Heart conditions and cardiovascular risk factors have a stronger association with decline in memory and thinking skills in middle-aged women than men, according to a study published in Neurology.

This is despite the fact that men have a higher prevalence of cardiovascular conditions and risk factors in midlife compared to women.

The decline in global cognition associated with coronary artery disease was more than two times greater for women than men

The study used 1,857 participants (920 men and 937 women) aged 50-69 at their initial visit. None of the patients had dementia.

Every 15 months for three years, study participants’ global cognition was evaluated with nine tests of memory, language, executive function and spatial skills.

The researchers obtained cardiovascular condition and risk factor information using the population-based Rochester Epidemiology Project. Conditions included coronary artery disease, heart rhythm disorders, congestive heart failure, peripheral artery disease and stroke, while risk factors included high blood pressure, diabetes, high cholesterol, smoking and obesity.

In total, 79% of the participants had at least one cardiovascular risk factor or condition — 83% of men, compared to 75% of women.

The study found that most cardiovascular conditions were more strongly associated with cognitive decline in women. For example, the annual decline in global cognition associated with coronary artery disease was more than two times greater for women than men.

Additionally, some cardiovascular risk factors, including diabetes, high cholesterol and coronary artery disease, were associated with a greater language decline in women. However, congestive heart failure was associated with greater language decline in men.

Middle-aged women at risk of heart disease would benefit from early monitoring

Senior author of the study, epidemiologist and neuroscientist Michelle Mielke, said it is therefore important to understand sex differences in the development of cognitive impairment to enhance the health of women and men.

She concludes that the study’s findings indicate that middle-aged women at risk of heart disease should be closely monitored by their GPs, as she explains: “While all men and women should be treated for cardiovascular conditions and risk factors in midlife, additional monitoring of women may be needed as a potential means of preventing cognitive decline."

Dr. Mielke says further research is now needed to examine potential mechanisms explaining sex differences in the relationship between cardiovascular factors and cognition, such as hormones, genetics, lifestyle and psychosocial factors.