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Modifiable risk factors associated with mild cognitive impairment in patients with stable coronary heart disease in the STABILITY trial

Session Poster session 7

Speaker Ralph Stewart

Event : ESC Congress 2015

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : R A H Stewart (Auckland,NZ), PW Armstrong (Edmonton,CA), K Chiswell (Durham,US), E Hagstrom (Uppsala,SE), C Held (Uppsala,SE), S Krug-Gourley (King of Preussia,US), CM Ryan (Pittsburgh,US), A Stebbins (Durham,US), L Wallentin (Uppsala,SE), HD White (Auckland,NZ)

Authors:
R.A.H. Stewart1 , P.W. Armstrong2 , K. Chiswell3 , E. Hagstrom4 , C. Held4 , S. Krug-Gourley5 , C.M. Ryan6 , A. Stebbins3 , L. Wallentin4 , H.D. White1 , 1Green Lane Cardiovascular Service, Auckland City Hospital - Auckland - New Zealand , 2Canadian Vigour Center, University of Alberta - Edmonton - Canada , 3Duke Clinical Research Institute, Duke University - Durham - United States of America , 4Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University - Uppsala - Sweden , 5Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline - King of Preussia - United States of America , 6Department of Psychiatry, University of Pittsburgh - Pittsburgh - United States of America ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 1088

Background: Decreased cognitive function is a major cause of disability in the elderly and is more prevalent in patients with cardiovascular disease.

Purpose: To evaluate associations between modifiable cardiovascular risk factors and mild cognitive impairment (MCI) in patients with chronic coronary heart disease (CHD) who participated in the global STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial.

Methods: 10,634 of 15,828 study participants completed the Montreal Cognitive Assessment (MoCA) test a mean of 3.17±0.37 years after randomisation to darapladib or placebo. The odds ratios (OR) for MCI (MoCA score <26 out of 30) versus normal cognitive function (MoCA score ≥26) were determined for clinical and demographic factors assessed at baseline using a multivariable model.

Results: The median age was 64 (IQR 59, 70) years and 82% were men. MoCA was <26 in 4,578 (43%) subjects. In the multivariable model older age, lower educational achievement, geographic region and country income level were each associated with MCI (P<0.0001). MCI was also more common in patients with a history of hypertension (OR 1.12, 95% Confidence Interval [CI] 1.02, 1.23), diabetes mellitus (OR 1.11, 95% CI 1.01, 1.21), LDL cholesterol >2.58mmol/L (OR 1.11, 95% CI 1.01, 1.23), HDL cholesterol <1.03mmol/L (OR 1.12, 95% CI 1.02, 1.23), <2.5 hours moderate intensity exercise each week (OR 1.15, 95% CI 1.06, 1.27), renal dysfunction (eGFR <60 mL/min, OR 1.10, 95% CI 1.00, 1.21) and history of stroke (OR 1.42, 95% CI 1.19, 1.70). Randomisation to darapladib or placebo, sex, obesity, current smoking, history of myocardial infarction, coronary artery bypass surgery, multi-vessel coronary artery disease and poly-vascular disease were not independently associated with MCI.

Conclusion: MCI is common in patients with stable CHD and associated with several cardiovascular risk factors, some of which are modifiable. These observations suggest that interventions which improve cardiovascular risk factors could, over the longer term, decrease the likelihood of developing cognitive impairment.

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