Introduction: Promoting cardiovascular health (CVH) by Life’s Simple 7 is associated with better cognitive function. In 2022, the American Heart Association (AHA) prompted Life’s Essential 8 (LE8) to strengthen CVH assessment. This study investigated the association between the new CVH metrics assessed by LE8 and cognitive function, thus providing evidence for implementing LE8 in the primordial prevention of cognitive impairment. Methods: 2,050 participants aged 60 and older from National Health and Nutrition Examination Survey 2011–2014 were included. Cognitive function was measured by the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). The overall and domain-specific cognitive function z-score was created. CVH score was calculated following AHA’s advisory. The multivariable linear regression model estimated the associations. Results: The CVH score assessed by LE8 was independently, positively, and linearly associated with the overall cognitive function. A per-10 point increase in CVH was associated with higher overall cognitive z-scores (β, 0.06; 95% confidence interval [CI], 0.03, 0.09), and participants with moderate (β, −0.14; 95% CI, −0.22, −0.05) and low CVH (β, −0.27; 95% CI, −0.37, −0.16) had lower overall cognitive z-scores compared to participants with high CVH. Similar patterns of associations were observed between CVH of AFT and DSST. Components of CVH were further associated with different domain-specific cognitive functions. Conclusion: Maintaining an ideal CVH improves cognitive function in older adults. Ideal adherence to individual components of LE8 was associated with improved overall and domain-specific cognitive functions. Therefore, promoting CVH according to LE8 might benefit cognitive function in the elderly.

Hayat SA, Luben R, Dalzell N, Moore S, Hogervorst E, Matthews FE, et al. Understanding the relationship between cognition and death: a within cohort examination of cognitive measures and mortality. Eur J Epidemiol. 2018;33(11):1049–62.
Jessen F, Amariglio RE, Buckley RF, van der Flier WM, Han Y, Molinuevo JL, et al. The characterisation of subjective cognitive decline. Lancet Neurol. 2020;19(3):271–8.
World Health Organisation. Dementia; 2022.
Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121(4):586–613.
Wu J, Xiong Y, Xia X, Orsini N, Qiu C, Kivipelto M, et al. Can dementia risk be reduced by following the American Heart Association’s Life’s Simple 7? A systematic review and dose-response meta-analysis. Ageing Res Rev. 2023;83:101788.
Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, et al. American Heart Association. Life’s essential 8: updating and enhancing the American Heart association’s construct of cardiovascular health: a presidential advisory from the American Heart association. Circulation. 2022;146(5):e18–43.
Leong RLF, Chee MWL. Understanding the need for sleep to improve cognition. Annu Rev Psychol. 2023;74:27–57.
Design and estimation for the national health interview survey, 1995-2004. Vital Health Stat 2. 2000;(130):1–31.
Parsons VL, Moriarity C, Jonas K, Moore TF, Davis KE, Tompkins L. Design and estimation for the national health interview survey, 2006-2015. Vital Health Stat 2. 2014(165):1–53.
Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, et al. The Consortium to establish a Registry for Alzheimer’s disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology. 1989;39(9):1159–65.
Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: administration, norms and commentary. New York: Oxford University Press; 2006.
Wechsler D. WAIS manual. New York: Psychological Corporation; 1997.
Lloyd-Jones DM, Ning H, Labarthe D, Brewer L, Sharma G, Rosamond W, et al. Status of cardiovascular health in US adults and children using the American Heart association’s new “life’s essential 8” metrics: prevalence estimates from the national health and nutrition examination survey (NHANES), 2013 through 2018. Circulation. 2022;146(11):822–35.
Caleyachetty R, Echouffo-Tcheugui JB, Muennig P, Zhu W, Muntner P, Shimbo D. Association between cumulative social risk and ideal cardiovascular health in US adults: NHANES 1999-2006. Int J Cardiol. 2015;191:296–300.
Graf GH, Li X, Kwon D, Belsky DW, Widom CS. Biological aging in maltreated children followed up into middle adulthood. Psychoneuroendocrinology. 2022;143:105848.
