Cross‐sectional association between cardiovascular risk score and cognitive performance in middle‐aged UK Biobank participants

Abstract

AbstractBackgroundCardiovascular diseases (CVD) have been linked with faster cognitive decline and incident dementia. The actual risk factors for CVD also tie to these adverse cognitive consequences in elderly adults. The cardiovascular risk score (CRS) provides direct estimation of total cardiovascular risk that suits well to the constraints of primary prevention. Further data especially in larger populations are required to examine whether CRS is also associated with cognitive performance in middle age.MethodsWe evaluated data from 420,381 participants [aged 37‐73 (mean: 55.9; SD: 8.1) years old; female: 234,464 (55.8%)] in the UK Biobank who were free from dementia and circulatory system diseases at enrollment. Four neurocognitive tests were administered to assess cognition in different domains, i.e., information processing speed (reaction time test, RT), visual episodic memory (pairs matching test, pairs), reasoning (fluid intelligence test, FI), and prospective memory (PM). Longer RT, making more errors during pairs test, lower FI, or making incorrect first choice during PM indicates poorer cognitive performance. To estimate CRS, we applied the 10‐year risk of fatal CVD estimation—the SCORE system—that is based on age, sex, systolic blood pressure, total cholesterol level, and current smoking status. Linear regression models (or logistic regression for PM) examined the associations of CRS with each cognitive outcome, with adjustment for ethnicity, college, social‐economic status, mental and behavioral disorders, diseases of the nervous system, and number of treatments/medications. Sensitivity analyses were done 10 times with randomly chosen subsets of 1/10 participants.ResultsThe cohort had a median 10‐year risk of 2.51% (inter‐quantile range: 1.02%‐4.84%; range: 0.08%‐74.3%) in developing fatal CVD. Increased CRS was associated with worse cognitive performance. Specifically, compared with those with CRS<5%, participants with CRS≥5%(higher CVD risk) took 1 ms longer in RT, made 1 more mistake in pairs test, had lower FI score by 0.27, and had 31.4% lower chance of making the correct choice during PM (all p’s<1E‐93). These observations were consistent across 10 sensitivity analyses.ConclusionIncreased cardiovascular risk during middle life is associated with poorer cognitive performance. Further studies are required to examine whether cardiovascular risk predicts future cognitive decline or dementia.