design, Setting, and Participants: Individual participant data from 5 cohorts (January 1971 to December 2017) were pooled from the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. The median (interquartile range) follow-up was 12.4 (5.9-21.0) years. Analysis began September 2018.

Main Outcomes and Measures: The primary outcome was change in global cognition, and secondary outcomes were change in memory and executive function.

Exposures: Race (black vs white).

Results: Among 34 349 participants, 19 378 individuals who were free of stroke and dementia and had longitudinal BP, cognitive, and covariate data were included in the analysis. The mean (SD) age at first cognitive assessment was 59.8 (10.4) years and ranged from 5 to 95 years. Of 19 378 individuals, 10 724 (55.3%) were female and 15 526 (80.1%) were white. Compared with white individuals, black individuals had significantly faster declines in global cognition (-0.03 points per year faster [95% CI, -0.05 to -0.01]; P = .004) and memory (-0.08 points per year faster [95% CI, -0.11 to -0.06]; P < .001) but significantly slower declines in executive function (0.09 points per year slower [95% CI, 0.08-0.10]; P < .001). Time-dependent cumulative mean systolic BP level was associated with significantly faster declines in global cognition (-0.018 points per year faster per each 10-mm Hg increase [95% CI, -0.023 to -0.014]; P < .001), memory (-0.028 points per year faster per each 10-mm Hg increase [95% CI, -0.035 to -0.021]; P < .001), and executive function (-0.01 points per year faster per each 10-mm Hg increase [95% CI, -0.014 to -0.007]; P < .001). After adjusting for cumulative mean systolic BP, differences between black and white individuals in cognitive slopes were attenuated for global cognition (-0.01 points per year [95% CI, -0.03 to 0.01]; P = .56) and memory (-0.06 points per year [95% CI, -0.08 to -0.03]; P < .001) but not executive function (0.10 points per year [95% CI, 0.09-0.11]; P < .001).

Conclusions and Relevance: These results suggest that black individuals' higher cumulative BP levels may contribute to racial differences in later-life cognitive decline.

1 aLevine, Deborah, A1 aGross, Alden, L1 aBriceño, Emily, M1 aTilton, Nicholas1 aKabeto, Mohammed, U1 aHingtgen, Stephanie, M1 aGiordani, Bruno, J1 aSussman, Jeremy, B1 aHayward, Rodney, A1 aBurke, James, F1 aElkind, Mitchell, S V1 aManly, Jennifer, J1 aMoran, Andrew, E1 aKulick, Erin, R1 aGottesman, Rebecca, F1 aWalker, Keenan, A1 aYano, Yuichiro1 aGaskin, Darrell, J1 aSidney, Stephen1 aYaffe, Kristine1 aSacco, Ralph, L1 aWright, Clinton, B1 aRoger, Veronique, L1 aAllen, Norrina, Bai1 aGalecki, Andrzej, T uhttps://chs-nhlbi.org/node/839803920nas a2200505 4500008004100000022001400041245005800055210005700113260001500170300001200185490000600197520255500203653000902758653002602767653002202793653001902815653002302834653001102857653001102868653001602879653000902895653001602904653001702920653001802937100002302955700002002978700002302998700002103021700002303042700002303065700002303088700002003111700002403131700002603155700002303181700002603204700002303230700002003253700002003273700001803293700002303311700002003334700002403354856003603378 2021 eng d a2574-380500aSex Differences in Cognitive Decline Among US Adults.0 aSex Differences in Cognitive Decline Among US Adults c2021 02 01 ae2101690 v43 a

Importance: Sex differences in dementia risk are unclear, but some studies have found greater risk for women.

Objective: To determine associations between sex and cognitive decline in order to better understand sex differences in dementia risk.

Design, Setting, and Participants: This cohort study used pooled analysis of individual participant data from 5 cohort studies for years 1971 to 2017: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Linear mixed-effects models were used to estimate changes in each continuous cognitive outcome over time by sex. Data analysis was completed from March 2019 to October 2020.

Exposure: Sex.

Main Outcomes and Measures: The primary outcome was change in global cognition. Secondary outcomes were change in memory and executive function. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition.

