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Updated: Aug 19, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Health status and cognitive function for risk stratification in chronic coronary and peripheral artery disease
Kim G Smolderen1,2, Carlos Mena-Hurtado1, John W Eikelboom3
1Department of Internal Medicine, Yale University, School of Medicine, Vascular Medicine Outcomes Program, 789 Howard Avenue, New Haven, CT 06519, USA.
Insights
Assessing health status and cognitive function can improve cardiovascular risk prediction in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). These factors help identify individuals at lower risk for adverse cardiovascular or limb events.
Area of Science:
- Cardiovascular Medicine
- Clinical Risk Assessment
Background:
- Traditional risk prediction for coronary artery disease (CAD) and peripheral artery disease (PAD) may not fully capture patient outcomes.
- The added value of health status and cognitive function assessments to existing biomedical frameworks is unclear.
Purpose of the Study:
- To investigate if health status and cognitive function assessments can enhance traditional risk prediction in CAD and PAD patients.
- To examine the association between health status, cognitive function, and subsequent adverse cardiovascular and limb events.
Main Methods:
- Utilized data from the COMPASS trial, including 23,433 CAD and 6,899 PAD patients.
- Assessed overall health status using the EQ-5D-3L visual analogue scale (VAS) and cognitive function with the Digit Symbol Substitution test (DSST).
- Employed hierarchical Cox regression models, adjusting for demographics, medical history, and risk factors.
Main Results:
- Higher EQ VAS and DSST scores were significantly associated with a lower risk of major adverse cardiovascular or limb events in both CAD and PAD cohorts.
- Increased EQ VAS scores (per 10 units) showed hazard ratios of 0.89 for both CAD and PAD.
- Increased DSST scores (per 5 units) showed hazard ratios of 0.95 for both CAD and PAD.
Conclusions:
- Health status and cognitive functioning assessments can augment cardiovascular risk stratification in CAD and PAD.
- Integrating these assessments into biomedical evaluations offers a more comprehensive approach to risk prediction.
Background And Aims:
It is unclear whether health status and cognitive function assessments can augment traditional coronary artery disease (CAD) and peripheral artery disease (PAD) biomedical risk prediction frameworks. We examined the association between health status and cognitive function and subsequent adverse cardiovascular and limb events in CAD and PAD.
Methods And Results:
Stable CAD and PAD patients from the international, multi-centre COMPASS trial completed the visual analogue scale (VAS) of the EQ-5D-3L to assess overall health status, and the Digit Symbol Substitution test (DSST) to assess cognitive function. Main outcomes were incident development of major adverse cardiovascular events, and the combined endpoint major adverse cardiovascular or limb events. The EQ VAS (per 10 unit increase) and DSST (per 5 unit increase) were added to fully adjusted (medications, demographics, cardiovascular history and risk factors) hierarchical Cox regression models. A total of 23 433 patients were in the CAD cohort and 6899 in the PAD cohort. Among both the CAD and PAD groups, higher scores on the EQ VAS (CAD: HR = 0.89, 95%CI 0.88-0.89; PAD HR = 0.89, 95%CI 0.88-0.89) and DSST (CAD HR = 0.95, 95%CI 0.94-0.95) (PAD HR = 0.95, 95%CI 0.94-0.95) were associated with a lower risk of a major adverse cardiovascular or limb events. Population attributable risks associated with the lower two quartiles vs. upper quartiles for the EQ-5D and DSST scores were 7% and 16%, respectively in the CAD cohort; and for PAD, at 14% and 18%, respectively.
Conclusions:
Adding health status and cognitive functioning information to biomedical evaluations can augment cardiovascular risk-stratification in CAD and PAD.
Clinicaltrials.Gov Identifier:
NCT01776424.
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