Tabaei BP, Chamany S, Driver CR, Kerker B, Silver L. Incidence of self-reported diabetes in New York City, 2002, 2004, and 2008. Prev Chronic Dis. 2012;9:E114.
U.S. Department of Health and Human Services. The Poverty Guidelines Updated Periodically in the Federal Register by the U.S. Department of Health and Human Services under the Authority of 42 U.S.C. 9902(2). Available from: [accessed on 8 September 2023].
Johnson CL, Paulose-Ram R, Ogden CL, Carroll MD, Kruszon-Moran D, Dohrmann SM, et al. National health and nutrition examination survey: analytic guidelines, 1999-2010. Vital Health Stat 2. 2013(161):1–24.
Wolter KM. Introduction to variance estimation. 2nd ed.Taylor series methods. New York: Springer; 2007.
Li H, Wang Z, Fu Z, Yan M, Wu N, Wu H, et al. Associations between blood cadmium levels and cognitive function in a cross-sectional study of US adults aged 60 years or older. BMJ Open. 2018;8(4):e020533.
Johannesen CDL, Langsted A, Mortensen MB, Nordestgaard BG. Association between low density lipoprotein and all cause and cause specific mortality in Denmark: prospective cohort study. BMJ. 2020;371:m4266.
Han X, Wang Y, Jiang Z, Li Y, Dong Y, Cong L, et al. Association of cardiovascular health metrics with dementia in rural Chinese older adults: a population-based study. Clin Interv Aging. 2022;17:947–56.
Samieri C, Perier MC, Gaye B, Proust-Lima C, Helmer C, Dartigues JF, et al. Association of cardiovascular health level in older age with cognitive decline and incident dementia. JAMA. 2018;320(7):657–64.
Wei J, Wang L, Kulshreshtha A, Xu H. Adherence to life’s Simple 7 and cognitive function among older adults: the national health and nutrition examination survey 2011 to 2014. J Am Heart Assoc. 2022;11(6):e022959.
Baradaran H, Demissie S, Himali JJ, Beiser A, Gupta A, Polak JF, et al. The progression of carotid atherosclerosis and imaging markers of dementia. Alzheimers Dement. 2020;6(1):e12015.
Wang R, Fratiglioni L, Kalpouzos G, Lövdén M, Laukka EJ, Bronge L, et al. Mixed brain lesions mediate the association between cardiovascular risk burden and cognitive decline in old age: a population-based study. Alzheimers Dement. 2017;13(3):247–56.
Foidl BM, Humpel C. Chronic treatment with five vascular risk factors causes cerebral amyloid angiopathy but no Alzheimer pathology in C57BL6 mice. Brain Behav Immun. 2019;78:52–64.
Iadecola C. Revisiting atherosclerosis and dementia. Nat Neurosci. 2020;23(6):691–2.
Sotaniemi M, Pulliainen V, Hokkanen L, Pirttilä T, Hallikainen I, Soininen H, et al. CERAD-neuropsychological battery in screening mild Alzheimer’s disease. Acta Neurol Scand. 2012;125(1):16–23.
Erickson KI, Donofry SD, Sewell KR, Brown BM, Stillman CM. Cognitive aging and the promise of physical activity. Annu Rev Clin Psychol. 2022;18:417–42.
Karlsson IK, Lehto K, Gatz M, Reynolds CA, Dahl Aslan AK. Age-dependent effects of body mass index across the adult life span on the risk of dementia: a cohort study with a genetic approach. BMC Med. 2020;18(1):131.
Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. 2005;4(8):487–99.
Lövdén M, Fratiglioni L, Glymour MM, Lindenberger U, Tucker-Drob EM. Education and cognitive functioning across the life span. Psychol Sci Public Interest. 2020;21(1):6–41.
Li R, Singh M. Sex differences in cognitive impairment and Alzheimer’s disease. Front Neuroendocrinol. 2014;35(3):385–403.
McCrimmon RJ, Ryan CM, Frier BM. Diabetes and cognitive dysfunction. Lancet. 2012;379(9833):2291–9.
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