Cardiovascular and Lifestyle Risk Factors and Cognitive Function in Patients With Stable Coronary Heart Disease

Ralph A H Stewart, Claes Held, Sue Krug-Gourley, Dawn Waterworth, Amanda Stebbins, Karen Chiswell, Emil Hagstrom, Paul W Armstrong, Lars Wallentin, Harvey White, Ralph A H Stewart, Claes Held, Sue Krug-Gourley, Dawn Waterworth, Amanda Stebbins, Karen Chiswell, Emil Hagstrom, Paul W Armstrong, Lars Wallentin, Harvey White

Abstract

Background Vascular risk factors have been associated with differences in cognitive performance in epidemiological studies, but evidence in patients with coronary heart disease is more limited. Methods and Results The Montreal Cognitive Assessment score obtained 3.2±0.37 years after randomization to darapladib, a reversible inhibitor of lipoprotein phospholipase A2 or placebo was evaluated for 10 634 patients with coronary heart disease from 38 countries in the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial. The Montreal Cognitive Assessment scores for darapladib and placebo groups were similar (mean± SD , 25.3±3.84 versus 25.4±3.73, respectively; P=0.27) and the adjusted odds ratio ( OR ) for mild cognitive impairment (Montreal Cognitive Assessment score <26) was 1.00 (95% CI , 0.93-1.09). Mild cognitive impairment was more likely with increasing age ( OR , 1.33 [1.27-1.41], +5 years after 65). For other baseline clinical characteristics, the strongest independent predictors of cognitive impairment were education (≤8 years versus college/university, OR , 2.95 [2.60-3.35]; >8 years/trade school versus college/university, OR , 1.38 [1.25-1.52] and geographic grouping). Cardiovascular risk factors independently associated with cognitive impairment were history of stroke ( OR , 1.43 [1.20-1.71]); <2.5 hours of moderate or vigorous intensity exercise/week ( OR , 1.19 [1.04-1.37]); high-density lipoprotein cholesterol <1.16 mmol/L ( OR , 1.19 [1.04-1.37]); diabetes mellitus requiring treatment ( OR , yes versus no: 1.15 [1.05-1.26]); and history of hypertension ( OR , 1.12 [1.02-1.23]). Conclusions In patients with stable coronary heart disease, cognitive performance was associated with modifiable cardiovascular risk factors, educational level, and global region, but was not influenced by darapladib. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00799903.

Trial registration: ClinicalTrials.gov NCT00799903.

Keywords: Montreal Cognitive Assessment; cognitive impairment; coronary heart disease; risk factor.

Figures

Figure 1
Figure 1
Study flow diagram. Flow diagram indicating STABILITY study participants who completed the MoCA after a median follow‐up of 3.2±0.4 years, and reasons for noncompletion by treatment allocation. MoCA indicates Montreal Cognitive Assessment. Patients may have more than one reason for exclusion; STABILITY, Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy.
Figure 2
Figure 2
MoCA score by age stratified by (A) physical activity level, and (B) education. Average age‐related change in MoCA score is plotted for subjects by presence or absence of (A) <2.5 h/wk of moderate or vigorous physical activity and (B) education level. MoCA indicates Montreal Cognitive Assessment.

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