Cardiovascular Health and Subsequent Cognitive Impairment and Decline in Coronary Heart Disease Patients

Background:
We investigated the association between a modified cardiovascular health (CVH) score in CHD patients and cognitive performance as well as its decline two decades later.

Methods:
322 surviving CD patients (mean age 58±6.4 y), who previously participated in a secondary prevention trial during 1990-1997, underwent an assessment of cognition and measures of atherosclerosis during 2004-2008 (T1) and were reassessed during 2011-2013 (T2) at mean ages of 72.6±6.4 and 77±6.4 yrs., respectively. Cognitive function was assessed using the NeuroTrax Computerized Cognitive Battery. CVH score at baseline was composed of 3 health factors (glucose, LDL-cholesterol, blood-pressure), 4 behaviors (physical-activity, adherence to Mediterranean diet, smoking, BMI), and body height assessing, in-part, early life environment. We categorized each of these 8 factors into best (2 points), intermediate (1 point), and poor levels (0 points). We used linear regression model to assess the relationship of baseline CVH score with cognitive scores and linear mixed model to assess the change.

Results:
Adjusted for age, educational level, sex, employment and depressive symptoms, a 1 point increment in the overall baseline CVH score was associated with higher executive function (p=0.006), visuospatial function (p=0.011), as well as a global cognitive function score (ß coefficient ± SE, 0.75±0.29 (p=0.010 ). Patients scoring in the higher tertile of CVH score revealed subsequent higher scores in the global cognitive function score (p=0.011) and in tests of visual spatial and executive function (p=0.024 and p=0.008, respectively). A 1 point overall CVH score increment was related to a slower global cognitive function (ß=0.04±0.02; p=0.005), visuospatial (ß=0.09±0.03; p=0.004) and executive function decline (ß=0.04±0.02; p=0.027).

Conclusion:
Favourable CVH among CHD patients was associated with subsequent higher cognitive functions. Our findings suggest that health behavior and early life environment are important determinants of late-life cognitive function.