Cardiovascular Health can Lower Dementia Risk in People with Diabetes

New research suggests that maintaining good cardiovascular health could significantly lower the risk of cognitive decline and dementia for people with type 2 diabetes. Moreover, a healthy lifestyle may offer protection even to those with a high genetic predisposition for dementia, according to the preliminary study presented recently at the American Heart Association’s Scientific Sessions 2025.

Type 2 diabetes, a condition where the body doesn't use insulin properly, has long been associated with poorer cognitive function and a more rapid decline in brain health over time. This new study explored how heart health and genetics interact to influence this risk. Researchers analyzed data from over 40,000 adults in the UK Biobank who had type 2 diabetes but were free of dementia at the start of the study.

The study followed these individuals for 13 years, tracking their cardiovascular health and whether they developed mild cognitive impairment or dementia. Mild cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. It involves problems with memory, language, or judgment that are noticeable but not severe enough to interfere with daily life.

It is essential to continue researching new strategies to help individuals with type 2 diabetes reduce their risk of cognitive decline, as they are considered at higher risk for developing it over time, and the prevalence of type 2 diabetes is very high.

G. Peter Gliebus, M.D., Chief of Neurology and director of Cognitive and Behavioral Neurology at Marcus Neuroscience Institute, part of Baptist Health, at Boca Raton Regional Hospital.

Life’s Essential 8: A Framework for Heart and Brain Health

To measure heart health, the researchers used the American Heart Association’s "Life’s Essential 8" framework. This guide outlines eight key components for ideal heart and brain health. Four are health behaviors: eating a balanced diet, being physically active, avoiding tobacco, and getting enough quality sleep.

The other four are health factors: managing weight, controlling cholesterol, managing blood sugar, and managing blood pressure. Participants were categorized as having low, moderate, or high cardiovascular health based on these metrics.

G. Peter Gliebus, M.D., Chief of Neurology and director of Cognitive and Behavioral Neurology at Marcus Neuroscience Institute, part of Baptist Health, at Boca Raton Regional Hospital, explains that this study is key as more research continues to explore the link between diabetes and cognitive decline.

“I see many patients with type 2 diabetes who are concerned about the potential for cognitive decline in the future,” said Dr. Gliebus, who was not involved in the study. “This study reinforces the critical importance of maintaining good cardiovascular health, managing risk factors, and adopting healthier lifestyles.“

What Role Does Genetics Play?

Genetics also played a crucial role in the study. The researchers used a polygenic risk score to determine each participant's genetic susceptibility to Alzheimer's disease, a common cause of dementia. This score combines multiple genetic variations to estimate a person's inherited risk. Participants were then grouped into low, moderate, and high genetic risk categories.

Over the 13-year follow-up period, the findings were significant. A total of 840 participants developed mild cognitive impairment, and 1,013 developed dementia. The results showed a clear pattern: better heart health was linked to better brain health. After accounting for factors like age, sex, and race, individuals with moderate or high cardiovascular health had a 15 percent lower risk of developing both mild cognitive impairment and dementia compared to those with poor cardiovascular health.

Perhaps the most compelling finding was for those facing a double challenge — type 2 diabetes and a high genetic risk for dementia. Within this high-risk group, participants who maintained moderate or high cardiovascular health saw a 27 percent lower risk of developing mild cognitive impairment and a 23 percent lower risk of dementia compared to their peers with low cardiovascular health. This suggests that lifestyle and health management can make a powerful difference.

“It also confirms the long-held suspicion that, even when genetics are not in one’s favor, lifestyle interventions can still play a significant role in preserving cognitive function,” Dr. Gliebus noted.

Future Research and Treatment

The study also found a physical connection in the brain. Better cardiovascular health scores were associated with greater brain volume. While some brain volume loss is a natural part of aging, accelerated loss is a hallmark of cognitive decline and dementia. This finding implies that keeping the heart healthy helps preserve the brain's physical structure. Similar trends were also noted in an analysis of U.S. adults, reinforcing the study's conclusions.

The high prevalence of Type 2 diabetes makes these findings particularly urgent. Experts agree that more work is needed to help this at-risk population protect their cognitive health.

“It is essential to continue researching new strategies to help individuals with type 2 diabetes reduce their risk of cognitive decline, as they are considered at higher risk for developing it over time, and the prevalence of type 2 diabetes is very high,” Dr. Gliebus advised. “These strategies may include new medications as well as lifestyle interventions.”

Actionable Steps: Taking Charge of Brain and Heart Health

For the millions of people living with type 2 diabetes, this study offers a hopeful and actionable message. While a genetic predisposition can feel like an unchangeable fate, focusing on the "Life's Essential 8" provides a clear roadmap for proactive health management.

By working to eat better, stay active, manage weight, and control blood pressure, blood sugar, and cholesterol, individuals can take meaningful steps to protect not only their hearts but also their long-term brain health.

“As we see progress in the management of diabetes and other cardiovascular risk factors, there is hope that these advancements will also contribute to lowering the risk of future cognitive decline,” Dr. Gliebus said.