Assessing sex differences between mid‐life cardiovascular conditions or risk factors and mid‐life cognition decline

Abstract

AbstractBackgroundThe association between mid‐life cardiovascular diseases or risk factors and cognition decline has been reported. However, sex differences in these associations have rarely been examined.MethodWe included 2,351 participants enrolled in the population‐based Mayo Clinic Study of Aging who were aged 30‐69 years at baseline. Participants were evaluated every 15 months by a coordinator, neurologic evaluation, and neuropsychological testing. The neuropsychological testing used nine tests to calculate global cognitive and domain‐specific (memory, language, executive function, and visuospatial skills) z‐scores. Nurse abstractors reviewed participant medical records to determine the presence and age at onset of cardiovascular diseases and risk factors. Linear mixed‐effect models evaluated the association between baseline cardiovascular conditions (coronary heart disease, myocardial infarction, atrial fibrillation, angina) or risk factors (hypertension, diabetes, dyslipidemia) and global and domain‐specific cognitive decline. Multivariable models adjusted for demographics, APOE, depression, and other medical conditions. Interactions between sex and each cardiovascular conditions or risk factors were examined; results were stratified by sex if the interaction was p<0.05.ResultOverall, 1651 (70.3%) participants had at least one cardiovascular condition or risk factor; the proportion of men was higher than women (875 (74.9%) vs.777 (65.7%), p<0.0001). Cross‐sectionally, baseline cardiovascular conditions and risk factors were not associated with cognitive performance in multivariable analyses and there were no sex differences. Longitudinally, several cardiovascular conditions and risk factors were associated with declines in global and/or domain‐specific z scores, with the exception of visual spatial z‐scores. Most cardiovascular conditions were more strongly associated with cognition among women: coronary heart disease, myocardial infraction, and angina were associated with global cognition decline only in women. Additionally, diabetes, dyslipidemia, and coronary heart disease were associated with language z‐score decline only in women.ConclusionMiddle aged cardiovascular conditions and risk factors are associated with mid‐life cognitive decline. Moreover, some specific cardiovascular conditions and risk factors, such as coronary artery disease, myocardial infraction, and angina have stronger associations with cognition decline among women.