Cardiovascular health has been associated with dementia onset, but little is known about the variation of such association by sex and age considering dementia subtypes. We assessed the role of sex and age in the association between cardiovascular risk and the onset of all-cause dementia, Alzheimer’s disease, and vascular dementia in people aged 50–74 years. This is a retrospective cohort study covering 922.973 Catalans who attended the primary care services of the Catalan Health Institute (Spain). Data were obtained from the System for the Development of Research in Primary Care (SIDIAP database). Exposure was the cardiovascular risk (CVR) at baseline categorized into four levels of Framingham-REGICOR score (FRS): low (FRS < 5%), low-intermediate (5% ≤ FRS < 7.5%), high-intermediate (7.5% ≤ FRS < 10%), high (FRS ≥ 10%), and one group with previous vascular disease. Cases of all-cause dementia and Alzheimer’s disease were identified using validated algorithms, and cases of vascular dementia were identified by diagnostic codes. We fitted stratified Cox models using age parametrized as b-Spline. A total of 51,454 incident cases of all-cause dementia were recorded over a mean follow-up of 12.7 years. The hazard ratios in the low-intermediate and high FRS groups were 1.12 (95% confidence interval: 1.08–1.15) and 1.55 (1.50–1.60) for all-cause dementia; 1.07 (1.03–1.11) and 1.17 (1.11–1.24) for Alzheimer’s disease; and 1.34 (1.21–1.50) and 1.90 (1.67–2.16) for vascular dementia. These associations were stronger in women and in midlife compared to later life in all dementia types. Women with a high Framingham-REGICOR score presented a similar risk of developing dementia — of any type — to women who had previous vascular disease, and at age 50–55, they showed three times higher risk of developing dementia risk compared to the lowest Framingham-REGICOR group. We found a dose‒response association between the Framingham-REGICOR score and the onset of all dementia types. Poor cardiovascular health in midlife increased the onset of all dementia types later in life, especially in women.

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性别在心血管健康和痴呆症之间的关联中很重要：来自现实世界数据的证据

心血管健康与痴呆症的发病有关，但考虑到痴呆症亚型，这种关联随性别和年龄的变化知之甚少。我们评估了 50-74 岁人群中性别和年龄在心血管风险与全因痴呆、阿尔茨海默氏病和血管性痴呆发病之间的关系中的作用。这是一项回顾性队列研究，涵盖 922.973 名参加加泰罗尼亚健康研究所（西班牙）初级保健服务的加泰罗尼亚人。数据来自初级保健研究发展系统（SIDIAP 数据库）。暴露是基线时的心血管风险 (CVR)，分为 Framingham-REGICOR 评分 (FRS) 的四个级别：低 (FRS < 5%)、中低 (5% ≤ FRS < 7.5%)、中高 (7.5%) ≤ FRS < 10%），高（FRS ≥ 10%），一组既往患有血管疾病。使用经过验证的算法识别全因痴呆和阿尔茨海默病病例，并通过诊断代码识别血管性痴呆病例。我们使用参数化为 b 样条的年龄来拟合分层 Cox 模型。在平均 12.7 年的随访中，总共记录了 51,454 例全因痴呆病例。低、中、高 FRS 组中全因痴呆的风险比分别为 1.12（95% 置信区间：1.08-1.15）和 1.55（1.50-1.60）；阿尔茨海默病为 1.07 (1.03–1.11) 和 1.17 (1.11–1.24)；血管性痴呆为 1.34 (1.21–1.50) 和 1.90 (1.67–2.16)。在所有痴呆类型中，与晚年相比，这些关联在女性和中年者中更为强烈。Framingham-REGICOR 评分高的女性患痴呆症（任何类型）的风险与以前患有血管疾病的女性相似，在 50-55 岁时，她们患痴呆症的风险是 Framingham-REGICOR 评分最低的女性的三倍-REGICOR集团。我们发现 Framingham-REGICOR 评分与所有痴呆类型的发病之间存在剂量反应关联。中年时期心血管健康状况不佳会增加晚年所有类型痴呆症的发病率，尤其是女性。