Having both diabetes, CAD increases risk for dementia
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Key takeaways:
- Patients with diabetes and CAD had a 37% higher risk for developing all-cause dementia than those with neither condition.
- The risk appeared greatest for vascular dementia.
Patients with both diabetes and CAD appeared at significantly greater risk for dementia, especially vascular dementia, according to study findings published in European Journal of Preventive Cardiology.
“Diabetes is associated with an increased risk of atherosclerotic CVD — including CAD,” Kevin Kris Warnakula Olesen, MD, PhD, a postdoctoral researcher in the department of cardiological medicine at Aarhus University Hospital in Denmark, and colleagues wrote. “Diabetic patients with CAD are much more likely to develop myocardial infarction, but also have more cerebrovascular events, such as stroke, when compared with diabetic patients without CAD. Diabetes is similarly linked to the development of cognitive impairment and dementia. The underlying mechanism is multifactorial and not yet fully understood.”
To test their hypothesis that diabetes with coexisting CAD increases risk for dementia, researchers conducted a real-world study that included 103,859 patients aged 65 years and older who underwent coronary angiography, identified using the Danish National Patient Registry. Of these patients, 3,876 (4%) had diabetes, 61,020 (59%) had CAD, and 15,774 (15%) had diabetes and CAD. A group of 23,189 (22%) patients without diabetes or CAD served as the study’s reference group.
The researchers tracked cases of all-cause dementia, Alzheimer’s dementia and vascular dementia among each group and calculated adjusted HRs compared with the reference group. They also assessed the relative excess risk due to interaction (RERI) between diabetes and CAD for each of the outcomes.
Median follow-up was 6.3 years (interquartile range, 3.2-10 years).
During follow-up, 5,592 patients (5.5%) were diagnosed with dementia. Dementia appeared most prevalent among patients with diabetes and CAD and least prevalent among patients with neither diabetes nor CAD.
Patients with diabetes and CAD were significantly more likely to be diagnosed with all-cause dementia (adjusted HR = 1.37; 95% CI, 1.24-1.51), Alzheimer’s dementia (aHR = 1.41; 95% CI, 1.23-1.62) and vascular dementia (aHR = 2.03; 95% CI, 1.69-2.45) compared with patients with neither condition.
The rate of all-cause dementia was modestly higher among patients with diabetes alone (aHR = 1.14; 95% CI, 0.97-1.33) and CAD alone (aHR = 1.11; 95% CI, 1.03-1.2) compared with the reference group.
Diabetes with CAD was associated with an elevated RERI for vascular dementia (0.69; 95% CI, 0.25-1.12), showing a “synergistic effect” of the two conditions, according to the researchers. However, the RERI was close to 0 for all-cause dementia (0.11; 95% CI, –0.07 to 0.29) and Alzheimer’s dementia (0.11; 95% CI, –0.16 to 0.37), “indicating that the effect was close to the sum of the individual effects of diabetes and CAD,” they wrote.
“We found that diabetes and CAD, separately, were only modest risk factors for dementia,” the researchers wrote. “However, diabetes and CAD in combination were associated with the highest risk of dementia, in particular vascular dementia. Our results suggest that the risk of dementia associated with diabetes is partly mediated through the presence of atherosclerotic CVD, which underscores the importance of atherosclerotic CVD prevention in diabetic patients to reduce the risk of cognitive decline.”
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