Primary exposure – the Ideal-CVH score

Ideal-CVH scores were calculated according to AHA guidelines⁷ by summing together 7 dichotomous variables with zero reflecting poor and 7 Ideal-CVH status. One point was awarded for each of the following; current self-reported non-smoker, body mass index < 25 and > 18.5Kg/m², adequate physical activity, a healthy diet, untreated total cholesterol <200mg/dL, untreated resting blood pressure <120/<80 mmHg, and fasting blood glucose <100 mg/dL. All factors were obtained from the Framingham Heart Study clinic except diet and physical activity, which were measured with the use of a validated food frequency and physical activity index questionnaire, respectively. Blood pressures were measured twice by a physician, with the average systolic and diastolic value used in the Ideal-CVH score. See Supplemental Table I in the online-only Data Supplement for complete details of how Ideal-CVH scores were calculated, including quantification of diet and physical activity. Given that certain vascular risk factors have an age-dependent association with dementia and cognitive function,¹⁴ we calculated both recent (exam 7; 1998-2001) and remote (exam 5; 1991-1995) Ideal-CVH scores.