Adults aged 45 to 65 with normal blood pressure, no type 2 diabetes and no smoking habit lived on average close to 13 more years without dementia than peers with all three risk factors. That is the headline finding from a new study led by researchers at NYU Langone Health.
The team tracked 12,409 people with an average starting age of 56, none of whom had dementia at the start. Over an average follow-up of 26 years, 3,008 developed dementia and 5,238 died without a diagnosis. People free of the three risk factors in midlife lived around 30 years without dementia, compared with roughly 17 years for those carrying all three.
What the study actually measured
The analysis drew on the long-running Atherosclerosis Risk in Communities study, a community-based cohort that began enrolling adults in 1986. Researchers logged high blood pressure, type 2 diabetes and current smoking during midlife, then followed participants into old age to see who developed dementia and when.
Because the design is observational, the results show a link, not proof that removing these factors caused the extra dementia-free years. Risk factors were also recorded at a single time point, so the study cannot capture people whose blood pressure or smoking status changed later.
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"Our findings argue that people need to actively avert these factors in midlife as a strategy for preserving brain health for more than a decade," said Josef Coresh, MD, PhD, the study's senior investigator and founding director of the Optimal Aging Institute at NYU Langone Health.
Why blood pressure, diabetes and smoking
All three factors damage blood vessels, and vascular health is increasingly recognized as central to brain health. The 2024 Lancet Commission on dementia concluded that around 45 percent of dementia cases worldwide could potentially be prevented or delayed by addressing 14 modifiable risk factors across the life course. Hypertension, diabetes and smoking all sit on that list, and the Commission specifically classifies smoking and diabetes as midlife risks.
The NYU Langone team also reported differences by sex and race. Women lived longer without dementia than men no matter how many risk factors they carried. Among people with all three risks, women averaged 18.1 dementia-free years and men 16.6. White participants averaged 19.6 years and Black participants 16, a gap Coresh linked to the need for targeted prevention.
"These results suggest that vascular risk reduction may benefit all groups, but that certain populations, such as Black adults, may especially benefit from targeted prevention efforts," Coresh said.
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What it means in practice
Dementia is common and rising. The Alzheimer's Association estimates that more than 7 million Americans age 65 and older are living with Alzheimer's disease in 2026, a number projected to reach nearly 13 million by 2050. Roughly 1 in 9 older Americans has the condition.
The three factors the new study highlights are among the most familiar targets in preventive medicine. Blood pressure and blood sugar are checked at routine visits, and smoking status is asked every time. Anyone in their 40s, 50s or 60s who is uncertain where they stand on any of the three should raise it with their doctor, especially if there is a family history of dementia or cardiovascular disease.
The evidence does not promise anyone 13 extra years. It does, however, add to a growing body of research suggesting that what happens to the heart and blood vessels in midlife has consequences that show up decades later in the brain.
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