Daniela B. Friedman

Background The Framingham 10‐year cardiovascular disease risk score, which is based on age, sex, smoking, total cholesterol, high‐density lipoprotein‐cholesterol, blood pressure, and diabetes, has been found to be associated with cognitive health, but these findings have not been validated in a representative sample in the United States. We aimed to examine the associations of Framingham risk score with cognitive function among older adults in a nationally representative sample, as well as by race or ethnicity, education, and family income. Methods and Results A total of 2254 older adults ≥60 years (57% female, 79% non‐Hispanic White) in the National Health and Nutrition Examination Survey 2011 to 2014 were included in the final sample for analysis. All components of the Framingham risk score were obtained with questionnaire or measured in the laboratory. Cognitive function was examined using the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Task (immediate and delayed memory), Digit Symbol Substitution Test, and Animal Fluency Test. Multivariable linear regression models were used to assess the associations between Framingham risk score and test‐specific and global cognition Z scores. Each incremental 5% in Framingham 10‐year cardiovascular disease risk was associated with lower Z scores for Digit Symbol Substitution Test (β=−0.06 [95% CI, −0.09 to −0.03]), delayed memory (β=−0.05 [95% CI, −0.08 to −0.01]), immediate memory (β=−0.07 [95% CI, −0.10 to −0.03]), and global cognition (β=−0.05 [95% CI, −0.09 to −0.02]). Socioeconomic status, particularly race or ethnicity and monthly income levels, were strong effect measure modifiers of the associations. Conclusions Lower cardiovascular risk factors are associated with better cognitive function.