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Published on: December 19, 2013
In a new study, postmenopausal women aged 65 to 79 years with CVD were at increased risk for cognitive decline compared with those who had no evidence of CVD.
In addition, hypertension and diabetes were associated with a greater risk for cognitive decline, but obesity was not.
For the Women’s Health Initiative Memory Study (WHIMS), Bernhard Haring, MD, MPH, and colleagues conducted neurocognitive exams on 6,455 cognitively intact, postmenopausal women aged 65 to 79 years; of those, 895 had CVD at baseline. The women were followed for a median of 8.4 years to examine whether CVD was linked to cognitive decline and if hypertension, diabetes and obesity modified the effect of CVD on cognitive function.
Participants self-reported whether they had CVD; those with prior mild cognitive impairment or stroke were excluded from the study. The researchers assessed cognitive decline via incidence of mild cognitive impairment or probable dementia via modified mini-mental state score, neurocognitive examinations and neuropsychiatric examinations.
Compared with those free of CVD, women with CVD were at increased risk for cognitive decline (HR=1.29; 95% CI, 1-1.67). Women with MI or other vascular disease were at highest risk (HR for MI=2.1; 95% CI, 1.4-3.15; HR for other vascular disease=1.97; 95% CI, 1.34-2.87).
There was a moderate association between cognitive decline and angina pectoris (HR=1.45; 95% CI, 1.05-2.01), but no association between cognitive decline and atrial fibrillation or HF.
The researchers also observed a link between cognitive decline and CABG (HR=2.63; 95% CI, 1.46-4.75), carotid endarectomy (HR=3.03; 95% CI, 1.23-7.47) and peripheral vascular disease (HR=1.82; 95% CI, 1.09-3.02), although not between cognitive decline and angioplasty (HR=1.67; 95% CI, 0.89-3.13).
Incidence rates for mild cognitive impairment or probable dementia were higher among women with any CVD (12.7 per 1,000 person years) compared with no CVD (7.8 per 1,000 person years). They also were higher for those with MI (20 per 1,000 person years) than without (8.1 per 1,000 person years).
Prevalent hypertension (HR=1.25; 95% CI, 1-1.57) and diabetes (HR=1.83; 95% CI, 1.24-2.7) increased the risk for cognitive decline, whereas obesity did not (HR=0.84; 95% CI, 0.65-1.08). In women with CVD, there was a trend toward diabetes increasing the risk for cognitive decline (HR=1.76; 95% CI, 0.9-3.44), but no relationship between cognitive decline and hypertension (HR=0.99; 95% CI, 0.59-1.64) or obesity (HR=0.81; 95% CI, 0.47-1.39).
“Vascular aging as reflected by the degree of atherosclerosis, arteriosclerosis and inflammation has emerged to provide the underlying complementary mechanistic and pathophysiological pathways between CVD and cognitive decline,” Haring, of the University of Würzburg in Germany, and colleagues wrote.
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