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Published on: April 23, 2021
Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years
Lewis H Kuller1, Oscar L Lopez2, Rachel H Mackey1
1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
In very elderly individuals, dementia occurs more frequently than coronary heart disease (CHD). Low coronary artery calcium (CAC) scores in white women significantly reduce dementia risk, highlighting atherosclerosis as a key factor in mortality.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Neurology
Background:
- Increased longevity due to advances in treating coronary heart disease (CHD) and stroke has led to a larger elderly population at risk for dementia.
- Dementia risk is a growing concern in aging populations.
Purpose of the Study:
- To evaluate the association between coronary and peripheral atherosclerosis and the risk of death, dementia, and CHD in the very elderly.
- To conduct sex- and race-specific analyses due to known differences in vascular disease prevalence, with a focus on women with low coronary artery calcium (CAC) scores.
Main Methods:
- The study analyzed subclinical cardiovascular disease markers (CAC, carotid intima-media thickness, stenosis, ankle-brachial index) in 532 participants (mean age 80) from the Cardiovascular Health Study-Cognition Study.
- Data were collected from 1998/1999 to 2012/2013, covering a period when participants aged to a mean of 93.
Main Results:
- Thirty-six percent of participants had high CAC scores (>400).
- Lower CAC scores were observed in women and African Americans compared to men.
- CAC scores and coronary calcifications correlated with increased mortality and CHD risk. Dementia incidence was higher than CHD incidence, and a prior dementia diagnosis was common among those who died. White women with low CAC scores showed a significantly reduced risk of dementia.
Conclusions:
- In individuals aged 80 and older, dementia incidence surpasses that of CHD.
- Coronary artery calcium (CAC) is a significant marker of atherosclerosis, predicting mortality, CHD, and myocardial infarction risk.
- Low CAC scores in white women were associated with a substantially decreased risk of dementia, suggesting a potential link between atherosclerosis prevention and reduced dementia pathology.
Background:
The successful prevention and treatment of coronary heart disease (CHD) and stroke has resulted in a substantial increase in longevity, with subsequent growth in the population of older people at risk for dementia.
Objectives:
The authors evaluated the relationship of coronary and other peripheral atherosclerosis to risk of death, dementia, and CHD in the very elderly. Because the extent of vascular disease differs substantially between men and women, sex- and race-specific analyses were included, with a specific focus on women with low coronary artery calcium (CAC) Agatston scores.
Methods:
We evaluated the relationship between measures of subclinical cardiovascular disease (CAC, carotid intimal medial thickness, stenosis, and ankle brachial index) and risk of dementia, CHD, and total mortality in 532 participants of the Cardiovascular Health Study-Cognition Study from 1998/1999 (mean age, 80 years) to 2012/2013 (mean age, 93 years).
Results:
Thirty-six percent of participants had CAC scores >400. Women and African-Americans had lower CAC scores. Few men had low CAC scores. CAC score and number of coronary calcifications were directly related to age-adjusted total mortality and CHD. The age-specific incidence of dementia was higher than for CHD. Only about 25% of deaths were caused by CHD and 16% by dementia. Approximately 64% of those who died had a prior diagnosis of dementia. White women with low CAC scores had a significantly decreased incidence of dementia.
Conclusions:
In subjects 80+ years of age, there is a greater incidence of dementia than of CHD. CAC, as a marker of atherosclerosis, is a determinant of mortality, and risk of CHD and myocardial infarction. White women with low CAC scores had a significantly decreased risk of dementia. A very important unanswered question, especially in the very elderly, is whether prevention of atherosclerosis and its complications is associated with less Alzheimer disease pathology and dementia. (Cardiovascular Health Study [CHS]; NCT00005133).
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