Cardiovascular health in midlife affects mental function later
Contact: Steven Lee, (210) 450-3823, lees22@uthscsa.edu
SAN ANTONIO, Aug. 4, 2026 – Physical activity and controlling blood sugar in midlife are associated with a significantly slower rate of cognitive decline later, with exercise particularly beneficial for Hispanics, new research from UT Health San Antonio, the academic health center of The University of Texas at San Antonio, suggests.
While cardiovascular issues at midlife are known to contribute to cognitive decline and dementia, the new study is among the first to examine those factors across ethnicities. It included 402 San Antonio participants, with 52% Hispanic and the remainder non-Hispanic white, and with a mean age of 57.9 and 58.5% women.
The results differed by ethnicity, with physical activity tied to slower cognitive decline especially for Hispanics, and lower fasting blood glucose levels associated with slower cognitive decline among non-Hispanic whites.
“By improving cardiovascular health through modifiable lifestyle changes, there is a potential to meaningfully alleviate the public health burden of Alzheimer’s disease and other dementias, particularly in high-risk populations,” said Claudia Satizabal, PhD, associate professor in the Department of Population Health Sciences at UT Health San Antonio and its Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, where she leads the Population Neuroscience Core.
She is co-senior author, along with Chen-Pin Wang, PhD, associate professor-research in the Department of Population Health Sciences, of the study titled, “Longitudinal association between midlife cardiovascular health and cognitive change in a bi-ethnic cohort,” published July 23 by Alzheimer’s & Dementia: Behavior & Socioeconomics of Aging.
The study authors all are with the Glenn Biggs Institute or The University of Texas Rio Grande Valley.
Modifiable risk factors and dementia
The study notes that an increase in global life expectancy combined with a higher proportion of older adults is leading to a higher prevalence of age-related conditions such as dementia, with currently 6.7 million individuals in the United States affected by Alzheimer’s disease.
But there’s a growing body of evidence suggesting that modifiable risk factors contribute substantially to cognitive decline and dementia, with recent estimates attributing nearly 40% of Alzheimer’s cases to those factors. Cardiovascular health has emerged as having a principal role in brain aging.
The American Heart Association’s Life’s Simple 7 (LS7) framework, which encompasses three behavioral factors (healthy diet, non-smoking and physical activity) and four health factors (blood pressure, body mass index, total cholesterol and fasting blood glucose), offers an integrated metric of cardiovascular health and has been proposed as a strategy to promote optimal brain health, according to the study.
Previous studies have examined the associations between adherence to LS7 and cognitive outcomes, with findings suggesting that higher LS7 scores are associated with better cognitive performance, reduced dementia risk and improved brain health. However, those relationships aren’t uniform across populations.
Notably, Hispanic older adults experience a disproportionate burden of Alzheimer’s and related dementias, with numbers showing that 14% of Hispanic adults aged 65 or older have Alzheimer’s, compared to 10% of non-Hispanic white older adults. Mexican Americans, the largest Hispanic population in the United States, carry particularly high rates of diabetes, obesity and dyslipidemia, all of which contribute to elevated risk of dementia.
An important contribution from South Texas
Despite these disparities, the study notes, Hispanic populations remain underrepresented in Alzheimer’s research, limiting the field’s ability to understand risk trajectories and identify effective prevention strategies.
To address this, UT Health San Antonio set out to examine the association between midlife cardiovascular health, measured using LS7 scores, and cognitive decline among Mexican American and non-Hispanic white older adults who participated in the San Antonio Heart Study (SAHS) and the San Antonio Longitudinal Study of Aging (SALSA).
The SAHS refers to a landmark, long-term health project by UT Health San Antonio that investigated the causes of Type 2 diabetes and heart disease, conducted from 1979 to the 2000s. It tracked more than 5,000 people to understand why specific ethnic groups face higher health risks.
Out of that grew the SALSA, also a major, long-term observational health study at UT Health San Antonio, designed to understand the disablement process, chronic diseases and healthy aging in older adults who were part of the SAHS.
“Importantly, the inclusion of both ethnic groups from the same source population and geographic setting allows for direct comparison within a shared contextual framework and strengthens our ability to identify disparities in cognitive aging and their cardiovascular correlates,” the new study notes.
The researchers this time assessed SAHS participants who later enrolled in the SALSA for cardiovascular health using the LS7 scores. They measured cognition up to four times using the Mini-Mental State Examination, an accepted 11-question screening test used to check memory, attention and thinking skills. And they used generalized estimating equation models adjusted for age, sex, income and education to relate cardiovascular factors to cognitive change.
Sensitivity analyses evaluated attrition bias, meaning that extra statistical checks were conducted to ensure that participants dropping out of the study didn’t invalidate the final results.
From this examination came the findings suggesting that any physical activity, or avoiding a sedentary lifestyle, is particularly associated with slower cognitive decline in Mexican Americans. Another factor emerging as significant was fasting glucose levels – a key health factor measuring the amount of sugar in the bloodstream after an eight- to 12-hour fast – as the researchers found that readings of 126 milligrams per deciliter or lower are associated with slower cognitive decline among non-Hispanic whites.
“Our findings suggest that engaging in any level of physical activity and potentially maintaining optimal fasting blood glucose levels in midlife are associated with a significantly slower rate of cognitive decline in late life,” said Janette Vazquez, PhD, first author of the study and currently a senior postdoctoral research fellow at the Glenn Biggs Institute. But since the results differed by ethnicity, she says, further research is needed in larger samples to replicate the differences.
“The longitudinal exploration of cardiovascular health throughout life, rather than assessing it at a single time point, could also provide further insight into the trajectory phenotypes contributing to cognitive decline by ethnicity,” Vazquez said.
Participants of this study are currently invited to participate in the San Antonio Heart and Mind Study (SAHMS) at the Glenn Biggs Institute to continue to yield key discoveries through the collection of state-of-the-art brain imaging and other neurological data.
Longitudinal association between midlife cardiovascular health and cognitive change in a bi-ethnic cohort
Janette Vazquez, Rebecca Bernal, Luis A. Aguirre, Jesus D. Melgarejo, Gladys Maestre, Sudha Seshadri, Helen P. Hazuda, Chen-Pin Wang, Claudia L. Satizabal
Published July 23, 2026, in Alzheimer’s & Dementia: Behavior & Socioeconomics of Aging
Link to full study: http://dx.doi.org/10.1002/bsa3.70096
UT Health San Antonio is the academic health center of The University of Texas at San Antonio (UT San Antonio), offering a comprehensive network of inpatient and outpatient care facilities staffed by medical, dental, nursing and allied health professionals who conduct more than 2.5 million patient visits each year. It is the region’s only academic health center and one of the nation’s leading health sciences institutions, supported by the schools of medicine, nursing, dentistry, health professions, graduate biomedical sciences and public health that are leading change and advancing fields throughout South Texas and the world. To learn about the many ways “We make lives better®,” visit UTHealthSA.org.
Stay connected with UT Health San Antonio on Facebook, Twitter, LinkedIn, Instagram and YouTube.
The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases at UT Health San Antonio is dedicated to providing comprehensive dementia care while advancing treatment through clinical trials and research. The Biggs Institute is a National Institute on Aging (NIA)-designated Alzheimer’s Disease Research Center (ADRC). UT Health San Antonio is the academic health center of The University of Texas at San Antonio (UT San Antonio). In addition to providing patient care and conducting research, the Biggs Institute partners with the School of Nursing at UT San Antonio to offer the Caring for the Caregiver program.