Key clinical point: Accelerated cognitive decline is associated with incident coronary heart disease after, but not before or immediately following, ischemic events.
Major finding: The slope representing temporal change in global cognitive score decreased by a mean of 0.039 per year, compared with the pre–coronary heart disease slope (P = .002).
Study details: A prospective study of 7,888 adults aged 50 years and older with no history of stroke, MI, angina, or dementia.
Disclosures: Funders included the National Natural Science Foundation of China, the Beijing Natural Science Foundation, and the Newton International Fellowship from the Academy of Medical Sciences. The researchers reported having no relevant financial disclosures.
Xie W et al. J Amer Coll Cardiol. 2019 Jun 17. doi: 10.1016/j.jacc.2019.04.019.
The findings “highlight the role of cardiovascular risk factors and cardiovascular health as crucial determinants of cognitive trajectories in later life,” wrote Suvi P. Rovio, PhD; Katja Pahkala, PhD; and Olli T. Raitakari, MD, PhD. For example, accelerated declines in verbal memory might indicate a specific vulnerability to vascular changes within the medial temporal lobe and hippocampus.
The fact that cognitive decline did not accelerate immediately after coronary heart disease suggests that CHD itself does not acutely alter the brain, such as by causing microinfarcts, they commented. Instead, CHD might induce longer-term shifts in cerebral vascular function by affecting the blood-brain barrier or perfusion and oxidation in the brain. While these complex relationships need further untangling, the study suggests interventions that cut CHD risk also might help prevent cognitive decline itself and slow the rate of cognitive decline if it occurs.
Dr. Rovio, Dr. Pahkala, and Dr. Raitakari are at the University of Turku (Finland) and Turku University Hospital. These comments are adapted from an editorial accompanying the article by Xie et al. (J Amer Coll Cardiol. 2019 Jun 17. doi: 10.1016/j.jacc.2019.04.020). They reported having no relevant financial disclosures.