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Background <p>Cardiometabolic risk factors contribute to cognitive decline and cerebrovascular pathology and are more prevalent among non-Hispanic Black (NHB) adults than non-Hispanic White (NHW) adults, with the greatest burden observed in males.</p> Methods <p>We analyzed 974 male participants (581 non-Hispanic White [NHW], 393 NHB) from the Health and Aging Brain Study – Health Disparities baseline visit. Multivariable linear regression models were used to examine associations between cardiometabolic risk factors, including hypertension, diabetes, dyslipidemia, obesity, and tobacco dependence, and outcomes of cognitive domain performance (memory, executive function, processing speed, and language) and white matter hyperintensity (WMH) burden, adjusting for age, education, apolipoprotein ε4 status, and race. Population intervention models (PIM), a counterfactual regression-based approach, were applied to estimate projected changes in cognition and WMH burden under hypothetical scenarios in which individual cardiometabolic risk factors were absent, with analyses stratified by racial ethnicity and mutually adjusted for the other cardiometabolic risks.</p> Results <p>Diabetes was associated with lower memory (β = − 0.14, 95% CI: − 0.27 to − 0.01) and language (β = − 0.15, 95% CI: − 0.29 to − 0.02). Tobacco dependence was linked to poorer performance across all domains (β range = − 0.20 to − 0.29). Hypertension was associated with greater WMH volume (β = 0.61, 95% CI: 0.09 to 1.12). PIM analyses projected memory gains from eliminating diabetes of 0.027 (95% CI: 0.002–0.052) in NHW and 0.039 (95% CI: 0.004–0.075) in NHB males, and gains from eliminating tobacco dependence of 0.015 (95% CI: 0.004–0.027) and 0.056 (95% CI: 0.017–0.098), respectively. Removing hypertension was projected to reduce WMH by − 0.394 (95% CI: − 0.769 to − 0.014) in NHW and − 0.481 (95% CI: − 0.940 to − 0.018) in NHB participants.</p>

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Projected Cognitive and Brain Aging Benefits of Eliminating Cardiometabolic Risks in Non-Hispanic White and Black Males – HABS-HD

  • 期刊论文

  • 发表日期：

    2026年3月5日

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  • Cellas A. Hayes,
  • Anhiti Dharmapuri,
  • Michelle C. Odden,
  • Roland J. Thorpe Jr.

摘要

Background

Cardiometabolic risk factors contribute to cognitive decline and cerebrovascular pathology and are more prevalent among non-Hispanic Black (NHB) adults than non-Hispanic White (NHW) adults, with the greatest burden observed in males.

Methods

We analyzed 974 male participants (581 non-Hispanic White [NHW], 393 NHB) from the Health and Aging Brain Study – Health Disparities baseline visit. Multivariable linear regression models were used to examine associations between cardiometabolic risk factors, including hypertension, diabetes, dyslipidemia, obesity, and tobacco dependence, and outcomes of cognitive domain performance (memory, executive function, processing speed, and language) and white matter hyperintensity (WMH) burden, adjusting for age, education, apolipoprotein ε4 status, and race. Population intervention models (PIM), a counterfactual regression-based approach, were applied to estimate projected changes in cognition and WMH burden under hypothetical scenarios in which individual cardiometabolic risk factors were absent, with analyses stratified by racial ethnicity and mutually adjusted for the other cardiometabolic risks.

Results

Diabetes was associated with lower memory (β = − 0.14, 95% CI: − 0.27 to − 0.01) and language (β = − 0.15, 95% CI: − 0.29 to − 0.02). Tobacco dependence was linked to poorer performance across all domains (β range = − 0.20 to − 0.29). Hypertension was associated with greater WMH volume (β = 0.61, 95% CI: 0.09 to 1.12). PIM analyses projected memory gains from eliminating diabetes of 0.027 (95% CI: 0.002–0.052) in NHW and 0.039 (95% CI: 0.004–0.075) in NHB males, and gains from eliminating tobacco dependence of 0.015 (95% CI: 0.004–0.027) and 0.056 (95% CI: 0.017–0.098), respectively. Removing hypertension was projected to reduce WMH by − 0.394 (95% CI: − 0.769 to − 0.014) in NHW and − 0.481 (95% CI: − 0.940 to − 0.018) in NHB participants.