European Journal of Epidemiology

, Volume 28, Issue 5, pp 405–416 | Cite as

Midlife cardiovascular risk factors and late cognitive impairment

  • Jyri J. Virta
  • Kauko Heikkilä
  • Markus Perola
  • Markku Koskenvuo
  • Ismo Räihä
  • Juha O. Rinne
  • Jaakko Kaprio


Cardiovascular risk factors increase the risk of dementia in later life. The aims of the current study were to assess the effect of multiple midlife cardiovascular risk factors on the risk of cognitive impairment in later life, and to assess the validity of the previously suggested CAIDE Study risk score predicting dementia risk 20 years later. A total of 2,165 Finnish twins were followed and at the end of the follow-up their cognitive status was assessed with a validated telephone interview. The assessment of the risk factors at baseline was based on a self-report questionnaire. Relative risk ratios (RR) were calculated and receiver operating characteristic analyses performed. Midlife obesity (RR 2.42, 95 % CI 1.47–3.98), hypertension (RR 1.38, 95 % CI 1.01–1.88) and low leisure time physical activity (RR 2.52, 95 % CI 1.10–5.76) increased the risk of cognitive impairment after a mean follow-up of 22.6 ± 2.3 years. Hypercholesterolemia did not significantly increase the risk (RR 1.52, 95 % CI 0.92–2.51). Overweight individuals who gained more than 10 % weight between 1981 and 1990 had an increased risk of cognitive impairment (RR 4.27, 95 % CI 1.62–11.2). The CAIDE Study risk score combining various individual risk factors had an area-under-curve of 0.74 (95 % CI 0.69–0.79, n = 591), and there was a strong association between an increasing risk score and the risk of cognitive impairment. The results indicate that multiple midlife cardiovascular risk factors increase the risk of cognitive impairment in later life. Also, a risk score including easily measurable midlife factors predicts an individual’s cognitive impairment risk well.


All cognitive disorders/dementia Alzheimer’s disease Risk factors in epidemiology Cohort studies 



Alzheimer’s disease


Finnish Cardiovascular Risk Factors, Aging and Dementia study






Mild impairment in cognitive function


Body mass index


Metabolic equivalent


Apolipoprotein E


Relative risk ratio

95 % CI

95 % confidence interval


Events per variable


Receiver operating characteristic




Odds ratio



The skilful assistance of research nurses Ulla Kulmala-Gråhn, Maarit Mantere and Kristiina Saanakorpi in interviewing the subjects is gratefully acknowledged. The assistance of Maarit Lappalainen at FIMM with ApoE genotyping is acknowledged. This study was financially supported by the Academy of Finland (project #205954), the Sigrid Juselius Foundation and Clinical grants of Turku University Hospital (EVO). The Finnish Twin Cohort study is part of the Academy of Finland Center of Excellence in Complex Disease Genetics (grant #s 213506, 129680).

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Jyri J. Virta
    • 1
    • 2
  • Kauko Heikkilä
    • 2
  • Markus Perola
    • 6
    • 7
  • Markku Koskenvuo
    • 2
  • Ismo Räihä
    • 4
    • 5
  • Juha O. Rinne
    • 1
    • 8
  • Jaakko Kaprio
    • 2
    • 3
    • 6
  1. 1.Turku PET CentreUniversity of Turku and Turku University HospitalTurkuFinland
  2. 2.Department of Public Health, Hjelt InstituteUniversity of HelsinkiHelsinkiFinland
  3. 3.Department of Mental Health and Substance Abuse ServicesNational Institute for Health and WelfareHelsinkiFinland
  4. 4.Institute of Clinical Medicine, Family MedicineUniversity of TurkuTurkuFinland
  5. 5.Department of Internal MedicineTurku City HospitalTurkuFinland
  6. 6.Institute for Molecular MedicineHelsinkiFinland
  7. 7.Unit for Genetic EpidemiologyNational Institute for Health and WelfareHelsinkiFinland
  8. 8.Department of NeurologyUniversity of Turku and Turku University HospitalTurkuFinland

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