Cardiovascular risk and cognitive performance: a population-based cross-sectional study (NEDICES2-RISK).

Javier Rubio Serrano, Beatriz Arregui-Gallego, Ileana Gefaell, Ester Tapias-Merino, Maria Del Canto De Hoyos-Alonso, Isabel Del Cura

Keywords: Heart Disease Risk Factors, Neuropsychological Tests, Cognitive Dysfunction, Clinical Decision Rules

Background:

Cardiovascular risk (CVR) factors can increase the likelihood of cognitive impairment. CVR functions seem to be a reliable predictor of this risk.

Research questions:

Is there a relationship between CVR and cognitive performance in the Spanish population?

Method:

Cross-sectional study of a community based cohort, aged 55 to 75 years with no previous cardiovascular events. The study estimated CVR using the Framingham REGICOR (Registre Gironí del Cor) and FRESCO (Función de Riesgo Española de acontecimientos Coronarios y Otros) equations. Participants underwent neuropsychological tests to explore the following cognitive domains: global cognition, memory, premorbid intelligence, verbal fluency, visuoconstruction, attention, and psychomotor speed. A generalized linear model was fitted to analyze the influence of CVR on cognitive performance for each risk function.

Results:

The study included 859 participants The median age was 67 (IQR: 62.00–71.0) years, and 56.2% were women. Women with higher CVR, as determined by REGICOR, had lower scores in the Trail Making Test A part 2 (TMTA-2) with an odds ratio (OR) of 4.35, (CI95% 1.16-18.45). High CVR by FRESCO, showed lower scores in the Immediate OR:5.16 (CI95% 1.91-15.64), and Delayed Recall tests OR:2.75, (CI95% 1.05-7.61), and TMTA part 1 (TMTA-1) OR:6.77 (CI95% 2.13-21.61). Men with higher CVR estimated with the REGICOR function had lower scores in the TMTA-1 OR:3.14 (CI95% 1.30-7.66), and TMTA-2 OR:2.75 (CI95% 1.18-6.44). Similarly, those with moderate CVR exhibited poorer scores in TMTA-1 OR:2.16 (CI95% 1.09-4.45). The FRESCO function also indicated that men with moderate CVR presented lower scores in the Immediate OR:2.23 (CI95% 1.20-4.19) and Delayed Recall tests OR:2.35 (CI95% 1.24-4.49), as well as TMTA-1 OR:2.49 (CI95% 1.14-5.55).

Conclusions:

Despite the absence of previous cardiovascular disease, poor cognitive performance was associated with high CVR in men and women. Memory, attention and psychomotor speed were the most affected cognitive domains.

Points for discussion:

Why do you think REGICOR and FRESCO differ in CVR levels?

This study is part of a 5 year follow up cohort, taking that into account, what should we recommed in the Primary Care setting to avoid future cognitive impairment?

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