Neurology: Longitudinal trajectories of cardiovascular risk associated with cognitive decline and dementia events

*For medical professionals to read and reference clinical information, 1s touches ▎Clinical question: How is the longitudinal trajectory of cardiovascular risk associated with cognitive decline and dementia events? Associations between cardiovascular risk factors and cognitive decline and dementia have recently been demonstrated, however most studies have examined such associations with cross-sectional data, lacking knowledge of the longitudinal dynamics of this risk
.

A study from Neurology assessed how persistent trajectories of cardiovascular risk affect subsequent risk of dementia and memory loss, assuming an accelerated, long-term cardiovascular risk determined based on the Framingham Risk Score (FRS) compared with stable cardiovascular risk.
Accumulation was more detrimental to cognitive and dementia status outcomes
.

Screenshots from the literature▎Study protocol: This study evaluated 1244 initially healthy community-dwelling subjects recruited from the prospective cohort Betula study
.

Cardiovascular disease risk, episodic memory performance, and dementia status based on FRS assessments were measured every 5 years for 20-25 years
.

▎Main findings: (1) 60% of subjects showed a moderate increase in cardiovascular risk over time, and an accelerated increase was observed in 18% of subjects, and 22% of subjects showed little change
.

(2) In contrast to a stable cardiovascular risk trajectory, an accelerated cardiovascular risk trajectory was predictive of Alzheimer's dementia (mean hazard ratio (RR): 3.
3-5.
7, 95% CI: 2.
6-17.
5 at T2, T5 1.
9-6.
7) or vascular dementia (mean RR: 3.
3-4.
1, 95% CI: 1.
1-16.
6 at T2, 1.
5-7.
6 at T5) and was associated with an increased risk of memory loss (mean RR: 1.
4 -1.
2, 95%CI: 1-1.
9 at T2, 1-1.
5 at T5)
.

(3) A stable cardiovascular risk trajectory appears to partially mitigate Alzheimer's dementia risk in APOE4 carriers
.

▎Conclusions: The results of this study suggest that longitudinal cumulative trajectories of cardiovascular risk predict dementia risk and are associated with memory decline
.

Therefore, clinical practice may benefit from direct intervention strategies targeting individuals with accelerated cardiovascular risk
.

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