Cognitive Decline May Precede Cardiovascular Events in Older Adults
Key Clinical Summary
- Findings from a large Aspirin in Reducing Events in the Elderly (ASPREE) cohort suggest cognitive changes could serve as early indicators of cardiovascular risk.
- Cognitive decline in older adults may begin 3–8 years before incident cardiovascular disease (CVD) events.
- Processing speed shows the earliest decline prior to CVD onset.
Cognitive decline may begin years before the onset of cardiovascular disease (CVD), according to an analysis published in JAMA Network Open. The study examined longitudinal cognitive trajectories in older adults and found that individuals who later experienced CVD events showed earlier and faster deterioration across multiple cognitive domains compared with matched controls.
Study Findings
This nested case-control study used data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial and its extension (ASPREE-XT), including community-dwelling adults aged 65 years or older in Australia and the US with no prior CVD at baseline. CVD included fatal coronary heart disease (CHD), nonfatal myocardial infarction (MI), fatal or nonfatal stroke, and hospitalization for heart failure (HHF).
Over 11 years, 1934 CVD events were recorded among 19,114 participants. Of these, 1887 individuals with adjudicated events were matched to 7548 controls. The analysis included 9435 participants (median age, 75.7 years; 52.7% male). Cognitive function was assessed using standardized tools measuring global cognition, episodic memory, processing speed, and verbal fluency.
Linear mixed-effects models revealed that participants who developed CVD had lower cognitive function beginning 3 to 8 years before the event. Processing speed declined earliest, with measurable differences up to 8 years prior. Declines were also observed in global cognition (β, −0.19; 95% CI, −0.33 to −0.06), episodic memory (β, −0.04; 95% CI, −0.11 to −0.03), processing speed (β, −0.28; 95% CI, −0.48 to −0.07), and verbal fluency (β, −0.15; 95% CI, −0.27 to −0.04). Composite global cognition (β, −0.11) and executive function (β, −0.07) also declined more rapidly.
Similar patterns were observed for CHD, stroke, and heart failure hospitalizations, but not for nonfatal myocardial infarction, where trends were comparable to controls.
Clinical Implications
These findings suggest that cognitive decline may not simply be a consequence of CVD but could precede and potentially signal underlying vascular pathology. Early declines in cognition may reflect subclinical changes or systemic processes linked to cardiovascular risk.
For clinicians, routine cognitive assessment in older adults may offer additional insight into long-term cardiovascular health and risk. Detecting subtle changes in cognition could help identify individuals at higher risk for future CVD events, potentially enabling earlier intervention or closer monitoring.
The results also highlight the need to integrate cognitive health into cardiovascular prevention strategies. However, further research is required to determine whether these associations are causal and whether modifying risk factors can alter cognitive trajectories or delay CVD onset.
Expert Commentary
“The differences in cognitive trajectories between case patients with CVD and control participants in this study may reflect shared pathways or risk factors that influence both cognitive function and CVD in older adults,” wrote Swarna Vishwanath, PhD, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, and study coauthors. “A life-course perspective may be necessary to fully understand this association, highlighting the influence of cardiovascular risk factors that emerge in childhood and persist into midlife.”
The researchers concluded that the findings “support further research into cognitive trajectories before CVD onset, particularly across diverse populations.”