Results: Among 34 349 participants, 26 088 who self-reported Black or White race, were free of stroke and dementia, and had covariate data at or before the first cognitive assessment were included for analysis. Median (interquartile range) follow-up was 7.9 (5.3-20.5) years. There were 11 775 (44.7%) men (median [interquartile range] age, 58 [51-66] years at first cognitive assessment; 2229 [18.9%] Black) and 14 313 women (median [interquartile range] age, 58 [51-67] years at first cognitive assessment; 3636 [25.4%] Black). Women had significantly higher baseline performance than men in global cognition (2.20 points higher; 95% CI, 2.04 to 2.35 points; P < .001), executive function (2.13 points higher; 95% CI, 1.98 to 2.29 points; P < .001), and memory (1.89 points higher; 95% CI, 1.72 to 2.06 points; P < .001). Compared with men, women had significantly faster declines in global cognition (-0.07 points/y faster; 95% CI, -0.08 to -0.05 points/y; P < .001) and executive function (-0.06 points/y faster; 95% CI, -0.07 to -0.05 points/y; P < .001). Men and women had similar declines in memory (-0.004 points/y faster; 95% CI, -0.023 to 0.014; P = .61).

Conclusions and Relevance: The results of this cohort study suggest that women may have greater cognitive reserve but faster cognitive decline than men, which could contribute to sex differences in late-life dementia.

10aAged10aCognitive Dysfunction10aCognitive Reserve10aCohort Studies10aExecutive Function10aHumans10aMemory10aMiddle Aged10aRisk10aSex Factors10aTime Factors10aUnited States1 aLevine, Deborah, A1 aGross, Alden, L1 aBriceño, Emily, M1 aTilton, Nicholas1 aGiordani, Bruno, J1 aSussman, Jeremy, B1 aHayward, Rodney, A1 aBurke, James, F1 aHingtgen, Stephanie1 aElkind, Mitchell, S V1 aManly, Jennifer, J1 aGottesman, Rebecca, F1 aGaskin, Darrell, J1 aSidney, Stephen1 aSacco, Ralph, L1 aTom, Sarah, E1 aWright, Clinton, B1 aYaffe, Kristine1 aGalecki, Andrzej, T uhttps://chs-nhlbi.org/node/870903752nas a2200493 4500008004100000022001400041245008000055210006900135260001600204300001400220490000800234520239900242653000902641653003002650653001402680653002602694653001102720653001102731653000902742653001602751653001202767653001702779653001802796653001002814100002002824700002402844700002102868700002102889700002302910700002602933700002802959700002602987700002203013700002003035700002303055700002303078700002003101700002003121700002003141700001803161700002003179700002303199856003603222 2023 eng d a1526-632X00aAssociation of Obesity With Cognitive Decline in Black and White Americans.0 aAssociation of Obesity With Cognitive Decline in Black and White c2023 Jan 10 ae220-e2310 v1003 a

BACKGROUND AND OBJECTIVES: There are disparities in the prevalence of obesity by race, and the relationship between obesity and cognitive decline is unclear. The objective of this study was to determine whether obesity is independently associated with cognitive decline and whether the association between obesity and cognitive decline differs in Black and White adults. We hypothesized that obesity is associated with greater cognitive decline compared with normal weight and that the effect of obesity on cognitive decline is more pronounced in Black adults compared with their White counterparts.

METHODS: We pooled data from 28,867 participants free of stroke and dementia (mean, SD: age 61 [10.7] years at the first cognitive assessment, 55% female, 24% Black, and 29% obese) from 6 cohorts. The primary outcome was the annual change in global cognition. We performed linear mixed-effects models with and without time-varying cumulative mean systolic blood pressure (SBP) and fasting plasma glucose (FPG). Global cognition was set to a t-score metric (mean 50, SD 10) at a participant's first cognitive assessment; a 1-point difference represents a 0.1 SD difference in global cognition across the 6 cohorts. The median follow-up was 6.5 years (25th percentile, 75th percentile: 5.03, 20.15).

RESULTS: Obese participants had lower baseline global cognition than normal-weight participants (difference in intercepts, -0.36 [95% CI, -0.46 to -0.17]; < 0.001). This difference in baseline global cognition was attenuated but was borderline significant after accounting for SBP and FPG (adjusted differences in intercepts, -0.19 [95% CI, -0.39 to 0.002]; = 0.05). There was no difference in the rate of decline in global cognition between obese and normal-weight participants (difference in slope, 0.009 points/year [95% CI, -0.009 to 0.03]; = 0.32). After accounting for SBP and FPG, obese participants had a slower decline in global cognition (adjusted difference in slope, 0.03 points/year slower [95% CI, 0.01 to 0.05]; < 0.001). There was no evidence that race modified the association between body mass index and global cognitive decline ( = 0.34).

DISCUSSION: These results suggest that obesity is associated with lower initial cognitive scores and may potentially attenuate declines in cognition after accounting for BP and FPG.

