Optimal cardiovascular health among people with Type 2 diabetes may offset dementia risk: Study

Having optimal cardiovascular health may offset the risk of developing mild cognitive impairment and dementia for people with Type 2 diabetes (T2D), even among those with a high genetic risk for cognitive decline, according to a preliminary study to be presented at the American Heart Association’s Scientific Sessions 2025. The meeting, Nov. 7-10, in New Orleans, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

According to the American Heart Association’s 2025 Heart Disease and Stroke Statistics Update, Type 2 diabetes is associated with worse cognitive functioning and faster cognitive decline. This study examined the combined impact of cardiovascular health, based on the Heart Association’s Life’s Essential 8, or LE8, and a high genetic risk for dementia on the risk of developing mild cognitive impairment and dementia in adults with Type 2 diabetes.

Life’s Essential 8 is a measure of cardiovascular health that includes eight essential components for ideal heart and brain health, as identified by the American Heart Association – 4 health behaviors and 4 health factors, including:

♦ Eat better.

♦ Be more active.

♦ Quit tobacco.

♦ Get healthy sleep.

♦ Manage weight.

♦ Control cholesterol.

♦ Manage blood sugar.

♦ Manage blood pressure.

“There are multiple factors associated with Type 2 diabetes that contribute to an increased risk of cognitive decline and dementia. People with Type 2 diabetes tend to have more obesity, higher blood pressure and insulin resistance. Controlling all those factors is also good for improving cardiovascular health,” said study corresponding author Yilin Yoshida, Ph.D., M.P.H., FAHA, an assistant professor of medicine and head of a research lab which studies precision diabetes management at Tulane University School of Medicine in New Orleans. “Our study found that following steps to improve cardiovascular health can also reduce the risk for cognitive impairment among people with Type 2 diabetes.”

Researchers examined health and genetic data in the UK Biobank for more than 40,000 dementia-free adults with Type 2 diabetes. They assessed the joint effects of cardiovascular health and a genetic risk for dementia on the risk of developing mild cognitive impairment and dementia over 13 years.

An Alzheimer’s disease-based polygenic risk score was used to predict incident dementia and to capture genetic susceptibility to cognitive decline, with genetic risk categorized by high, moderate and low.

The analysis found:

♦ During the 13-year follow-up period, 840 of the participants developed mild cognitive impairment and 1,013 developed dementia.

♦ Overall, after adjusting for age, sex and race, participants with moderate or high cardiovascular health had a 15% lower risk of developing mild cognitive impairment and a 15% lower risk of developing dementia compared to those with low cardiovascular health.

♦ Among participants with a high genetic risk score, those with moderate or high cardiovascular health had a 27% lower risk of developing mild cognitive impairment and a 23% lower risk of developing dementia compared to those with low cardiovascular health.

♦ Better cardiovascular health scores were also positively and significantly associated with brain volume, signifying that people with higher Life’s Essential 8 scores were more likely to have maintained brain volume. While a loss of brain volume is a natural part of the aging process, it is also a feature of cognitive decline and dementia.

♦ An analysis of U.S. adults showed similar trends.

“Genes are not destiny. Maintaining optimal cardiovascular health can protect brain health even for people with Type 2 diabetes who carry the highest genetic risk for dementia,” said study first author Xiu Wu, Ph.D., a postdoctoral fellow of medicine in the Yilin Yoshida Lab at Tulane University School of Medicine in New Orleans. “That means, if you have a family history of Alzheimer’s or cognitive impairment, you can make the modifiable lifestyle changes that may help protect yourself.”

“There has been previous research showing the benefits of following Life’s Essential 8 to reduce cognitive impairment in other populations, so it is interesting to observe these study results supporting similar findings among people with Type 2 diabetes, whom we know are also at increased risk for Alzheimer’s disease and dementia,” said Hugo Aparicio, M.D., M.P.H., FAHA, volunteer chair of the American Heart Association’s Stroke Council Brain Health Committee. “It’s another great example of what’s good for the heart is good for the brain, even when your genes may be stacked against you.” Aparicio, who was not involved in this study, is an associate professor of Neurology at Boston University Chobanian & Avedisian School of Medicine.

The researchers noted the study had some limitations. It was an observational review of data and cannot establish cause and effect. Since most people do not undergo testing for genetic risk for dementia they may not know if they are at risk for it or not, although it is not known if participants in this study had such genetic testing.

“In the past, we focused on the message: live healthy, live long. However, it’s not just living long, it’s living long and maintaining our cognitive function and capacity for longer independence and better quality of life. Our study’s findings support that you can do both,” Yoshida said. “Maintaining optimal cardiovascular health can protect brain health even for people with Type 2 diabetes who carry the highest genetic risk for dementia.”

Study details, background or design:

♦ Health and genetic data were taken from the UK Biobank, a large-scale biomedical database that includes genetic and health information for over 500,000 adults living in the United Kingdom, ages 40 to 69 years when they enrolled between 2006 and 2010.

♦ This analysis included cardiovascular health data for 15,613 dementia-free adults with Type 2 diabetes. An additional analysis of 20,160 dementia-free adults from the National Institutes of Health’s All of Us Research Hub was also reviewed for comparison to a representative U.S. population.

♦ Cardiovascular health was assessed using the American Heart Association’s Life’s Essential 8 score. Cardiovascular health was classified as high (80-100 score), moderate (50-79 score) and low (0-49 score) based on eight metrics: smoking status, physical activity, diet, sleep, body mass index, blood pressure, blood glucose levels and cholesterol levels. The data was collected at the initial assessment visit (2006-2010) at which participants were recruited and consent given, then repeated during a repeat assessment visit (2012-13), at an initial imaging visit after 2014 and at a repeat imaging visit after 2019.

♦ A group of more than 20,000 dementia-free adults from the National Institutes of Health’s All of Us Research Hub was also reviewed for a comparison representative of the general U.S. population. Researchers noted 667 adults had mild cognitive impairment and 538 adults had dementia during a 15-year follow-up period.

Reference: Optimal cardiovascular health among people with Type 2 diabetes may offset dementia risk, American Heart Association, Meeting: American Heart Association Scientific Sessions 2025.