Midlife Vascular Risk Burden and Dementia-Free Survival Years — Jiaqi Hu et al.
A prospective ARIC cohort study (12,409 participants, median 26.3 years follow-up, 3,008 dementia cases) reframes vascular risk in the metric that matters most to patients: dementia-free survival years, not hazard ratios. Compared with zero risk factors, having all three (diabetes, hypertension, current smoking) at midlife raised dementia hazard 2.7x and death-without-dementia hazard 5.6x — and cut dementia-free survival from 30.1 years to 17.5 years, a 12.6-year difference. The highest-risk group actually showed LOWER lifetime dementia incidence by age 95, but only because competing mortality removed people first. Women outlived men dementia-free (18.1 vs 16.6 years with 3 risk factors); Black participants had shorter dementia-free survival than White participants (16.0 vs 19.6 years). The takeaway: expressing vascular risk in time-based terms gives clinicians a patient-centered frame — preserving midlife vascular health buys over a decade of cognitively intact life.