Sex Differences in the Impact of Atherosclerotic Cardiovascular Risk Burden on Cognitive Health

Sex affects the prevalence of atherosclerotic cardiovascular disease (ASCVD) risk factors but whether sex differences exist in the associations between ASCVD risk burden and cognitive function is unclear.

This cross-sectional study included participants from a population-based cohort study in China that recruited community-dwelling adults aged 50 to 75 years without baseline cardiovascular disease and stroke. The 10-year ASCVD risk burden was quantified with 3 multivariate risk prediction equations. Cognitive domains of memory, attention, visuospatial function, executive function, and processing speed were assessed. Multivariable linear regression models were used to examine the interaction terms between sex and ASCVD risk scores on cognition.

The final analytical sample included 2180 participants. Mean±SD age was 60.14 (6.38) and 52.1% were women. Men showed significantly higher ASCVD risk burden than women at baseline but the effect of ASCVD risk on 2-year cognition were amplified in women compared with men, for the domains of memory (eg, β=-0.20 [95% CI, -0.26 to -0.13] versus β=-0.11 [95% CI, -0.16 to -0.07]), executive function (eg, β=-0.23 [95% CI, -0.31 to -0.16] versus β=-0.16 [95% CI, -0.21 to -0.10]), and processing speed (eg, β=-0.33 [95% CI, -0.39 to -0.27] versus β=-0.17 [95% CI, -0.21 to -0.13]). Sex-stratified analyses showed different neuropsychological profiles at moderate ASCVD risk burden levels, suggesting sex-specific ASCVD-risk related cognitive phenotypes.

Sex differences in cognitive health affected by ASCVD risk underscore the importance of sex-specific cognitive monitoring during ASCVD risk management and better vascular risk control in women to prevent cognitive decline.