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Blood vessel health

Because damage to the blood vessels in the brain can cause dementia or strokes, it’s very important to maintain good blood vessel health. You can do this by monitoring and controlling blood pressure, cholesterol levels, and diabetes.  Managing these factors can decrease your risk of developing dementia, having heart attacks or strokes, and may play a key role in protecting brain health.

High blood pressure (hypertension)

High blood pressure or hypertension can be associated with strokes and increased risk of vascular dementia. Managing high blood pressure can reduce your risk of dementia. High blood pressure is generally defined as a blood pressure over 120/80 mm Hg. You may hear your health care provider refer to ‘systolic’ or ‘diastolic’ blood pressure; these refer to the top and bottom numbers of your blood pressure. The top number is called the ‘systolic’ blood pressure, and the bottom number is called the ‘diastolic’ blood pressure.

Blood pressure targets

For most people, the top number (systolic) should be less than 140 and the bottom number (diastolic) should be less than 90. However, for some people with diabetes, the target might be less than 130/80 mm Hg. For others who might be at higher risk of heart disease, or for some older adults or those who are frail, the targets might be different.

According to the Lancet Commission report on dementia prevention, the evidence around dementia risk reduction says you should aim to maintain a systolic blood pressure (top number) of 130 mm Hg or less in midlife from around 40 years old.

Talk to your doctor about the best blood pressure target for you in order to balance the benefits of managing your blood vessel health, while ensuring that you are not running into adverse effects of your blood pressure getting too low.

Managing high blood pressure

There are non-medication things that you can do to help manage high blood pressure, including some of the other lifestyle factors that we’ve mentioned above, such as:

• Diet
• Exercise
• Reducing alcohol consumption, as well as
• Stress reduction

Medications – known as anti-hypertensives – are often needed if non-drug approaches can’t bring the blood pressure to a reasonable target. Sometimes people might need more than one class of anti-hypertensive drug. At this time, anti-hypertensive drug treatment for hypertension is the only known effective preventive medication for dementia. (Although there is some new research on medications for diabetes that is also showing promise.)

You can learn more about high blood pressure, choosing a blood pressure monitor, and tracking your blood pressure on the Hypertension Canada website.

Diabetes and hemoglobin A1C test

Diabetes can impact your blood vessels, and increase your risk of blood vessel damage and dementia. Conversely, good management of your diabetes can help to reduce your risk of dementia.

A hemoglobin A1C (HbA1C) test is a blood test that shows what your average blood sugar (glucose) level was over the past two to three months. Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been:

• A normal A1C level is below 5.7%
• Prediabetes is between 5.7 to 6.4%. Having prediabetes is a risk factor for getting type 2 diabetes. People with prediabetes may need retests every year.
• Type 2 diabetes is above 6.5%
• If you have diabetes, you should have the A1C test at least twice a year.

The A1C goal for many people with diabetes is below 7%. For older adults with multiple medical conditions the goal is to keep the A1C less than 8%.

It may be different for you. Ask what your goal should be. If your A1C result is too high, you may need to change your diabetes care plan.

It’s important to balance the benefits of maintaining a good A1C level with the risks of low blood sugars or the side effects of multiple medications.

Diabetes and eye health

Diabetes is also associated with several eye conditions, including diabetic retinopathy, which leads to vision loss. New evidence shows that untreated vision loss is associated with an increased risk for dementia. Diabetic retinopathy can be prevented, or its progress can be slowed with consistent blood sugar management and a healthy lifestyle.

Managing diabetes

There are non-medication things that you can do to help manage diabetes, including some of the same lifestyle factors that we’ve mentioned above, such as diet and exercise.

Many people may also require medications to manage their diabetes if non-drug approaches can’t bring the blood sugars or HbA1C to manageable levels.

You can learn more about diabetes on the Diabetes Canada website.

High cholesterol (dyslipidemia)

In addition to its impact on blood vessel health, there is new evidence that high LDL cholesterol (also referred to as 'bad cholesterol') is also an independent risk factor for dementia.

Diet, exercise, and weight management are non-medication approaches to high cholesterol. If those are not effective in lowering your cholesterol, then there may be a role for cholesterol-lowering drugs like statins or others.

Unlike anti-hypertensives, there is currently no evidence that statin medications reduce the risk of dementia on their own.

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How to Promote Brain Health

Learn more about how lifestyle choices, blood vessel health and other health conditions can impact your brain health.  (30 minutes)

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