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 1998-2014 in 1,305 U.S. adults age ≥65 newly diagnosed with CVD vs. 2,610 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 1,029 participants over 8 years. The probability of death over the study period was greater in the CVD group (19.8% vs. 13.8%, p <.001). 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%, p = 0.64). 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.

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“…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.…”

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