Certain Cardiovascular Conditions, Risks May be Worse for Cognition in Middle-aged Women

Cardiovascular (CV) conditions, such as coronary artery disease (CAD), and CV risk factors (eg, diabetes and hypertension) had stronger associations with cognition decline in mid-life for women than men despite a higher prevalence of those conditions in men, according to a new Mayo Clinic study.

"It is well-known that men, compared to women, have a higher prevalence of cardiovascular conditions and risk factors in midlife. However, our study suggests that women in midlife with these conditions and risk factors are at greater risk of cognitive decline," said senior author Michelle Mielke, PhD, a Mayo Clinic epidemiologist and neuroscientist, in the organization’s press release. "Thus, while all men and women should be treated for cardiovascular conditions and risk factors in midlife, additional monitoring of women may be needed as a potential means of preventing cognitive decline."

The research included 1857 participants without dementia enrolled in the population-based Mayo Clinic Study of Aging who were aged between 50 to 69 years at baseline. Of the participants, 920 were men and 937 were women.

For an average of 3 years, participants were evaluated every 15 months by a coordinator and with neurologic evaluation and neuropsychological testing. Participants’ global cognition was evaluated with 9 tests of memory, language, executive function, and visuospatial skills.

Nurse abstractors reviewed study participants’ medical records obtained from the population-based Rochester Epidemiology Project to determine the presence of CV conditions (CAD, arrhythmias, congestive heart failure) and risk factors (hypertension, diabetes, dyslipidemia, obesity, smoking).

Overall, 1465 (70.3%) participants had at least 1 CV condition or risk factor, and the proportion of men was higher than women (767 (83.4%) vs 698 (74.5%); P<.0001), according to the study abstract.

The results showed that most CV conditions were more strongly associated with cognition among women than men. CAD and the other CV conditions were associated with global cognitive decline only in women (all p<.05).

Also, diabetes, dyslipidemia, and CAD were associated with greater language decline in women (all p<.05); but congestive heart failure was associated with greater language decline in men only (all p<.05).

Mielke stressed the importance of understanding sex differences in the development of cognitive impairment to improve the health of women and men. Future research should focus across the life span to determine any potential mechanisms that explain sex differences in the relationship between CV factors and cognition (eg, hormones, genetics, lifestyle factors), added Mielke.

Reference: Mielke MM, Huo N, Vemuri P, et al. Sex differences in the association between midlife cardiovascular conditions or risk factors with midlife cognitive decline. Neurology. Published online January 5, 2022. DOI: 10.1212/WNL.0000000000013174.