Cognitive function in childhood and cardiovascular disease risk factors up to 6 decades later: Pooled data from two birth cohort studies

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Abstract Background Higher childhood (pre-morbid) cognitive function (IQ) appears to confer a lower risk of cardiovascular disease (CVD) episodes in adulthood, however, the underpinning mechanisms are uncertain. We tested the association between childhood cognitive ability and later CVD risk factors that may underpin this gradient. Methods We used data from two well-characterized prospective birth cohort studies initiated in the United Kingdom in 1958 (N=10870) and 1970 (N=9278). Cognitive function was quantified using validated written tests at around 10 years of age. A total of 16 biological, psychosocial, and behavioral risk factors were collected at 46-48 (1970 cohort) and 61-65 (1958 cohort) years of age in both studies. Associations were summarized using linear and logistic regression. Results After pooling the data and controlling for early life confounding factors, higher childhood cognitive ability was related to more favorable levels of 4/4 psychosocial, 3/3 behavioral, and 6/9 biological risk factors in middle/older age. The magnitude of these relationships increased from biological, to behavioral then psychosocial risk factors. For example, a one standard deviation higher cognitive test score was related to protective levels of body mass index (beta coefficient [95% confidence interval]: -0.58 [-0.70, -0.45]; p-value <0.001), triglycerides (-0.03 [-0.04, -0.01]; <0.001), cigarette smoking (odds ratio [95% confidence interval]: 0.72 [0.67, 0.76] <0.001), depressive symptoms (0.79 [0.74, 0.84]; <0.001), and a high prestige occupation (2.27 [2.21, 2.35]; <0.001). There was some evidence of mediation via educational attainment. Conclusions The present correlations implicate a series of mechanistic pathways which may connect cognition with subsequent CVD events. The greater burden of unfavorable risk factors at the lower end of the cognition spectrum suggests that compliance with preventive health advice may be sub-optimal. Clinical Perspective What is new? This is the most comprehensive examination of cardiovascular disease risk factors in relation to antecedent (pre-morbid) cognitive function (IQ) Pooling data from two large cohort studies of births from 1958 and 1970 in the UK, children with high cognitive function experienced the most favorable levels of a range of psychosocial, behavioral, and biological CVD risk factors up to six decades later. What are the clinical implications? These IQ–risk factor correlations implicate a series of mechanistic pathways connecting cognition with future CVD events. It also seems likely that preventive health advice from clinicians, including lifestyle modification and drug treatments, may be associated with low levels of compliance and/or initiation in people at the lower end of the cognition spectrum.

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