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Background: The role of cognitive abilities in the development of arteriosclerotic disease is still not fully understood. The purpose of the present study was to evaluate the mediating role of lifestyle, socioeconomic status (SES) and conventional cardiovascular disease (CVD) risk factors in the association between cognitive ability at age 19 and subclinical atherosclerosis at age 60 years.

Methods: An observational study design was employed. Data on the results from cognitive tests of conscripts tested at age 19 were collected for 1009 men. At the age of 60, they were included in the trial VIsualiZation of asymptomatic Atherosclerotic disease for optimum cardiovascular prevention, which was conducted as part of the Västerbotten Intervention Program (VIPVIZA). VIPVIZA is a randomised controlled trial, aimed at primary prevention of CVD in Västerbotten County, Sweden. Prior to any intervention, they underwent carotid ultrasonography and CVD risk factor assessment. Lifestyle habits and marital status were self-reported, and education and urban or rural residency were registered. Crude associations between cognitive ability at age 19 and the risk of CVD, assessed with the European Systematic Coronary Risk Evaluation 2 (SCORE2), as well as subclinical atherosclerosis, as demonstrated by the presence of carotid plaques (no plaque, plaque unilateral, or plaque bilateral), were evaluated. A path-analytic model tested mediating factors from cognitive ability in young adulthood to subclinical atherosclerosis at age 60.

Results: Results from cognitive tests at age 19 were in separate unadjusted analyses inversely and linearly associated with SCORE2 and with subclinical atherosclerosis. The association with carotid plaque at age 60 was mainly indirect and mediated by adult SES, which in turn had its main effect through adherence to healthy lifestyle habits via CVD risk of carotid plaques.

Conclusions: Cognitive ability at age 19 is a factor that is upstream of adult SES and our study indicates that cognitive ability at a young age has long-term consequences via SES and lifestyle habits for CVD risk and atherosclerosis.