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Coronary Heart Disease Before Age 45 May Increase Risk Of Dementia Later In Life
Adults diagnosed with coronary heart disease, especially before the age of 45, may be at increased risk of developing dementia, Alzheimer's disease and vascular dementia later in life, according to new research published today in the Journal of the American Heart Association.
"Coronary heart disease has previously been associated with dementia risk in older adults; however, this is believed to be the first large-scale study examining whether the age of coronary heart disease onset may impact the risk of developing dementia later in life," said Fanfan Zheng, Ph.D., senior study author and researcher in the School of Nursing at the Chinese Academy of Medical Sciences & Peking Union Medical College in Beijing, China.
"In previous research, we found that adults experienced accelerated cognitive decline after new diagnoses of coronary heart disease," she said.
The researchers assessed the potential relationship between age at coronary heart disease onset and the development of dementia by analyzing health data from the UK Biobank.
The analysis found:
"What surprised us most was the linear relationship between age of coronary heart disease onset and dementia. This shows the huge detrimental influence of premature coronary heart disease on brain health," Zheng said.
"As more people live longer and are diagnosed with coronary heart disease at a younger age, it's likely there will be a large increase in the number of people living with dementia in years to come. Health care professionals should be aware of individuals diagnosed with coronary heart disease at a young age. The next step is to determine whether modifying cardiovascular risk early in life will promote better brain health later in life," she added.
Study details and background:
According to the American Heart Association's 2023 Statistical Update, coronary heart disease caused 382,820 deaths in 2020. The estimated rate of dementia (alone, not including Alzheimer's) in U.S. Adults, 65 years of age and older, was 10.5% in 2012, with a rate of 7.3% in males and 12.9% in females, according to the Aging, Demographics and Memory Study, which is a supplemental study of the long-running Health and Retirement Study in the U.S.
The study's limitations included that it is an observational study, meaning the findings do not confirm cause and effect, and that more than 94% of the study population from the UK Biobank self-identified as white, meaning the findings may not be generalizable to people of other races or ethnicities.
More information: Association Between Onset Age of Coronary Heart Disease and Incident Dementia: A Prospective Cohort Study, Journal of the American Heart Association (2023). DOI: 10.1161/JAHA.123.031407
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Coronary Heart Disease By Age 45 Linked With Subsequent Dementia
Younger onset age of coronary heart disease was tied to higher risks of incident all-cause dementia, Alzheimer's disease, and vascular dementia, a large prospective cohort study in Great Britain showed.
Each 10-year decrease in coronary heart disease onset age was associated with a 25% increased risk of all-cause dementia, a 29% increased risk of Alzheimer's disease, and a 22% increased risk of vascular dementia (all P<0.001), reported Fanfan Zheng, PhD, of the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, and co-authors in the Journal of the American Heart Association.
Across all age groups, coronary heart disease diagnosed before age 45 had the highest hazard ratio (HR) for incident dementia compared with people who didn't have coronary heart disease (HR 2.40, P<0.001).
"Coronary heart disease has previously been associated with dementia risk in older adults, however, this is believed to be the first large-scale study examining whether the age of coronary heart disease onset may impact the risk of developing dementia later in life," Zheng said in a statement.
"In previous research, we found that adults experienced accelerated cognitive decline after new diagnoses of coronary heart disease," she added.
The researchers assessed data from 432,667 participants in the ongoing U.K. Biobank study. Participants had a mean age of 57 at baseline and about 55% were women. Overall, 11.7% (50,685 people) had coronary heart disease at the time of enrollment and through the follow-up period.
Over a median follow-up of 12.8 years, 5,876 cases of all-cause dementia, 2,540 cases of Alzheimer's disease, and 1,220 cases of vascular dementia emerged.
After adjusting for multiple covariates ranging from age and sex to BMI and statin use, people with coronary heart disease had a 36% increased risk of all-cause dementia (P<0.001), 13% greater risk of Alzheimer's (P=0.019), and 78% higher risk of vascular dementia (P<0.001) compared with all other participants who didn't have coronary heart disease.
In a propensity score-matched analysis, people with coronary heart disease had significantly higher risks of dementia than matched controls in all onset age groups. Hazard ratios rose with decreasing onset age.
Compared with people who had coronary heart disease onset at age 60 or older, those with onset at age 45 or younger had a 71% higher risk of all-cause dementia (P<0.001), 75% higher risk of Alzheimer's disease (P=0.003), and 65% higher risk of vascular dementia (P=0.015).
"What surprised us most was the linear relationship between age of coronary heart disease onset and dementia. This shows the huge detrimental influence of premature coronary heart disease on brain health," Zheng said.
"As more people live longer and are diagnosed with coronary heart disease at a younger age, it's likely there will be a large increase in the number of people living with dementia in years to come," she observed.
"Healthcare professionals should be aware of individuals diagnosed with coronary heart disease at a young age," Zheng added. "The next step is to determine whether modifying cardiovascular risk early in life will promote better brain health later in life."
The study was observational, so cause and effect cannot be determined, the researchers noted. More than 94% of the study population were white, and the findings may not apply to people of other races or ethnicities, they acknowledged.
Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer's, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson's, ALS, concussion, CTE, sleep, pain, and more. Follow
Disclosures
This study was supported by the National Natural Science Foundation of China, the Non-Profit Central Research Institute Fund of Chinese Academy of Medical Sciences, and the 2022 China Medical Board-Open Competition research grant.
The researchers reported no disclosures.