10aAged10aBlack or African American10aCognition10aCognitive Dysfunction10aFemale10aHumans10aMale10aMiddle Aged10aObesity10aRisk Factors10aUnited States10aWhite1 aQuaye, Emmanuel1 aGalecki, Andrzej, T1 aTilton, Nicholas1 aWhitney, Rachael1 aBriceño, Emily, M1 aElkind, Mitchell, S V1 aFitzpatrick, Annette, L1 aGottesman, Rebecca, F1 aGriswold, Michael1 aGross, Alden, L1 aHeckbert, Susan, R1 aHughes, Timothy, M1 aLongstreth, W T1 aSacco, Ralph, L1 aSidney, Stephen1 aWindham, Gwen1 aYaffe, Kristine1 aLevine, Deborah, A uhttps://chs-nhlbi.org/node/929104118nas a2200577 4500008004100000022001400041245009700055210006900152260001600221300001200237490000600249520255000255653001002805653000902815653003002824653001902854653002402873653001402897653001102911653002302922653001102945653001702956653001402973653002002987653002503007653000903032653001603041653001803057653001703075653001103092653002803103653001803131653001003149653001703159100002303176700001403199700001503213700002603228700002403254700002403278700002603302700002303328700002003351700002603371700002003397700002303417700001803440700002303458700002303481856003603504 2024 eng d a2574-380500aCumulative Systolic Blood Pressure and Incident Stroke Type Variation by Race and Ethnicity.0 aCumulative Systolic Blood Pressure and Incident Stroke Type Vari c2024 May 01 ae2485020 v73 a

IMPORTANCE: Stroke risk varies by systolic blood pressure (SBP), race, and ethnicity. The association between cumulative mean SBP and incident stroke type is unclear, and whether this association differs by race and ethnicity remains unknown.

OBJECTIVE: To examine the association between cumulative mean SBP and first incident stroke among 3 major stroke types-ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)-and explore how these associations vary by race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: Individual participant data from 6 US longitudinal cohorts (January 1, 1971, to December 31, 2019) were pooled. The analysis was performed from January 1, 2022, to January 2, 2024. The median follow-up was 21.6 (IQR, 13.6-31.8) years.

EXPOSURE: Time-dependent cumulative mean SBP.

MAIN OUTCOMES AND MEASURES: The primary outcome was time from baseline visit to first incident stroke. Secondary outcomes consisted of time to first incident IS, ICH, and SAH.

RESULTS: Among 40 016 participants, 38 167 who were 18 years or older at baseline with no history of stroke and at least 1 SBP measurement before the first incident stroke were included in the analysis. Of these, 54.0% were women; 25.0% were Black, 8.9% were Hispanic of any race, and 66.2% were White. The mean (SD) age at baseline was 53.4 (17.0) years and the mean (SD) SBP at baseline was 136.9 (20.4) mm Hg. A 10-mm Hg higher cumulative mean SBP was associated with a higher risk of overall stroke (hazard ratio [HR], 1.20 [95% CI, 1.18-1.23]), IS (HR, 1.20 [95% CI, 1.17-1.22]), and ICH (HR, 1.31 [95% CI, 1.25-1.38]) but not SAH (HR, 1.13 [95% CI, 0.99-1.29]; P = .06). Compared with White participants, Black participants had a higher risk of IS (HR, 1.20 [95% CI, 1.09-1.33]) and ICH (HR, 1.67 [95% CI, 1.30-2.13]) and Hispanic participants of any race had a higher risk of SAH (HR, 3.81 [95% CI, 1.29-11.22]). There was no consistent evidence that race and ethnicity modified the association of cumulative mean SBP with first incident stroke and stroke type.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that cumulative mean SBP was associated with incident stroke type, but the associations did not differ by race and ethnicity. Culturally informed stroke prevention programs should address modifiable risk factors such as SBP along with social determinants of health and structural inequities in society.

10aAdult10aAged10aBlack or African American10aBlood Pressure10aCerebral Hemorrhage10aEthnicity10aFemale10aHispanic or Latino10aHumans10aHypertension10aIncidence10aIschemic Stroke10aLongitudinal Studies10aMale10aMiddle Aged10aRacial Groups10aRisk Factors10aStroke10aSubarachnoid Hemorrhage10aUnited States10aWhite10aWhite People1 aJohnson, Kimson, E1 aLi, Hanyu1 aZhang, Min1 aSpringer, Mellanie, V1 aGalecki, Andrzej, T1 aWhitney, Rachael, T1 aGottesman, Rebecca, F1 aHayward, Rodney, A1 aSidney, Stephen1 aElkind, Mitchell, S V1 aLongstreth, W T1 aHeckbert, Susan, R1 aGerber, Yariv1 aSullivan, Kevin, J1 aLevine, Deborah, A uhttps://chs-nhlbi.org/node/9972