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      Coronary heart disease and risk for cognitive impairment or dementia: Systematic review and meta-analysis

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          Abstract

          Aims/Hypothesis

          Accumulating evidence suggests an association between coronary heart disease and risk for cognitive impairment or dementia, but no study has systematically reviewed this association. Therefore, we summarized the available evidence on the association between coronary heart disease and risk for cognitive impairment or dementia.

          Methods

          Medline, Embase, PsycINFO, and CINAHL were searched for all publications until 8 th January 2016. Articles were included if they fulfilled the inclusion criteria: (1) myocardial infarction, angina pectoris or coronary heart disease (combination of both) as predictor variable; (2) cognition, cognitive impairment or dementia as outcome; (3) population-based study; (4) prospective (≥1 year follow-up), cross-sectional or case-control study design; (5) ≥100 participants; and (6) aged ≥45 years. Reference lists of publications and secondary literature were hand-searched for possible missing articles. Two reviewers independently screened all abstracts and extracted information from potential relevant full-text articles using a standardized data collection form. Study quality was assessed with the Newcastle-Ottawa Scale. We pooled estimates from the most fully adjusted model using random-effects meta-analysis.

          Results

          We identified 6,132 abstracts, of which 24 studies were included. A meta-analysis of 10 prospective cohort studies showed that coronary heart disease was associated with increased risk of cognitive impairment or dementia (OR = 1.45, 95%CI = 1.21–1.74, p<0.001). Between-study heterogeneity was low ( I 2 = 25.7%, 95%CI = 0–64, p = 0.207). Similar significant associations were found in separate meta-analyses of prospective cohort studies for the individual predictors (myocardial infarction, angina pectoris). In contrast, meta-analyses of cross-sectional and case-control studies were inconclusive.

          Conclusion/Interpretation

          This meta-analysis suggests that coronary heart disease is prospectively associated with increased odds of developing cognitive impairment or dementia. Given the projected worldwide increase in the number of people affected by coronary heart disease and dementia, insight into causal mechanisms or common pathways underlying the heart-brain connection is needed.

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          Most cited references30

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          Dementia and Alzheimer's disease incidence in relationship to cardiovascular disease in the Cardiovascular Health Study cohort.

          Steven T. DeKosky, Oscar Lopez, Lewis Kuller … (2005)
          To determine whether coronary artery disease, peripheral arterial disease (PAD), or noninvasive markers of cardiovascular disease (CVD) predict the onset of dementia and Alzheimer's disease (AD). Longitudinal cohort study. Four U.S. communities. Men and women (N=3,602) with a brain magnetic resonance imaging (MRI) scan but no dementia were followed for 5.4 years. Participants with stroke were excluded. Neurologists and psychiatrists classified incident cases of dementia and subtype using neuropsychological tests, examination, medical records and informant interviews. CVD was defined at the time of the MRI scan. Noninvasive tests of CVD were assessed within 1 year of the MRI. Apolipoprotein E allele status, age, race, sex, education, Mini-Mental State Examination score, and income were assessed as potential confounders. The incidence of dementia was higher in those with prevalent CVD, particularly in the subgroup with PAD. The rate of AD was 34.4 per 1,000 person-years for those with a history of CVD, versus 22.2 per 1,000 person-years without a history of CVD (adjusted hazard ratio (HR)=1.3, 95% confidence interval (CI)=1.0-1.7). Rates of AD were highest in those with PAD (57.4 vs 23.7 per 100 person-years, adjusted HR=2.4, 95% CI=1.4-4.2). Results were similar with further exclusion of those with vascular dementia from the AD group. A gradient of increasing risk was noted with the extent of vascular disease. Older adults with CVD other than stroke had a higher risk of dementia and AD than did those without CVD. The risk was highest in people with PAD, suggesting that extensive peripheral atherosclerosis is a risk factor for AD.
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            Cardiovascular Risk Factors Promote Brain Hypoperfusion Leading to Cognitive Decline and Dementia

            Jack C de la Torre (2012)
            Heart disease is the major leading cause of death and disability in the world. Mainly affecting the elderly population, heart disease and its main outcome, cardiovascular disease, have become an important risk factor in the development of cognitive decline and Alzheimer's disease (AD). This paper examines the evidence linking chronic brain hypoperfusion induced by a variety of cardiovascular deficits in the development of cognitive impairment preceding AD. The evidence indicates a strong association between AD and cardiovascular risk factors, including ApoE4, atrial fibrillation, thrombotic events, hypertension, hypotension, heart failure, high serum markers of inflammation, coronary artery disease, low cardiac index, and valvular pathology. In elderly people whose cerebral perfusion is already diminished by their advanced age, additional reduction of cerebral blood flow stemming from abnormalities in the heart-brain vascular loop ostensibly increases the probability of developing AD. Evidence also suggests that a neuronal energy crisis brought on by relentless brain hypoperfusion may be responsible for protein synthesis abnormalities that later result in the classic neurodegenerative lesions involving the formation of amyloid-beta plaques and neurofibrillary tangles. Insight into how cardiovascular risk factors can induce progressive cognitive impairment offers an enhanced understanding of the multifactorial pathophysiology characterizing AD and ways at preventing or managing the cardiovascular precursors of this dementia.
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              Atherosclerosis and risk for dementia.

