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Incident Heart Failure and Cognitive Decline: The Atherosclerosis Risk in Communities Study
Jan Bressler1, David S Knopman2, A Richey Sharrett3
1Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.
Insights
Cognitive decline, particularly in information processing speed, may predict future heart failure (HF) risk in middle-aged adults. Early detection of cognitive changes could identify individuals at higher risk for developing HF.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Cognitive impairment is common in heart failure (HF) patients.
- Cognitive decline may signal subclinical vascular disease and future cardiovascular risk.
Purpose of the Study:
- To investigate the association between cognitive function changes and incident heart failure (HF).
Main Methods:
- Prospective cohort study (Atherosclerosis Risk in Communities Study) with 7962 white and 1933 African-American participants (aged 46-70).
- Used Cox proportional hazards regression to analyze cognitive test scores (Delayed Word Recall, Digit Symbol Substitution Test [DSST], Word Fluency) and incident HF over a mean 12.6-year follow-up.
- Adjusted for age, gender, race, and education.
Main Results:
- A significant increased risk of developing HF was observed in participants with the greatest decline in DSST scores (HR=1.17, P=.009).
- Lowest baseline DSST scores were also associated with a significantly increased HF risk (HR=1.43, P<.001).
Conclusions:
- Reduced information processing speed, indicated by DSST performance, may predict heart failure risk in middle age.
- Cognitive function tests could serve as early indicators for cardiovascular risk assessment.
Background:
Cognitive impairment is found in a significant proportion of patients with heart failure (HF). Although cognitive impairment may be a consequence of HF, early signs of cognitive impairment may also indicate subclinical vascular disease, and thus a risk factor for future cardiovascular events.
Methods And Results:
The Atherosclerosis Risk in Communities Study is a prospective cohort study of the development of atherosclerosis. Cox proportional hazards regression was used to examine the association between mean 6-year change in cognitive function and incident HF in 7962 white and 1933 African-American men and women aged 46 to 70 years and free of clinical stroke. Scores were obtained for the Delayed Word Recall Test, the Digit Symbol Substitution Test (DSST), and the Word Fluency Test. There was a significantly increased risk of developing HF during the mean 12.6-year follow-up period after adjustment for age, gender, race, and education for those in the quartile with the greatest decline in DSST scores (hazard ratio [HR] = 1.17, P = .009), and in the quartile with the lowest baseline DSST scores (HR = 1.43, P < .001).
Conclusions:
The results suggest that relatively low performance on a test of information processing speed may serve as an indicator of HF risk in middle age.
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