Cardiovascular risk and all-cause mortality in a memory clinic population

Abstract

Introduction: The prevalence of atherosclerotic cardiovascular diseases and its associated mortality are increasing worldwide. In persons with cognitive impairment, the potential benefits from treatment of hypertension and dyslipidaemia may be overestimated due to competing mortality risks related to cognitive impairment. We therefore aim to explore the association between cardiovascular risk and all-cause mortality in a memory clinic population, and whether this relation is modified by cognitive and physical performance. Methods: All patients from the Amsterdam Ageing Cohort who visited the memory clinic were included. Cardiovascular risk was assessed with the SCORE2-OP, a validated instrument to estimate 5- and 10-year risk for non-fatal myocardial infarction, non-fatal stroke and cardiovascular mortality in persons aged ≥70 years. A 10-year risk of <7.5% was considered as low and ≥7,5% as high. Mortality data was obtained from the Dutch municipal register. Hazard ratios (HR) and their 95% confidential intervals (95%CI) were calculated for the association between cardiovascular risk and all-cause mortality (Model 1) and adjusted for age (Model 2). Stratified analyses were performed according to cognitive diagnosis (subjective cognitive decline (SCD), mild cognitive impairment (MCI), dementia) and gait speed < and ≥ 0.8m/s. Results: 1048 patients were included (mean age 79.2 ± 6.3 years, 50.4% male). Five hundred seventy-four patients (54.8%) had a low cardiovascular risk and 474 (45.2%) a high risk. Furthermore, 215 (20.5%) had SCD, 293 (28.0%) MCI, and 540 (51,5%) dementia. In the total sample, high cardiovascular risk was associated with all-cause mortality: HR 1.83 (95%CI 1.46 – 2.31, Model 1). The association was stronger in patients with SCD (HR 3.37 (95%CI 1.62 – 7.00)) and normal gait speed (1.71 (95%CI 1.24 – 2.37)), than in patients with dementia (HR 1.47 (95%CI 1.11 – 1.94)) and low gait speed (HR 1.41 (95%CI 1.00 – 1.98)). After adjusting for age, all associations became statistically non-significant. Discussion: In a Dutch memory clinic population, high cardiovascular risk is associated with all- cause mortality, but only in patients with normal cognitive and physical functioning. It is expected that in these patients, targeting cardiovascular risk factors will have the largest impact on reducing mortality risk.