Does Incident Cardiovascular Disease Lead to Greater Odds of Functional and Cognitive Impairment? Insights from the Health and Retirement Study.

BACKGROUND: While studies to date have broadly shown that cardiovascular disease (CVD) increases cognitive and physical impairment risk, there is still limited understanding of the magnitude of this risk among relevant CVD subtypes or age cohorts.

METHODS: We analyzed longitudinal data from 16,679 U.S. Health and Retirement Study (HRS) participants who were age ≥65 years at study entry. Primary endpoints were physical impairment (ADL impairment) or cognitive impairment (Langa-Weir Classification of dementia). We compared these endpoints among participants who developed incident CVD versus those who were CVD-free, both in the short-term (<2 years post diagnosis) and long-term (>5 years), controlling for sociodemographic and health characteristics. We then analyzed effects by CVD subtype (atrial fibrillation, congestive heart failure, ischemic heart disease, stroke) and age-at-diagnosis (65-74, 75-84, ≥85).

RESULTS: Over a median follow-up of 10 years, 8,750 participants (52%) developed incident CVD. Incident CVD was associated with a significantly higher adjusted odds [aOR] of short-term and long-term physical and cognitive impairment. The oldest (≥85) age-at-diagnosis subgroup had the highest risk of short-term physical (aOR 3.01, 95% confidence-interval [CI] 2.40-3.77) and cognitive impairment (aOR 1.96, 95% CI 1.55-2.48), as well as long-term impairment. All CVD subtypes were associated with higher odds of physical and cognitive impairment, with the highest risk for patients with incident stroke.

CONCLUSIONS: Incident CVD was associated with increased risk of physical and cognitive impairment across CVD subtypes. Impairment risk after CVD was highest among the oldest patients (≥85 years) who should therefore remain a target for prevention efforts.