Cognitive impairment and risk of cardiovascular events and mortality

Area of Science:

• Cardiology
• Neurology
• Public Health

Background:

• Cognitive impairment is a potential risk factor for cardiovascular (CV) events.
• The association between cognitive function and CV outcomes requires further investigation in high-risk populations.

Purpose of the Study:

• To prospectively evaluate the independent association between Mini-Mental State Examination (MMSE) scores and major adverse cardiovascular events (MACE).
• To assess the predictive value of cognitive impairment on myocardial infarction, stroke, heart failure hospitalizations, and mortality in a high-risk CV cohort.

Main Methods:

• A Cox regression model was used to analyze data from 30,959 individuals in two large CV trials.
• Participants were categorized into four groups based on baseline MMSE scores.
• Analyses were adjusted for numerous demographic, clinical, and lifestyle factors.

Main Results:

• A graded increase in the risk of major vascular events was observed with decreasing MMSE scores (P < 0.0001).
• MMSE score was significantly associated with stroke, heart failure, and CV death, but not myocardial infarction or angina.
• Impaired performance in orientation, attention-calculation, recall, and design copy domains were most predictive of adverse outcomes.

Conclusions:

• In individuals at increased cardiovascular risk, impaired cognitive function on baseline testing is associated with a graded increase in the risk of stroke, heart failure, and CV death.
• A Mini-Mental State Examination score below 24 conferred a risk of cardiovascular events comparable to that of a previous stroke.