Optimal Cardiovascular Health May Offset Dementia Risk in Type 2 Diabetes Patients

A preliminary study to be presented at the American Heart Association's Scientific Sessions 2025 reveals that optimal cardiovascular health may offset the risk of developing mild cognitive impairment and dementia for people with Type 2 diabetes, including those with high genetic risk for cognitive decline. The research examined health and genetic data from the UK Biobank for more than 40,000 dementia-free adults with Type 2 diabetes over a 13-year period.

According to the American Heart Association's 2025 Heart Disease and Stroke Statistics Update, Type 2 diabetes is associated with worse cognitive functioning and faster cognitive decline. This study specifically investigated the combined impact of cardiovascular health, based on the Heart Association's Life's Essential 8, and genetic risk for dementia on cognitive outcomes in adults with Type 2 diabetes.

The findings showed that during the 13-year follow-up period, 840 participants developed mild cognitive impairment and 1,013 developed dementia. After adjusting for age, sex and race, participants with moderate or high cardiovascular health had a 15% lower risk of developing mild cognitive impairment and a 15% lower risk of developing dementia compared to those with low cardiovascular health. Among participants with a high genetic risk score, those with moderate or high cardiovascular health had an even more substantial reduction - 27% lower risk of developing mild cognitive impairment and 23% lower risk of developing dementia compared to those with low cardiovascular health.

"Genes are not destiny. Maintaining optimal cardiovascular health can protect brain health even for people with Type 2 diabetes who carry the highest genetic risk for dementia," said study first author Xiu Wu, Ph.D., a postdoctoral fellow of medicine in the Yilin Yoshida Lab at Tulane University School of Medicine in New Orleans. "That means, if you have a family history of Alzheimer's or cognitive impairment, you can make the modifiable lifestyle changes that may help protect yourself."

The study also found that better cardiovascular health scores were positively and significantly associated with brain volume, indicating that people with higher Life's Essential 8 scores were more likely to have maintained brain volume. While brain volume loss is a natural part of aging, it is also a feature of cognitive decline and dementia. An analysis of U.S. adults from the National Institutes of Health's All of Us Research Hub showed similar trends, with 667 adults developing mild cognitive impairment and 538 developing dementia during a 15-year follow-up period.

Life's Essential 8 includes eight essential components for ideal heart and brain health: eating better, being more active, quitting tobacco, getting healthy sleep, managing weight, controlling cholesterol, managing blood sugar, and managing blood pressure. Study corresponding author Yilin Yoshida, Ph.D., M.P.H., FAHA, explained that "there are multiple factors associated with Type 2 diabetes that contribute to an increased risk of cognitive decline and dementia. People with Type 2 diabetes tend to have more obesity, higher blood pressure and insulin resistance. Controlling all those factors is also good for improving cardiovascular health."

Hugo Aparicio, M.D., M.P.H., FAHA, volunteer chair of the American Heart Association's Stroke Council Brain Health Committee, noted that "there has been previous research showing the benefits of following Life's Essential 8 to reduce cognitive impairment in other populations, so it is interesting to observe these study results supporting similar findings among people with Type 2 diabetes, whom we know are also at increased risk for Alzheimer's disease and dementia. It's another great example of what's good for the heart is good for the brain, even when your genes may be stacked against you."

The researchers emphasized that while the study had limitations as an observational review that cannot establish cause and effect, the findings support the importance of cardiovascular health maintenance for brain protection. Yoshida concluded that "in the past, we focused on the message: live healthy, live long. However, it's not just living long, it's living long and maintaining our cognitive function and capacity for longer independence and better quality of life. Our study's findings support that you can do both."