From the Journals

Cognitive decline sped up after CHD

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Targeting CHD might slow cognitive decline

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.


 

FROM THE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

Cognitive decline accelerates in the long term after patients develop coronary heart disease (CHD), according to the results of a large prospective study with a median of 12 years of follow-up.

“We found that incident CHD was significantly associated with faster post–CHD-diagnosis cognitive decline, but not pre–CHD-diagnosis or short-term cognitive decline after the event,” Wuxiang Xie, PhD, of Peking University Health Science Center, Beijing, and associates wrote in the Journal of the American College of Cardiology. Linear mixed models showed that cognitive decline sped up during the year after incident CHD.

Past research had suggested a link between accelerated cognitive decline and CHD, but the temporal pattern of the relationship was unclear. For the study, Dr. Xie and associates followed 7,888 adults from the English Longitudinal Study of Aging who were an average of 62 years old and had no history of stroke, MI, angina, or dementia (Alzheimer’s disease or otherwise). All participants underwent a baseline cognitive assessment for verbal memory, semantic fluency, and temporal orientation, plus a median of six follow-up assessments.

In all, 480 (6%) participants developed CHD during follow-up. Their rate of cognitive decline remained constant before and immediately after their CHD diagnosis, but in subsequent years, they experienced significant accelerations in loss of global cognitive function, verbal memory, and temporal orientation even after accounting for time and many demographic and clinical variables. For example, the slope representing temporal change in global cognitive score decreased by a mean of 0.039 per year, compared with the pre-CHD slope (slope difference, –0.039; 95% confidence interval, –0.063 to –0.015; P =. 002). Semantic fluency also declined faster after CHD, but the difference, compared with before CHD, did not reach statistical significance (P = .11).

Individuals without CHD showed no such accelerations in cognitive decline throughout follow-up in adjusted models, the researchers wrote. “Based on repeated cognitive measurements over a long follow-up period, this study revealed a reliable and robust trajectory of cognitive decline [after CHD]. Future studies are warranted to determine the precise mechanisms linking incident CHD to cognitive decline.”

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.

SOURCE: Xie W et al. J Amer Coll Cardiol. 2019 Jun 17. doi: 10.1016/j.jacc.2019.04.019.

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