Primary Source
Journal of the American Heart Association
Source Reference: Liang J, et al "Association between onset age of coronary heart disease and incident dementia: a prospective cohort study" J Am Heart Assoc 2023; DOI: 10.1161/JAHA.123.031407.
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High Cholesterol, High Blood Pressure Earlier In Life May Raise Your Risk Of Heart Disease
High blood pressure and high LDL (or "bad") cholesterol that is linked to genetics increases the risk of developing coronary heart disease throughout life, a new study reports.
In addition, researchers say high blood pressure and high LDL cholesterol before age 55 are linked to a greater risk of coronary heart disease later in life, regardless of a person's blood pressure and cholesterol levels in their later years.
This suggests that high blood pressure and high LDL cholesterol have lasting effects on a person's future risk of coronary heart disease, the researchers write.
It also supports the need for earlier treatment of these two risk factors for coronary heart disease, researchers say, as well as ongoing treatment for older adults.
"This study provides compelling evidence that elevated blood pressure and LDL-cholesterol beginning early in life substantially raise the lifetime risk of coronary heart disease, irrespective of later interventions to lower these risk factors," said Dr. Michael Shapiro, a professor of cardiology at Wake Forest University School of Medicine in North Carolina who was not involved in the new research.
The study was published in the journal PLOS ONE.
Coronary heart disease is a condition where the heart's arteries can't deliver enough oxygen-rich blood to the heart, which can lead to a heart attack.
This condition is the result of coronary artery disease, which is the buildup of plaque in the arteries of the heart.
Risk factors for coronary artery disease include:
While the formation of plaques can begin early in life, living a healthy lifestyle — such as eating healthy, managing your weight, and getting regular physical activity — can reduce the risk of developing coronary artery disease.
The new study is called a Mendelian randomization study, which is like a genetic version of a randomized controlled trial.
Mendelian randomization relies on the fact that people are born with different variants of genes, in this case related to blood pressure or LDL cholesterol. Some variants increase a person's risk while others lower their risk.
With this approach, researchers "were able to consider individuals that have a genetic predisposition to higher blood pressure or cholesterol, and compare them to those that have predisposition to lower blood pressure or cholesterol," said Dr. Dipender Gill, a clinical research fellow in the School of Public Health at Imperial College London who was not involved in the study.
This allows them to examine how blood pressure and LDL cholesterol levels influence the risk of developing coronary heart disease across the lifespan.
The study included more than 450,000 participants in the UK Biobank, a large-scale research resource containing genetic, lifestyle, and health information.
The results of the study show that having a "genetic predisposition to higher LDL-C and blood pressure in those under age 55 years leads to a… higher likelihood of ultimately developing coronary disease," Shapiro told Healthline.
This applies not just to people with a genetic risk but to all people because lifestyle factors can also lead to high blood pressure and high LDL cholesterol, even at younger ages.
The results of the new study contrast with those of an earlier Mendelian randomization study, which found that high blood pressure and LDL cholesterol may not be related to a greater risk of coronary heart disease at older ages.
That earlier study suggests older adults may not benefit from medications that lower their blood pressure and LDL cholesterol, at least in terms of lowering their risk of coronary heart disease.
However, the authors of the new study point out that the earlier study used a different method of analysis, compared to the one they used.
As a result, "our findings suggest that old age alone should not be a reason to withhold otherwise appropriate [LDL cholesterol]- and [blood pressure]-lowering treatments," they wrote.
The new study's results do fit with an earlier Mendelian randomization study by Gill and his colleagues that found that elevated blood pressure in midlife can increase the risk of coronary artery disease later on.
Large randomized controlled trials have also found that older adults may benefit from blood pressure medications and cholesterol-lowering statins.
The authors of the new paper write that their findings highlight the importance of controlling blood pressure and LDL cholesterol levels early in life.
"Even in individuals that are younger, having a genetic predisposition to lower blood pressure or cholesterol still has a beneficial effect," Gill told Healthline.
Sometimes high blood pressure and LDL cholesterol is thought to be a problem of older age, but what the study shows is that "modifying these risk factors throughout life is important," he said.
"So even below the age of 55, lowering your blood pressure and cholesterol is still likely to have a beneficial effect on your overall risk across the life course," Gill added.
Shapiro agreed.
"Delaying aggressive management of LDL cholesterol and blood pressure in younger patients, even those not yet at high near-term cardiovascular risk, allows a cumulative disease process to take hold that may be difficult to reverse," he said.
Committees that write clinical treatment guidelines should reconsider whether blood pressure or cholesterol-lowering medications may be appropriate for younger adults, he added.
Currently, these drugs are mainly reserved for people with "immediate high risk" of coronary artery disease, said Shapiro, a trend that overlooks the "lasting harm" of being exposed to high blood pressure or LDL cholesterol earlier in life.
While medications may be appropriate for some younger people — if you're wondering about whether you can benefit, check with your doctor — lifestyle changes made earlier in life can also help people maintain healthy blood pressure and cholesterol levels.
"Even if you're young — younger than 55 — it's still important to have a good healthy lifestyle and a good blood pressure and a good cholesterol level," said Gill.
"It's not just relevant once you're older," he said. "It's an important thing to be on top of all through your adult life."
In a genetic study called a Mendelian randomization study, researchers found that people with a genetic predisposition to high blood pressure and high LDL cholesterol had a higher risk of coronary heart disease later in life.
This was true regardless of their blood pressure and cholesterol levels later in life, suggesting the need for earlier treatment of these risk factors for heart disease. It also highlights the importance of treating these conditions in older adults.
Medications are available to help manage blood pressure and cholesterol, but lifestyle changes such as eating healthy and getting regular physical activity can also help.
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