Department of Social Medicine, Osaka University Graduate School of Medicine.
Department of Public Health, Kindai University Faculty of Medicine.
Environ Health Prev Med. 2023;28:11. doi: 10.1265/ehpm.22-00187.
Sex- and age-specific impacts of cardiovascular risk factors on the development of dementia have not been well evaluated. We investigated these impacts of smoking, overweight/obesity, hypertension, and diabetes mellitus on the risk of disabling dementia.
The study participants were 25,029 (10,134 men and 14,895 women) Japanese aged 40-74 years without disabling dementia at baseline (2008-2013). They were assessed on smoking status (non-current or current), overweight/obesity (body mass index ≥25 kg/m and ≥30 kg/m, respectively), hypertension (systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or any antihypertensive medication use), and diabetes mellitus (a fasting serum glucose ≥126 mg/dL, non-fasting glucose ≥200 mg/dL, hemoglobin A1c ≥6.5% by the National Glycohemoglobin Standardization Program or glucose-lowering medication use) at baseline. Disabling dementia was identified as the level of care required ≥1 and cognitive disability grade ≥IIa according to the National Long-term Care Insurance Database. We used a Cox proportional regression model to estimate hazard ratios and 95% confidence intervals (95% CIs) of disabling dementia according to the cardiovascular risk factors and calculated the population attributable fractions (PAFs).
During a median follow-up of 9.1 years, 1,322 (606 men and 716 women) developed disabling dementia. Current smoking and hypertension were associated with a higher risk of disabling dementia in both sexes, whereas overweight or obesity was not associated with the risk in either sex. Diabetes mellitus was associated with a higher risk only in women (p for sex interaction = 0.04). The significant PAFs were 13% for smoking and 14% for hypertension in men and 3% for smoking, 12% for hypertension, and 5% for diabetes mellitus in women. The total PAFs of the significant risk factors were 28% in men and 20% in women. When stratified by age, hypertension in midlife (40-64 years) was associated with the increased risk in men, while diabetes mellitus in later-life (65-74 years) was so in women.
A substantial burden of disabling dementia was attributable to smoking, and hypertension in both sexes and diabetes mellitus in women, which may require the management of these cardiovascular risk factors to prevent dementia.
心血管危险因素对痴呆发展的性别和年龄特异性影响尚未得到很好的评估。我们研究了吸烟、超重/肥胖、高血压和糖尿病对致残性痴呆风险的这些影响。
研究参与者为 25029 名（男性 10134 名，女性 14895 名）年龄在 40-74 岁之间、基线时无致残性痴呆的日本成年人（2008-2013 年）。他们的吸烟状况（非当前或当前）、超重/肥胖（体重指数分别≥25kg/m 和≥30kg/m）、高血压（收缩压≥140mmHg，舒张压≥90mmHg 或任何降压药物使用）和糖尿病（空腹血清葡萄糖≥126mg/dL，非空腹血糖≥200mg/dL，糖化血红蛋白≥6.5%由国家糖化血红蛋白标准化计划或降糖药物使用）在基线时进行评估。根据国家长期护理保险数据库，致残性痴呆被确定为需要≥1 级护理和认知残疾等级≥IIa 的水平。我们使用 Cox 比例风险回归模型根据心血管危险因素估计致残性痴呆的风险比和 95%置信区间（95%CI），并计算人群归因分数（PAF）。
在中位随访 9.1 年期间，1322 名（男性 606 名，女性 716 名）发生了致残性痴呆。目前吸烟和高血压与两性致残性痴呆的风险增加相关，而超重或肥胖与两性的风险无关。糖尿病仅与女性的风险增加相关（性别交互作用的 p 值=0.04）。男性中吸烟和高血压的显著 PAF 分别为 13%和 14%，女性中吸烟、高血压和糖尿病的 PAF 分别为 3%、12%和 5%。显著危险因素的总 PAF 分别为男性的 28%和女性的 20%。按年龄分层时，中年（40-64 岁）的高血压与男性的风险增加相关，而老年（65-74 岁）的糖尿病与女性的风险增加相关。
大量的致残性痴呆归因于吸烟以及两性的高血压和女性的糖尿病，这可能需要管理这些心血管危险因素以预防痴呆。
