Women with vascular issues at higher risk of cognitive decline than men

Women with cardiovascular conditions and related risk factors in mid-life are more likely to face cognitive decline than men. This is despite a higher prevalence of cardiovascular disease (CVD) in men. This finding comes from a population-based study published in Neurology investigating whether there are differences between the sexes when it comes to associations between cognitive decline and mid-life CVD conditions. “In terms of vascular disease, most studies historically have looked at vascular factors in late life affecting cognition, or looked at it in mid-life predicting late life cognitive risk of dementia. Few studies have looked at the association of mid-life vascular factors and mid-life cognition,” said study coauthor Michelle Mielke, PhD, a professor of epidemiology and neurology at the Mayo Clinic in Rochester, Minnesota. Read: Cycling reduces all-cause mortality including CVD by 24% in diabetics Several sex-based key differences are already known. For one, men generally develop cardiovascular risk factors such as hypertension, diabetes, dyslipidemia at younger age and have a higher risk of developing coronary heart disease (CHD) than women. But women have a higher risk of stroke, which tends to occur at older age. “Specifically, we found that certain cardiovascular conditions, such as diabetes, heart disease and dyslipidemia had stronger associations with cognitive decline in women compared to men,” she said. For the prospective study, researchers used data from the Mayo Clinic Study on Aging (MCSA). The MCSA is a long-term population cohort study initially launched in 2004 to investigate the prevalence, incidence and risk factors for mild cognitive impairment (MCI). It included people aged 70 to 89 years of age living in Olmstead County, Minnesota, but was expanded to include those aged 50 to 69 in 2012. The study included the 1,857 participants who were non-demented and aged 50 to 69 at their baseline visit between February 2012 and February 2020. Each participant had an in-person interview with a study co-ordinator every 15 months, as well as a physician examination, and neuropsychological testing by a psychometrist. The neuropsychological testing included testing of different aspects of memory, language, executive function and visuospatial skills. Of the participants 920 were men, 937 were women and there was an overall mean BMI of 29.7. A total of 1,465 (78.9%) of the participants had at least one cardiovascular condition or risk factor, occurring in 767 (83.4%) men and 698 (74.5%) women. Men had a higher frequency of individual cardiovascular conditions—CHD, arrhythmias, congestive heart failure (CHF), peripheral vascular disease (PVD), and stroke—or risk factors —hypertension, diabetes, dyslipidemia, smoking status ever or never, body mass index (BMI), and obesity. The mean follow-up years of all participants was three years. A total of 1,394 participants had follow-up and were included in the study analyses. Over time, it was found that baseline risk factors for CVD, or a history of ever smoking was associated with greater decline in cognitive scores in general. People with overt cardiovascular conditions also had greater decline in cognition scores compared to those without. More specifically, participants who had diabetes, CHD, or other cardiovascular conditions at baseline, and who ever smoked, had significantly greater decline in memory, language and attention measures. However, hyperlipidemia, BMI and obesity were not associated with declines in cognition. Hypertension was associated with greater declines in language and attention while CHF was associated with a greater decline in memory. For a number of cardiovascular conditions and risk factors, women demonstrated greater cognitive decline than men. For example, women with CHD, or other cardiovascular conditions had two-fold greater declines in global cognition and memory than men. Women with risk factors such as diabetes dyslipidemia, CHD, other cardiovascular conditions, or obesity had greater declines in language scores. In contrast, men with CHF or whomever smoked had stronger associations with declines in language scores than women. The declines in cognitive score doesn’t necessarily mean an increased risk for dementia, Dr. Mielke told the Medical Post. The authors noted that the study “contributes to the field by including the evaluation of multiple cognitive domains.” The study adds to the increasing understanding of the differences between women and men when it comes to cardiovascular risks, said cardiologist Dr. Sharon Mulvagh, professor of medicine at Dalhousie University and co-director of the Maritime Heart Center Women’s Heart Health Clinic. She was not part of the study group. She noted that the cohort appeared to have better than average health. “The issue they highlight in this study is something that has been recognized,” she said. But heart disease in women is generally under-recognized, under-researched and undertreated. And woman-specific cardiovascular areas need more focus, such as pregnancy-related issues which can have longer term effects – such as hypertension in pregnancy including preeclampsia, eclampsia, gestational diabetes, and preterm birth. Dr. Mulvagh recommended that doctors look at the Heart and Stroke Foundation of Canada 2019 Report on Heart, Stroke and Vascular Cognitive Impairment which addresses the spectrum and interconnectedness of these heart/brain issues. It highlights that many of these risks are higher for women. For example, it stated that 12% more women than men die of heart conditions, stroke or vascular cognitive impairment. The best thing is to work at prevention both for CVD and dementia, which translates into maintaining good vascular health, she said. This follows the normal recommendations of having a heart healthy lifestyle, including healthy diet, physical activity, screening and treatment for cardiovascular risk factors, she said.

Women with vascular issues at higher risk of cognitive decline than men

Register for free access or login.

Related Topics