Optimizing cardiovascular health to mitigate cognitive decline: Physical activity as a primary modifiable target

Cardiovascular disease has been consistently associated with cognitive impairment; however, the relationship between Life’s Essential 8 (LE8), a novel composite metric of cardiovascular health (CVH), and cognitive function in older adults remains inadequately characterized. This study aimed to investigate the cross-sectional association between LE8 scores and cognitive function among United States older adults and identify the relative contributions of individual LE8 components. We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey 2011 to 2014 cycles. A total of 2108 participants aged ≥ 60 years with complete cognitive assessment and LE8 data were included. Cognitive function was evaluated using 4 validated neuropsychological tests: Consortium to Establish a Registry for Alzheimer Disease Word Learning and Delayed Recall, animal fluency test, and Digit Symbol Substitution Test. Composite and domain-specific z -scores were computed. Weighted multiple linear regression models were employed to examine LE8-cognition associations, adjusting for demographic and clinical covariates. Weighted quantile sum regression was applied to determine the relative contribution weights of individual LE8 components. In fully adjusted models, each 10-point increment in LE8 score was associated with a 0.09-unit increase in composite cognitive z -score (95% confidence intervals: 0.04–0.14, P  < .001). Compared with low CVH (LE8 < 50), high CVH (LE8 ≥ 80) demonstrated significantly higher cognitive z -scores ( β  = 0.41, 95% confidence intervals: 0.25–0.57, P  < .001). Weighted quantile sum regression identified moderate physical activity as the predominant contributor (weight = 0.56) to cognitive performance, followed by blood glucose (0.19) and blood pressure (0.14). Higher LE8 scores are significantly associated with better cognitive function in older adults, with moderate physical activity emerging as the most influential modifiable factor. These findings underscore the potential of integrated CVH optimization as a strategy for cognitive preservation in aging populations.