Association of prior ASCVD with post-stroke dementia

Takeaway

• Patients with stroke and prior atherosclerotic cardiovascular disease (ASCVD) were at a higher risk of developing subsequent dementia.
• However, the risk of post-stroke dementia was attenuated, with only a slight increase with prior ASCVD after adjustments for confounding.

• Findings highlight the importance of adequately adjusting for known risk factors for dementia when investigating the association of cardiovascular risk factors with dementia in patients with stroke.

Study design

• A retrospective cohort study of 63,959 patients with first-ever stroke (median age, 75 years) using the Clinical Practice Research Datalink (CPRD) with linkage to hospital data.
• Funding: National Institute for Health Research School of Primary Care Research.

• Of 63,959 patients, 16,900 (26.4%), 14,880 (23.3%) and 3886 (6.1%) had prior ASCVD, coronary heart disease (CHD) and peripheral artery disease (PAD), respectively.
• During a median follow-up of 3.6 years, 7265 (11.4%) patients developed post-stroke dementia (incidence rate, 27.3 per 1000 person-years).
• In the minimally adjusted model (only accounting for demographics and lifestyle), the HR (95% CI) of dementia was:
  • 1.18 (1.12-1.25) for ASCVD;
  • 1.16 (1.10-1.23) for CHD; and
  • 1.25 (1.13-1.37) for PAD.
• The HR (95% CI) additionally adjusted for multimorbidity and medications was:
  • 1.07 (1.00-1.13) for ASCVD;
  • 1.04 (0.98-1.11) for CHD; and
  • 1.11 (1.00-1.22) for PAD.
• No linear association was observed between the age of ASCVD onset and post-stroke dementia (P_trend>.05 for all).
• The risk of dementia was not increased with the duration of pre-stroke ASCVD (P_trend>.05 for all).

• Retrospective design.