Middle aged adults who avoid high blood pressure, diabetes and smoking may experience nearly 13 additional years of life without dementia, according to research led by NYU Langone Health. The findings connect cardiovascular wellness during midlife with cognitive health decades later.

The study, published in the journal Neurology Open Access, examined long term health data to assess how vascular risks between ages 48 and 68 were associated with later brain function. Researchers focused on three common factors: elevated blood pressure, diabetes and smoking.

Participants who avoided all three factors experienced substantially more years without dementia than those who had all three. However, the study was observational and could not establish direct cause and effect.

"Our findings argue that people need to actively avert these factors in midlife as a strategy for preserving brain health for more than a decade," said Dr. Josef Coresh, the study’s senior investigator and founding director of the Optimal Aging Institute at NYU Langone, in a press release.

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Coresh said identifying practical ways to delay memory loss is important because roughly 42% of Americans are projected to develop dementia after turning 55. The findings highlighted late middle age as a significant period for monitoring cardiovascular health.

The researchers reviewed information from the Atherosclerosis Risk in Communities study, an ongoing trial that began in 1986. The analysis included more than 12,000 participants who did not have dementia and whose average age was 56.

Participants were screened for smoking habits, elevated blood pressure and diabetes. Researchers then followed their health trajectories for an average of 26 years, allowing them to compare outcomes across different midlife risk profiles.

By the conclusion of the observation period, 3,008 participants had developed dementia. Another 5,238 participants died without experiencing cognitive impairment.

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A clear difference emerged between participants who avoided the three vascular risks and those who experienced all of them. People without any of the factors averaged 30 dementia free years after their baseline examinations.

In comparison, participants who had high blood pressure, diabetes and smoked averaged 17 years before developing dementia or dying. That difference amounted to nearly 13 additional years of life without dementia for those who avoided all three risks.

The results also showed differences based on sex. Female participants experienced longer periods of cognitive health than male participants, regardless of the number of vascular risks recorded.

Among people with all three factors, women lived an average of 18.1 years without dementia. Men with the same risk profile averaged 16.6 years without dementia.

Differences were also reported by race. White participants with all three factors averaged 19.6 dementia free years, while Black participants with the same three factors averaged 16.0 years.

"These results suggest that vascular risk reduction may benefit all groups, but that certain populations, such as Black adults, may especially benefit from targeted prevention efforts," Coresh said, expressing hope that the findings would encourage people to stop smoking and monitor cardiovascular health beginning in their late 40s.

The authors acknowledged several limitations. Because the research was observational, its findings could not prove that avoiding the three factors directly caused participants to experience more years without dementia.

Health status was also recorded during a single visit. As a result, some lifestyle changes that may have occurred during midlife were not reported in the available data.

Separately, Dr. Joe Verghese, MD, a neurologist at Stony Brook Medicine, said older adults who walked at a significantly faster speed than their peers were about half as likely to develop cognitive impairment. The central NYU Langone Health study, meanwhile, specifically examined smoking, diabetes and elevated blood pressure during midlife.

Overall, the research found a strong association between avoiding the three vascular factors from ages 48 to 68 and experiencing more years of life without dementia. Its authors emphasized cardiovascular prevention during midlife while noting that further research would be needed to establish cause and effect.