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Is Premature Cardiovascular Disease Connected to Faster Cognitive Decline?

McNair Dallas Law

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Premature cardiovascular disease (CVD) was associated with accelerated decline in cognition and white matter health in midlife, a large prospective cohort study showed.

Recent research showed that on a composite cognitive score, those with premature cardiovascular disease (CVD) events before age 60 were more than three times as likely to drop by at least 1.5 standard deviations more than the race-specific average over five years, Kristine Yaffe, MD, of the University of California San Francisco, and colleagues reported in Neurology.

MedPage Today’s recent article entitled, “Early CVD Linked to Accelerated Cognitive Decline,” notes that among over 3,000 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, this type of premature CVD was significantly associated with worse cognitive function in four of five domains:

  • Global cognition (-0.22, 95% CI -0.37 to -0.08)
  • Verbal memory (-0.28, 95% CI -0.44 to -0.12)
  • Processing speed (-0.46, 95% CI -0.62 to -0.31)
  • Executive function (-0.38, 95% CI -0.55 to -0.22)

The researchers found that the prevalence of accelerated cognitive decline among the 2,722 participants with cognitive assessment both at year 25 and 30 in the study was 13% in those with premature CVD and 5% without premature CVD, the researchers found.

“Our research suggests that a person’s 20s and 30s are a crucial time to begin protecting brain health through cardiovascular disease prevention and intervention,” coauthor Xiaqing Jiang, PhD, of the University of California San Francisco, said in a statement. “Preventing these diseases may delay the onset of cognitive decline and promote a healthier brain throughout life.”

Previous research has connected CVD, such as heart disease and stroke, with an increased risk for cognitive impairment and dementia in seniors. However, less has been known about how having these diseases before age 60 impacts cognition and brain health over the course of life.

Jiang added, “Our study found that cardiovascular events earlier in life are associated with worse cognition, accelerated cognitive decline, and poor brain health in middle age.”

CARDIA had also previously linked cardiovascular risk factors in mid-life to cognitive decline. Over the 30-year follow-up, 4.7% of participants had at least one premature CVD event, which was defined as one of the following:

  • Coronary heart disease
  • Stroke
  • Transient ischemic attack (TIA)
  • Congestive heart failure
  • Carotid artery disease; or
  • Peripheral artery disease before age 60.

They were an average age of 48 years at the first event, with follow-up cognitive assessment occurring an average of 7.7 years later.

“In multivariable-adjusted models, these brain MRI parameters [with the exception of total mean diffusivity] were independently associated with worse cognitive function in several domains, including global cognition, verbal learning and memory, processing speed, and executive function,” noted Yaffe and co-authors.

“The association between premature CVD and cognitive function in some specific domains may differ by sex and race,” authors noted. “In addition, having premature CVD was associated with a greater burden of WMH and [some] alterations of white matter integrity … These associations were not entirely driven by stroke/TIA, and were independent of shared risk factors for CVD, cognitive function, and brain health, including demographics.”

Compared to participants without premature CVD, those with premature CVD events were older and more likely to be male, Black, less educated and have CV risk factors.

In contrast to older adults, “CVD incidence and mortality among young and middle-aged adults have been steady or increasing,” authors noted. “Indeed, about half of CVD events among men and one-third among women occur during young and middle adulthood.”

Reference: MedPage Today (Jan. 25, 2023) “Early CVD Linked to Accelerated Cognitive Decline”

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