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Coronary Heart Disease By Age 45 Linked With Later 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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Women At Risk Of Death From Heart Disease Due To Consistent Lack Of Preventative Treatment
The consistent undertreatment of women with cardiovascular disease may have led to preventable heart attacks, stroke and even death, according to new research from the University of Aberdeen.
In the first study of its kind to look at cardiovascular disease over a long period of time, data from more than 25,000 participants spanning over 25 years was analyzed to identify patterns in long-term health outcomes and how they differ between the sexes.
The team led by Dr. Tiberiu Pana, Honorary Clinical Research Fellow at the University and Internal Medicine Training Doctor with NHS Grampian, published their findings in the European Journal of Preventive Cardiology.
Their initial analysis showed that men had a 49% greater risk of developing heart disease than women, and a 43% higher risk of dying from a heart condition compared to women. The age at which heart disease presented itself also differed between the sexes.
Men with cardiovascular disease typically would present with a heart attack in their 50s, whereas women would typically present in their 60s, and this would most likely be in the form of a rhythm disorder or stroke.
However, a crucial finding revealed that, following a diagnosis of heart disease during the study, the death rate from cardiovascular causes for women rose to that of their male counterparts. Therefore, the apparent advantage of younger women was somehow lost.
This rise in the mortality rate in women, Dr. Pana suggests may be explained by the differential treatment with prevention medication found between men and women. Dr. Pana said, "The consistent undertreatment of women with heart or circulatory disorders from our analyses is worrying," adding that: "Our analysis found that women were 30 to 50% less likely to be treated with preventative medicine compared to men."
Another potential explanation according to Dr. Pana implicates the influence of menopause in women, suggesting hormonal changes may erode the early advantage. The authors suggest that targeted preventative measures around the time of menopause in women may prevent heart disease and improve health outcomes later in life.
Dr. Pana adds, "This is the first study to delineate sex differences from the same population, over very long follow-up while controlling for factors such as lifestyle, socio-economic status and history of cardiovascular disease.
"This allowed us to determine that the systematic undertreatment of women with preventative medications may play a role in the diminishing female sex advantage in survival once they developed heart disease.
"Our findings highlight how it is important to consider how future prevention campaigns should focus differently on men and women.
"While lifestyle undoubtedly has an impact on the type and the onset of heart disease, preventive medicine like blood pressure agents and lipid lowering agents can have significant impact on reducing risk of heart attack and stroke it is vital that everyone is actively involved in making decisions about their care following diagnosis of cardiovascular disease and proactively discuss these treatments with their doctors in order to ensure they minimize their risks as much as possible.
"Everyone should consider minimizing their risk factors for heart disease as early as possible in life, such as regularly monitoring their blood pressure, keeping a healthy weight and being physically active.
"However, it is even more important that people be aware of the need to take preventative medicines after suffering a heart or circulatory disorder in order to minimize their risk of recurrence or death."
More information: Tiberiu A Pana et al, Sex-specific lifetime risk of cardiovascular events: the European Prospective Investigation into Cancer-Norfolk prospective population cohort study, European Journal of Preventive Cardiology (2023). DOI: 10.1093/eurjpc/zwad283
Citation: Women at risk of death from heart disease due to consistent lack of preventative treatment (2023, November 30) retrieved 1 December 2023 from https://medicalxpress.Com/news/2023-11-women-death-heart-disease-due.Html
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How Can Adults With Congenital Heart Disease Reduce Risks? Study Finds Lifetime Cardiology Monitoring Is Key
Heart failure is a potentially urgent health concern for young adults with congenital heart disease (ACHD) that is often overlooked and undertreated, even as hospitalizations for this condition continue to rise.
New research from Mayo Clinic shows that young adults in the U.S. Living with congenital heart disease are at an increased risk of death or cardiovascular complications after being hospitalized for heart failure. However, study data published in the Journal of the American Heart Association also found that patients who had been receiving recent cardiology care before a heart failure hospitalization were less likely to die.
"More than 85% of children born with congenital heart disease reach adulthood. They are likely to experience complications later, yet 61% of these patients beyond the age of 18 do not see a cardiology specialist," says Luke Burchill, M.B.B.S., Ph.D., a cardiologist at Mayo Clinic and first author of the study. "These young adult patients have a strong need for individualized care pathways to improve their quality of life and monitor health issues like heart failure."
Dr. Luke Burchill talks about congenital heart disease. Credit: Mayo ClinicPrior research showed that heart failure hospitalizations of U.S. Adults with congenital heart disease increased dramatically from 1998 to 2011. To further understand this trend and its effect on patients and hospital resources, Dr. Burchill and colleagues used national data to study a retrospective cohort of adults with congenital heart disease hospitalized in the past decade. The percentage of ACHD heart failure hospitalizations increased significantly, rising from 6.6% in 2010 to 14% in 2020.
In more than 26,000 unique hospital admissions of ACHD patients, 22% had heart failure, and 78% did not. Those admitted with heart failure had a higher risk of death and other major heart and brain complications and used more health care resources, including rehospitalization and post-acute care services, than those admitted without heart failure. However, people who had a cardiology clinic visit within 30 days prior to hospital admission had lower death rates due to any causes at the 90-day and 1-year mark.
The ACHD patients with heart failure were nearly twice as likely as those without heart failure to be readmitted to a hospital, especially those under age 45, regardless of their type of congenital heart disease. Younger patients also required more medical or supportive care after they left the hospital before they could return home and care for themselves.
"Many of the patients I meet with ACHD and heart failure share a similar story of not having their heart-related symptoms taken seriously, leading to a delayed recognition and treatment of heart failure. The good news is that we can reset the course for most," says Dr. Burchill.
"We have new medications to restrengthen the heart, new options for replacing heart valves without opening the chest, and low-risk treatments for returning heart rhythm to normal. We aim to shift the focus from heart failure to heart function and patient success in feeling better and living longer."
More information: Pradyumna Agasthi et al, Mortality and Morbidity of Heart Failure Hospitalization in Adult Patients With Congenital Heart Disease, Journal of the American Heart Association (2023). DOI: 10.1161/JAHA.123.030649
Citation: How can adults with congenital heart disease reduce risks? Study finds lifetime cardiology monitoring is key (2023, November 29) retrieved 1 December 2023 from https://medicalxpress.Com/news/2023-11-adults-congenital-heart-disease-lifetime.Html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
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