Cardiometabolic multimorbidity impacts dementia risk
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Cardiometabolic multimorbidity and midlife onset of cardiometabolic disease are significantly associated with an increased risk for dementia, and genetic background may underlie this association, researchers reported.
“These findings add to the growing evidence of a connection between cardiometabolic multimorbidity and both vascular and neurodegenerative forms of dementia and highlight the need for special monitoring of individuals who develop type 2 diabetes, heart disease or stroke in midlife in order to reduce their risk of developing dementia in older age,” Abigail Dove, PhD student at Karolinska Institutet in Sweden, and colleagues wrote.
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Dove and colleagues analyzed 17,913 dementia-free twins aged 60 years or older (mean age, 70 years; 55% women) from the nationwide Swedish Twin Registry to determine the impact of cardiometabolic multimorbidity on the risk for dementia, to compare dementia risk for mid- vs. late-life onset of cardiometabolic disease (CMD) and to study the genetic nature of the CMD/dementia association. The study was split into separate study designs testing each of these endpoints.
The group was monitored over a maximum of 18 years to determine the relationship between mid- and late-life onset of dementia. The follow-up period included the time elapsed between the initial study and the diagnosis of dementia, death or a final follow-up in December 2016 (mean follow-up period, 15.4 years).
For the co-twin, genetic design of the study, researchers compared the CMD/dementia association in 54 monozygotic twin pairs and 302 dizygotic twin pairs to identify whether there was a genetic factor common to both CMDs and dementia.
At baseline, there were 3,312 participants (18.5%) with one CMD and 839 participants (4.7%) with at least two CMDs. During the follow-up period, 3,020 participants developed dementia.
Compared with those with no CMDs, individuals with at least two CMDs were at higher risk for dementia (HR = 2.1; 95% CI, 1.73-2.57; P < .05), as were people with one CMD to a lesser extent (HR = 1.42; 95% CI, 1.27-1.58; P < .05). There was also an increased risk for dementia in individuals who developed CMDs in midlife compared with individuals who developed CMDs in late life, according to the researchers.
In the co-twin design, researchers found that dizygotic twins (HR = 1.55; 95% CI, 1.15-2.09) were at increased risk for dementia compared with monozygotic twins (HR = 0.99; 95% CI, 0.5-1.98; P for interaction = .005).
“Using a twin study design, we also provide evidence that genetic background may underpin the association between cardiometabolic disease and dementia,” Dove and colleagues wrote. “Our findings call for the identification of these common genes for both CMDs and dementia in future studies.”
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