Avoiding Three Midlife Risk Factors Is Linked to 13 More Dementia-Free Years

Avoiding high blood pressure, diabetes, and smoking between the ages of 48 and 68 is associated with an average of nearly 13 additional dementia-free years, according to a study published August 5 in Neurology Open Access. Researchers from NYU Langone Health found that midlife vascular health significantly impacts the timing of cognitive decline and overall lifespan without dementia.

The study analyzed data from 12,409 participants with an average age of 56 who did not have dementia at the start of the observation period. These individuals were part of the community-based Atherosclerosis Risk in Communities (ARIC) Study, which began in 1986. Researchers followed the group for an average of 26 years to track the onset of dementia and mortality.

Findings showed a stark difference in outcomes based on the presence of the three risk factors. Those with no risk factors lived an average of 30 years without dementia after the study began. In contrast, participants who smoked and had both high blood pressure and diabetes lived an average of 17 years before developing the condition, a difference of 13 years, according to NYU Langone Health.

During the tracking period, 3,008 participants developed dementia, while 5,238 died without ever developing the condition, the researchers reported.

Demographic differences in dementia-free survival

The research team also examined how these vascular risk factors affected different demographic groups. The data indicated that women generally lived longer without dementia than men, regardless of how many risk factors they possessed. Specifically, women with all three risk factors lived an average of 18.1 years without dementia, compared to 16.6 years for men, according to NYU Langone Health.

Racial disparities were also evident in the findings. White participants with all three risk factors lived an average of 19.6 years without dementia, while Black participants with the same risk factors lived an average of 16.0 years, the study found.

Dr. Josef Coresh, a senior investigator on the study and founding director of the Optimal Aging Institute at NYU Langone, stated that these results suggest Black adults may benefit particularly from targeted prevention efforts.

Vascular health and midlife prevention

The study emphasizes the role of vascular health in brain preservation. Dr. Coresh noted that a significant amount of dementia is preventable and that much of this potential relates to vascular risk factors.

According to Time, a 2025 study found that 42% of Americans are at risk of developing dementia after age 55. The World Health Organization reports that dementia affects more than 57 million people worldwide and stands as the seventh leading cause of death globally.

The researchers identified the window between ages 45 and 65 as a critical period for intervention. Dr. Coresh argued that actively averting high blood pressure, diabetes, and smoking during midlife is a strategy for preserving brain health for more than a decade.

Study limitations and associations

The researchers clarified that the study was not designed to prove that avoiding these three factors causes the delay in dementia. Instead, the study established an association between the absence of these risk factors and a longer dementia-free life.

Additionally, the study had limitations regarding how data was collected. Risk factors were measured only once at the start of the study. Dr. Jordan Weiss, an assistant professor at the Optimal Aging Institute and study author, noted that the researchers did not capture changes over time, such as smoking cessation or the worsening of health conditions.

The research was supported by grants from the National Institutes of Health (NIH). The study authors included Jiaqi Hu of Tsinghua University, Jason Smith of the University of North Carolina School of Medicine, and researchers from Johns Hopkins Bloomberg School of Public Health and the University of Minnesota, among others.