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Cognitive Decline Before and After Incident Coronary Events
Study Questions:
Given that coronary heart disease (CHD) may predispose people to cerebrovascular damage, is incident CHD associated with accelerated cognitive decline before and/or after incident CHD diagnosis?
Methods:
This is a large, prospective cohort, community-based study of adults ≥50 years living in England. Eligible subjects had no history of stroke, myocardial infarction (MI)/angina, or dementia at baseline and no incident stroke during follow-up. Cognitive assessments were completed every 2 years. Incident CHD was defined as a self-reported diagnosis of doctor-diagnosed MI and/or angina during follow-up. The incident CHD diagnosis date was calculated as between the date of the prior interview and the date of the interview where CHD was reported. Thus, the actual date of incident CHD was not recorded.
Results:
A total of 7,888 participants were included with a mean age of 62.1 (± 10.2) years. The median follow-up was 12 years (interquartile range, 6-14 years). After adjustment for potential confounders, participants with incident CHD had a faster rate of global cognitive decline overall than did participants without incident CHD. The rate of cognitive decline before CHD diagnosis was similar between CHD and CHD-free subjects. After adjustment, participants with a CHD diagnosis did not experience short-term cognitive decline compared with their pre-CHD diagnosis decline. In the long-term following CHD diagnosis, global cognitive function declined significantly faster than it did before the event.
Conclusions:
Compared to CHD-free subjects, accelerated cognitive decline was observed in CHD patients in the long-term after CHD diagnosis—but not in the years before nor in the short-term after CHD diagnosis.
Perspective:
This study suggests that aggressive primary prevention of CHD may have a beneficial effect in preventing cognitive decline. Such prevention could have a considerable impact on cognitive outcomes on a population level. The best strategy for preventing cognitive decline in patients post-CHD remains uncertain, and the reasons incident CHD is associated with long-term but not short-term cognitive decline remain unclear. Shared vascular risk factors (i.e., residual confounding) or conceivably even long-term exposure to treatments for CHD may be involved.
Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Prevention, Sleep Apnea
Keywords: Acute Coronary Syndrome, Angina Pectoris, Cognition, Coronary Disease, Dementia, Myocardial Infarction, Myocardial Ischemia, Primary Prevention, Risk Factors, Stroke, Vascular Diseases
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