              Marieke van Oijen, Frank Jan de Jong, Jacqueline Witteman … (2007)
              Atherosclerosis has been implicated in the development of dementia and its major subtypes, Alzheimer's disease and vascular dementia. However, support for this association mainly comes from cross-sectional studies. We investigated the association of atherosclerosis with dementia and subtypes of dementia during long follow-up, with various noninvasive measures of atherosclerosis. This study was based on 6,647 participants in the Rotterdam Study, a population-based prospective cohort study among 7,983 elderly subjects. At baseline (1990-1993) and at the third survey (1997-1999), common carotid intima media thickness, carotid plaques, and peripheral arterial disease (measured as ankle-brachial index) were measured. During follow-up (mean, 9.0 years), 678 subjects developed dementia. We estimated the associations of different measures of atherosclerosis with risk for dementia and subtypes of dementia by means of Cox proportional hazard models. Analyses were repeated and stratified on duration of follow-up. To evaluate competing risk for mortality, we examined the association between measures of atherosclerosis and risk for dementia or mortality by combining the two in a single outcome measure. We found that atherosclerosis, predominantly carotid atherosclerosis, was associated with an increased risk for dementia during short follow-up. This association attenuated with longer follow-up, likely because of the strong association between atherosclerosis and mortality. The associations did not differ across apolipoprotein E genotypes. Our findings suggest that atherosclerosis is associated with an increased risk for dementia. Stronger associations between atherosclerosis and mortality may attenuate the association between atherosclerosis and dementia in prospective cohort studies with long follow-up periods.
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                Author and article information

                Contributors
                Kay Deckers:
                ORCID: http://orcid.org/0000-0003-1339-2974
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Syenna H. J. Schievink: Role: InvestigationRole: Writing – review & editing
                Maria M. F. Rodriquez: Role: InvestigationRole: Writing – review & editing
                Robert J. van Oostenbrugge: Role: Writing – review & editing
                Martin P. J. van Boxtel: Role: ConceptualizationRole: Writing – review & editing
                Frans R. J. Verhey: Role: Writing – review & editing
                Sebastian Köhler: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Stephen D Ginsberg: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 8 September 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 9
                Electronic Location Identifier: e0184244
                Affiliations
                [1 ] Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
                [2 ] Departamento de Psiquiatria, Hospital Alvaro Cunqueiro, Complexo Universitario de Vigo, Vigo, Spain
                [3 ] Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
                Nathan S Kline Institute, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-1339-2974
                Article
                Publisher ID: PONE-D-17-05997
                DOI: 10.1371/journal.pone.0184244
                PMC ID: 5590905
                PubMed ID: 28886155
                SO-VID: ee52b21d-09fe-40cf-8df9-7293b5c526cd
                Copyright © © 2017 Deckers et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 14 February 2017
                Date accepted : 21 August 2017
                Page count
                Figures: 2, Tables: 3, Pages: 15
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Science
                Subject: Cognitive Neuroscience
                Subject: Cognitive Neurology
                Subject: Cognitive Impairment
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Neuroscience
                Subject: Cognitive Neurology
                Subject: Cognitive Impairment
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Cognitive Neurology
                Subject: Cognitive Impairment
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Dementia
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Dementia
                Subject: Medicine and Health Sciences
                Subject: Cardiology
                Subject: Myocardial Infarction
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Coronary Heart Disease
                Subject: Medicine and Health Sciences
                Subject: Cardiology
                Subject: Coronary Heart Disease
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Dementia
                Subject: Alzheimer Disease
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Dementia
                Subject: Alzheimer Disease
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Neurodegenerative Diseases
                Subject: Alzheimer Disease
                Subject: Research and Analysis Methods
                Subject: Mathematical and Statistical Techniques
                Subject: Statistical Methods
                Subject: Meta-Analysis
                Subject: Physical Sciences
                Subject: Mathematics
                Subject: Statistics (Mathematics)
                Subject: Statistical Methods
                Subject: Meta-Analysis
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Alzheimer Disease Diagnosis and Management
                Custom metadata
                Data Availability Data are available from DataverseNL: http://hdl.handle.net/10411/EC8JX9.

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                ScienceOpen disciplines: Uncategorized

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