Abstract
BackgroundWe 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.MethodsWe 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.ResultsMean 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.ConclusionsOverall, 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.
Highlights
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
We designed our present study to examine whether cognitively normal older adults with a diagnosis of CVD experienced a greater incidence of subsequent cognitive impairment, measured using an administered global assessment of cognitive function, compared to people without a diagnosis of CVD
Definition of CVD group To define the diagnosis of CVD, we used participant self-report based on the question, “Has a doctor told you that you have had a heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems?” This definition of CVD encompassed the non-stroke cardiovascular conditions, such as heart failure, myocardial infarction, atrial fibrillation, and coronary artery disease, shown in prior research to impact cognitive function [4, 6, 7, 16, 18]
Summary
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. We designed our present study to examine whether cognitively normal older adults with a diagnosis of CVD experienced a greater incidence of subsequent cognitive impairment, measured using an administered global assessment of cognitive function, compared to people without a diagnosis of CVD. We used data from the Health and Retirement Study (HRS), a large, well-characterized cohort study with a long duration of follow-up, an important feature given that many of the proposed biologic mechanisms connecting CVD and cognitive impairment are slow-acting processes. In order to limit the potential for bias from to high rates of attrition due to death, we used a cumulative incidence function to analyze the likelihood of cognitive impairment while accounting for the competing risk of death
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