Coronary Artery Calcium and Cognitive Decline in the Diabetes Prevention Program Outcomes Study

Area of Science:

• Cardiology
• Neurology
• Endocrinology

Background:

• The Diabetes Prevention Program Outcomes Study (DPPOS) investigated long-term outcomes in participants with prediabetes.
• Coronary artery calcium (CAC) is a marker of atherosclerosis.
• Cognitive function is crucial for daily living and can be affected by metabolic and vascular conditions.

Purpose of the Study:

• To examine the association between coronary artery calcium (CAC) and cognitive function in adults with impaired glucose tolerance or type 2 diabetes.
• To determine if CAC predicts longitudinal cognitive decline in this population.

Main Methods:

• Utilized data from 1931 participants in the DPPOS, a randomized controlled trial.
• Assessed CAC using computed tomography (Agatston score) approximately 14 years after randomization.
• Evaluated cognitive performance using the Spanish English Verbal Learning Test (SEVLT) and Digit Symbol Substitution Test at 14 and 19 years post-randomization.

Main Results:

• Unadjusted analyses showed higher CAC scores (>300) associated with poorer cognitive performance at 14 years.
• CAC >300 was linked to a greater 5-year decline in SEVLT Immediate Recall (both sexes) and SEVLT Delayed Recall (women).
• After adjusting for multiple covariates, CAC >300 remained independently associated with a greater decline in SEVLT Delayed Recall specifically in women.

Conclusions:

• In women with prediabetes or type 2 diabetes, elevated CAC (>300) is independently associated with a significant decline in verbal memory over time.
• These findings suggest a link between subclinical atherosclerosis and cognitive impairment in women with glucose metabolism disorders.
• Managing cardiovascular risk factors may be important for preserving cognitive function in this demographic.