Cardiovascular health in midlife may influence mental function later in life.
A person’s activity level and blood sugar in middle age may help shape how quickly thinking skills decline decades later. Research from UT Health San Antonio, the academic health center of The University of Texas at San Antonio, found that physical activity and better glucose control were associated with slower cognitive decline, although the strongest patterns differed by ethnicity.
The study followed 402 San Antonio residents, 52% of whom were Hispanic and the rest non-Hispanic white. Participants had an average age of 57.9 years, and 58.5% were women.
Physical activity was especially strongly associated with slower cognitive decline among Hispanic participants. Among non-Hispanic white participants, lower fasting blood glucose was linked to a slower rate of decline.
“By improving cardiovascular health through modifiable lifestyle changes, there is a potential to meaningfully alleviate the public health burden of Alzheimer’s disease and other dementias, particularly in high-risk populations,” said Claudia Satizabal, PhD, associate professor in the Department of Population Health Sciences at UT Health San Antonio and its Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, where she leads the Population Neuroscience Core.
Satizabal is co-senior author with Chen-Pin Wang, PhD, associate professor-research in the Department of Population Health Sciences. Their study, titled “Longitudinal association between midlife cardiovascular health and cognitive change in a bi-ethnic cohort,” was published July 23 in Alzheimer’s & Dementia: Behavior & Socioeconomics of Aging.
Heart health may shape brain aging
All of the authors are affiliated with the Glenn Biggs Institute or The University of Texas Rio Grande Valley.
As life expectancy rises and older adults make up a larger share of the population, dementia and other conditions associated with aging are becoming more common. Alzheimer’s disease currently affects 6.7 million people in the United States.
Evidence increasingly indicates that modifiable risk factors contribute substantially to dementia and cognitive decline. Recent estimates attribute nearly 40% of Alzheimer’s cases to such factors, with cardiovascular health emerging as a major influence on how the brain ages.
The American Heart Association’s Life’s Simple 7 (LS7) framework combines three behavioral measures, a healthy diet, not smoking, and physical activity, with four health measures, blood pressure, body mass index, total cholesterol, and fasting blood glucose. Researchers use the combined score to evaluate cardiovascular health, and the framework has also been proposed as a way to support brain health.
Earlier studies have linked higher LS7 scores with stronger cognitive performance, healthier brains, and lower dementia risk. However, those associations do not appear to be the same across all populations.
Hispanic adults remain underrepresented
Hispanic older adults carry a disproportionate burden of Alzheimer’s disease and related dementias. About 14% of Hispanic adults aged 65 or older have Alzheimer’s, compared with 10% of non-Hispanic white adults in the same age group.
Mexican Americans, the largest Hispanic population in the United States, also have particularly high rates of diabetes, obesity, and dyslipidemia, which involves unhealthy levels of fats in the blood. Each condition contributes to an elevated risk of dementia.
Despite these disparities, Hispanic communities remain underrepresented in Alzheimer’s research. This limits scientists’ ability to trace how risk develops over time and to identify prevention strategies that may work across different populations.
Decades of data enable comparison
To address that gap, UT Health San Antonio researchers examined whether cardiovascular health in middle age, measured through LS7 scores, was associated with later cognitive decline among Mexican American and non-Hispanic white adults.
The participants had taken part in the San Antonio Heart Study (SAHS) and later joined the San Antonio Longitudinal Study of Aging (SALSA).
The SAHS was a long-term UT Health San Antonio research project that investigated the causes of Type 2 diabetes and heart disease from 1979 through the 2000s. It followed more than 5,000 people to examine why certain ethnic groups experienced greater health risks.
SALSA grew from that earlier work. The long-term observational study followed older SAHS participants to investigate chronic illness, healthy aging, and the process through which people develop disabilities.
“Importantly, the inclusion of both ethnic groups from the same source population and geographic setting allows for direct comparison within a shared contextual framework and strengthens our ability to identify disparities in cognitive aging and their cardiovascular correlates,” the new study notes.
For the latest analysis, researchers calculated LS7 scores for SAHS participants who later entered SALSA. They assessed cognitive function as many as four times using the Mini-Mental State Examination, an 11-question screening tool that evaluates memory, attention, and other thinking abilities.
The researchers then used generalized estimating equation models to connect cardiovascular measures with changes in cognition. Their analysis accounted for age, sex, income, and education.
They also performed sensitivity analyses to evaluate attrition bias. These additional statistical checks tested whether participants leaving the study early could have distorted the results.
Exercise and glucose show different patterns
The analysis found that any physical activity, including simply avoiding a sedentary lifestyle, was particularly associated with slower cognitive decline among Mexican American participants.
Fasting glucose also emerged as an important factor. This measure records the amount of sugar in the bloodstream after eight to 12 hours without food. Among non-Hispanic white participants, readings of 126 milligrams per deciliter or lower were associated with slower cognitive decline.
“Our findings suggest that engaging in any level of physical activity and potentially maintaining optimal fasting blood glucose levels in midlife are associated with a significantly slower rate of cognitive decline in late life,” said Janette Vazquez, PhD, first author of the study and currently a senior postdoctoral fellow at the Glenn Biggs Institute.
Because the associations differed by ethnicity, Vazquez said that larger studies are needed to determine whether those differences can be replicated.
“The longitudinal exploration of cardiovascular health throughout life, rather than assessing it at a single time point, could also provide further insight into the trajectory phenotypes contributing to cognitive decline by ethnicity,” Vazquez said.
Reference: “Longitudinal association between midlife cardiovascular health and cognitive change in a bi-ethnic cohort” by Janette Vazquez, Rebecca Bernal, Luis A. Aguirre, Jesus D. Melgarejo, Gladys Maestre, Sudha Seshadri, Helen P. Hazuda, Chen-Pin Wang and Claudia L. Satizabal, 23 July 2026, Alzheimer’s & Dementia: Behavior & Socioeconomics of Aging.
DOI: 10.1002/bsa3.70096
This work was supported by the T32 training grant in Pathobiology of Occlusive Vascular Disease (T32 HL007446), the San Antonio Heart and Mind Study (R01 AG082360), San Antonio Longitudinal Study of Aging (R01 AG010444, R01 AG016518), and the Burroughs Wellcome Fund Postdoctoral Diversity Enrichment Program.
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