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Cardiovascular disease linked to cognitive decline in postmenopausal women

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A new study has found that postmenopausal women with cardiovascular disease are more likely to develop cognitive impairment (problems with perceiving, thinking, or remembering). The study, conducted by researchers in the United States and Germany, was published in the December 2013 issue of the Journal of the American Heart Association.

The study authors note that the number of people suffering from cardiovascular diseases has increased in recent decades; thus, making cardiovascular‐related death the leading cause of death in developed nations. Also, during this time period, the number of individuals affected by mild cognitive impairment or dementia has been steadily growing; thus, making cognitive decline a significant threat and health burden to aging individuals. They note that previous studies have examined the association between atherosclerotic disease and the risk for developing dementia or mild cognitive impairment. Furthermore, it is currently widely accepted that atherosclerosis is an important cause of many vascular diseases that may also alter cognitive functioning by decreasing the blood supply to the brain. The authors cite that several studies have provided significant evidence that cardiovascular risk factors such as hypertension, diabetes, and adiposity increase the risk of dementia. Despite this research, however, findings on the relationship between the various sites of atherosclerotic lesions and the risk for developing mild cognitive impairment or dementia among older individuals remains controversial. In addition, other cardiac conditions such as atrial fibrillation or heart failure are often the consequence of underlying cardiovascular disease. Both these conditions result in a decrease in cardiac output; thus, increasing the risk for thromboembolism (a blood clot traveling to the brain), and have been associated by some previous studies with cognitive decline.

In view of the foregoing, the authors conducted a study to assess the association of women with a history of myocardial infarction (heart attack), angina pectoris, atrial fibrillation, heart failure, other invasive vascular procedures or diseases including coronary bypass surgery, angioplasty, carotid endarterectomy, peripheral vascular disease (or a combination) with the incidence of mild cognitive impairment or dementia later in life. They also assessed the effect of hypertension, diabetes, and adiposity (overweight) on this relationship.

The researchers accessed data from 6,455 cognitively intact, postmenopausal women aged 65 to 79 years old who were enrolled in the Women's Health Initiative Memory Study (WHIMS). Cardiovascular disease was determined by self‐reporting. To evaluate cognitive decline, the investigators assessed the incidence of mild cognitive impairment or dementia with a modified mini‐mental state examination (3 MS) score, neurocognitive, and neuropsychiatric examinations. The average duration of follow‐up was 8.4 years. Compared to women who did not have cardiovascular disease, women with cardiovascular disease were at increased risk for cognitive decline. Women with myocardial infarction or other vascular disease were at the highest risk. Angina pectoris was moderately associated with cognitive decline; however, no significant relationships were found for atrial fibrillation or heart failure. Among women without cardiovascular disease, hypertension and diabetes increased the risk for cognitive decline. Diabetes tended to increase the risk for mild cognitive impairment or dementia in women with cardiovascular disease. No significant trend was found for adiposity.

The authors concluded that cardiovascular disease is associated with cognitive decline in postmenopausal women. Hypertension and diabetes, but not adiposity, are associated with a higher risk for cognitive decline. They recommended that further research should be conducted on the potential of cardiovascular disease prevention for preserving cognitive functioning.

Take home message:
Family history is a factor in the development of cardiovascular disease; however, poor lifestyle choices, such as poor diet, lack of exercise, and smoking, increase the risk of cardiovascular disease regardless of a good family history in regard to cardiovascular disease.



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