Cardiovascular disease and cumulative incidence of cognitive impairment in the Health and Retirement Study

Abstract

Background We sought to examine whether people with a diagnosis of cardiovascular disease (CVD) experienced a greater incidence of subsequent cognitive impairment (CI) compared to people without CVD, as suggested by prior studies, using a large longitudinal cohort. Methods We employed Health and Retirement Study (HRS) data collected biennially from 1998 to 2014 in 1305 U.S. adults age ≥ 65 newly diagnosed with CVD vs. 2610 age- and gender-matched controls. Diagnosis of CVD was adjudicated with an established HRS methodology and included self-reported coronary heart disease, angina, heart failure, myocardial infarction, or other heart conditions. CI was defined as a score < 11 on the 27-point modified Telephone Interview for Cognitive Status. We examined incidence of CI over an 8-year period using a cumulative incidence function accounting for the competing risk of death. Results Mean age at study entry was 73 years, 55% were female, and 13% were non-white. Cognitive impairment developed in 1029 participants over 8 years. The probability of death over the study period was greater in the CVD group (19.8% vs. 13.8%, absolute difference 6.0, 95% confidence interval 2.2 to 9.7%). The cumulative incidence analysis, which adjusted for the competing risk of death, showed no significant difference in likelihood of cognitive impairment between the CVD and control groups (29.7% vs. 30.6%, absolute difference − 0.9, 95% confidence interval − 5.6 to 3.7%). This finding did not change after adjusting for relevant demographic and clinical characteristics using a proportional subdistribution hazard regression model. Conclusions Overall, we found no increased risk of subsequent CI among participants with CVD (compared with no CVD), despite previous studies indicating that incident CVD accelerates cognitive decline.

Cardiovascular disease risk models and dementia or cognitive decline: a systematic review

“…Other than CANHEART, specific CVD risk models were associated with a lower risk for dementia or cognitive decline ( Covello et al, 2021 ; Jeon et al, 2021 ; Speh et al, 2021 ). CVD risk models from multiethnic cohorts were proven to predict dementia or cognitive decline in diverse race populations, such as White, H/L, Black, or Asian.…”

“…Increasing evidence demonstrates that heart and brain health are inextricably linked ( Zhao et al, 2023 ). Patients diagnosed with cardiovascular disease (CVD) usually had poorer cognition than those without CVD ( Covello et al, 2021 ). According to the most recent descriptions of novel pathological reasons, mixed dementia (Alzheimer’s disease and cerebrovascular injuries) is more common among the oldest seniors (those over 90 years old; Livingston et al, 2020 ).…”

Cognitive trajectories and incident dementia after a cardiovascular event in older adults

“…A recent retrospective cohort study of predominantly younger adults found CVD diagnosis increased the risk of dementia by 17% 4 . However, despite previous reports that incident CVD accelerated cognitive decline, a large recent study of older adults (mean 73 years) found no increased risk of cognitive impairment among participants with CVD compared with no CVD 5 …”

“…4 However, despite previous reports that incident CVD accelerated cognitive decline, a large recent study of older adults (mean 73 years) found no increased risk of cognitive impairment among participants with CVD compared with no CVD. 5 Furthermore, the majority of past studies examined individual CVD events. There is good evidence that stroke, which causes direct end organ damage, is associated with an increased risk of cognitive decline and dementia [6][7][8][9] ; however, fewer studies have investigated the association with other CVDs.…”